For a quality metrics reality check, just ask a nurse

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Alexandra Wilson Pecci, for HealthLeaders Media, October 9, 2012


Nurse leaders, I have a homework assignment for you. Formally survey your staff about their perceptions of your hospital's quality of care. It might be one of the most enlightening things you can do to get an accurate, big-picture look at how well your organization is caring for its patients.

Staff nurses probably didn't need a study to tell them this, but research shows that nurses provide an exceptionally accurate barometer for measuring hospital quality.

The retrospective study, published in the journal Research in Nursing and Health, used data from 396 acute care hospitals and 16,241 nurses from California, Pennsylvania, Florida, and New Jersey. Researchers compared nurses' reports on quality of care from the Multi-State Nursing Care and Patient Safety Study from 2006–2007 with outcomes data such as patient assessments; care measures for heart failure, pneumonia, acute myocardial infarction and surgical care; and administrative data on mortality and failure to rescue.

Nurses were asked "How would you describe the quality of nursing care delivered to patients in your unit?" They could answer excellent, good, fair, and poor. As it turns out, the way they answered this question strongly correlated to actual outcomes data.

The researchers found that nurse reports of excellent care did, in fact, correspond with higher levels of patient satisfaction, better scores for processes of care, and better results for patients in the hospital with regard to mortality and failure to rescue.

For every additional 10% in the proportion of nurses reporting that the quality of care on their unit was excellent, there was a 3.7 point increase in the percentage of patients who would recommend the hospital. There was also a 5% decrease in the odds of mortality and failure-to-rescue for surgical patients.

Reports of excellent quality were also linked with good work environments that support professional nursing practices. It's a finding that echoes another recent study which showed that "when supported by their practice environments, nurses employ practices that can assist in interrupting medication errors before they reach the patients."

The opposite is also true: This summer, I wrote about a study that linked nurse burnout to higher healthcare-associated infection rates.

The idea that nurses would be able to deliver an accurate assessment of hospital quality isn't surprising if you stop to consider how deeply embedded nurses are in the trenches of day-to-day patient care.

Of course, they're at the patients' bedsides. But for all practical purposes, nurses really are the most crucial part of the machinery that keeps a hospital running 24-7. They're also the "face" of the hospital, and interact with so many different people throughout the day, from families, to patients, to physicians.

"Nurses have insight into aspects of quality that aren't always documented, but which can make the all-important difference in patient outcomes," said one of the lead investigators, Matthew McHugh, PhD, JD, MPH, RN, CRNP, assistant professor at the University of Pennsylvania School of Nursing, in a statement.

"They are involved in direct interactions with patients, provide education and support to patients and their families, work alongside other members of the inter-professional healthcare team, and regularly interact with other frontline staff and management, and know how technology and information systems are integrated into the health care system. These things make a difference."

The authors note that although patients will always be the most relevant reporters, nurses' knack for accuracy can fill in the gaps when patients can't report for themselves, such as with critical care, end-of-life care, or even pediatrics.

So, hospital execs and nurse managers, maybe it's time to administer an anonymous survey asking your nurses to answer that one single question: "How would you describe the quality of nursing care delivered to patients in your unit?" As this study shows, the results could deliver yet another reason for nurse leaders to support—and listen to—their staff.

Source: HealthLeaders Media