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By Debra Wood, RN, contributor

Nurses know they provide great care and patients do better under their skillful watch. A new study from Harvard Medical School confirms that hospitals with higher registered nurse staffing perform better than other facilities.

“The difference in our findings between RN staffing and LPN staffing was interesting to me in that more RNs were associated with better quality and more LPNs associated with worse quality,” said Bruce Landon, M.D., MBA, associate professor of health care policy at Harvard Medical School in Boston. “I do not interpret that as LPNs give poor care, but you see more LPNs at institutions that are skimping on RN care in general.”

In the paper’s commentary, the authors suggest that nurses serve as crucial links between physicians and patients, which influences outcomes, and that adequate staffing allows time for patient teaching and other duties.

“A lot of the counseling and prevention things are under the purview of nurses. To the extent you have good nurses and adequate coverage and staffing, they are able to do those functions better,” Landon said.

The researchers calculated nurse-staffing levels as the average number of hours of care by a registered nurse or a licensed practical nurse per inpatient day. This measure was derived by adjusting reports of nurse staffing levels by the average inpatient census at each hospital.

The study also found that nonprofit hospitals consistently preformed better than for-profit facilities, and that federal and military hospitals performed best.

“Most people think there is a different outlook and philosophy in how [nonprofit hospitals] are managed,” Landon said. “Not-for-profits are investing more in services and patient care, so it’s not shocking to see them do better.”

Landon said the findings showing high performance by federal hospitals suggests that quality improvement initiatives by the Veterans Health Administration deserve further study. The VA has launched information and computerized reporting systems, which the authors speculate could contribute to their better outcomes. Overall, greater use of advanced technologies contributed to higher quality care, according to the study.

The comprehensive study examined the characteristics of hospitals that are associated with higher quality of care when treating congestive heart failure, acute myocardial infarction and pneumonia. The research team used information from more than 4,000 U.S. hospitals that reported data to The Joint Commission or the Centers for Medicare and Medicaid Services.

The Medicare Modernization Act of 2003 required hospitals to report their performance on 10 measures for these three diseases to receive their full Medicare payment. Landon said this is an important study because of its comprehensiveness and that it is the first study to use the data.

“It gives a picture of things that are going on and also tells things that are amenable to intervention,” Landon said. “My guess is if you were going to design an improvement program, the way to do it wouldn’t be to say we will improve MI care. The way to do it is to improve counseling care on the floor or medication in the emergency room, across a broad range of conditions.”

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