RN staffing levels and work environments could have an impact on health outcomes for patients who suffer in-hospital cardiac arrest, according to a recent study in the January issue of Medical Care.
The study, led by Matthew McHugh, PhD, JD, MPH, RN, CRNP, FAAN, associate professor of nursing at the University of Pennsylvania School of Nursing, looked at discrepancies between survival rates at some hospitals for in-hospital cardiac arrests and other hospitals. Researchers analyzed data from more than 11,000 patients who suffered IHCA at 75 hospitals in four states between 2005 and 2007 using information from the American Heart Association’s Get With the Guidelines — Resuscitation database, according to a Penn Nursing Science news release. The analysis included data from a national survey of hospitals characteristics and nurse staffing to examine how those issues affected survival rates after IHCA. Less than one-fourth of IHCA patients are discharged form the hospital alive, according to the news release. While looking at the data for the study, researchers found that only 15% of patients survived to hospital discharge, with most of the ICHAs taking place in an ICU and 80% of them witnessed, the news release stated. Among factors that improved chances of survival were whether the patient had a heart rhythm that could be improved by an electric shock. Patients who were monitored also had a higher chance of survival, the news release said.
Staffing rates played a role in improving IHCA survival rates, with researchers finding that on medical/surgical units, each additional patient per nurse was associated with a 5% relative reduction in the odds of survival. They also found a 16% lower survival rate at hospitals with poor work environments. “These results add to a large body of literature suggesting that outcomes are better when nurses have a more reasonable workload and work in good hospital work environments,” McHugh said in the news release. “Improving nurse working conditions holds promise for improving survival following IHCA.”
Working condition classifications were based on a survey examining key areas of nursing practice, including nurse participation, leadership and support, the news release said. But ICU staffing levels did not greatly increase the chances of survival after IHCA.
“Nearly half of IHCAs occur on medical/surgical units, which also have the most variable staffing levels and the most problematic work environments,” McHugh and co-authors wrote in the study, according to the release. Too many patients on a unit could make it difficult for nurses to monitor conditions and identify changes and also quickly intervene during crucial moments and emergencies, which could have an impact on outcomes, the release stated.
At the same time, McHugh and researchers concluded the solution is not as simple as increasing nursing staff and would require a change in workplace culture. “Improvement of work environments … requires a change of inter-professional culture and extended delegation of care management to those care providers who are closest to patients,” study authors wrote, according to the release.
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