High Registered Nurse Staffing Levels Tied to Lower Mortality Rates

A higher registered nurse staffing level was associated with a lower mortality rate among Medicare beneficiaries admitted to an acute care hospital with sepsis, a study published in JAMA Health Forum found.

CMS implemented the Sepsis Core Measure SEP-1 to ensure that hospitals meet the required criteria for identifying and treating sepsis. Past research has shown that nurses may play a critical role in initiating sepsis treatment and communication protocols that reduce sepsis-related mortality.

Researchers gathered 2018 data from the American Hospital Association (AHA) Annual Survey, CMS Hospital Compare, and Medicare claims to determine the association between registered nurse staffing levels and SEP-1 scores.

The survey reflects data from 1,958 general acute care hospitals and 702,140 Medicare beneficiaries.

The mean hospital SEP-1 score was 56.1 out of 100. Hospitals provided a mean of 6.2 registered nurse hours per patient day, with larger hospitals, for-profit hospitals, and major teaching hospitals providing more nurse hours per patient day.

High technology hospitals and hospitals located in metropolitan areas and the Pacific region of the US also had more registered nurse hours per patient day compared to the average number of hours.

Each additional registered nurse hours per patient day was associated with a 3 percent decrease in the odds of 60-day mortality related to sepsis.

Having an intensivist on staff—a medical practitioner specializing in caring for critically ill patients—was associated with a 16 percent decrease in the odds of mortality. This may speak to the benefits of interprofessional communication between nurses and other physicians, the study suggested.

If all hospitals were staffed at six registered nurse hours per patient day or higher, hospitals could see 1,266 fewer sepsis-related deaths, researchers found. If the registered nurse staffing level increased to seven nurse hours per patient day or higher, there could be 2,549 patient deaths avoided.

As registered nurse hours per patient day increased, the number of deaths avoided also rose. Eight nurse hours per patient day was associated with 4,306 fewer deaths, while nine hours per patient day correlated with 6,360 fewer deaths.

“Based on our analysis of hospitals and patients nationwide, the study findings suggest that nurse workload is an overlooked and underused aspect of the treatment bundle for patients with a diagnosis of sepsis,” researchers wrote.

The results add to the substantial number of ways that nurses are essential to the healthcare industry. However, hospitals and physician practices have faced significant nurse workforce shortages since the COVID-19 pandemic.

One study revealed that one-third of nurses plan to quit their current position by the end of 2022 due to burnout, stressful environments, and poor compensation.

Another report from Nurse.com found that the share of nurses considering leaving the profession increased from 11 percent in 2020 to 29 percent in 2021.

Just as a shortage of nurses may negatively impact patients with sepsis, nurse understaffing affected patient safety and practice management during the first few months of the COVID-19 pandemic. A study found a correlation between nurse understaffing and safety workarounds, leading to near misses.