A study published in the June issue of Medical Care finds that elderly intensive care unit (ICU) patients experience lower rates of nosocomial infections and better clinical outcomes in hospitals where nurses enjoy better working conditions, including higher nurse staffing levels and less frequent overtime. To investigate the link between the work environment and nosocomial infection rates, researchers from Columbia University Medical Center in New York examined data from the Centers for Medicare and Medicaid Services and the National Nosocomial Infection Surveillance system on 15,846 elderly patients in 51 adult ICUs in 31 hospitals. In addition, the study team surveyed 1,095 R.N.s about their working conditions and analyzed payroll data to discern objective measures of staffing, overtime, wages and other factors.
The researchers found that the ICUs with the highest nurse staffing levels achieved a lower incidence of central line-associated bloodstream infections, ventilator-associated pneumonia, 30-day mortality and pressure ulcers among elderly Medicare patients. ICUs in which R.N.s worked more overtime hours had increased rates of catheter-associated urinary tract infections and bedsores. Hospital profitability and nurse-perceived organizational climate, however, had inconsistent associations with patient outcomes across ICUs, and nurse wages and Magnet accreditation had no apparent associations. In light of the findings, the researchers assert that "involvement from hospital administrators, staffing professionals, legislators and consumers is needed in order to address problems in the ICU work environment." Specifically, they suggest that hospitals curb nurse overtime by increasing the number of qualified float nurses through cross-training, enabling facilities to more effectively cope with fluctuations in ICU staffing needs.
