ICU Working Conditions for Nurses Linked to Increased Patient Infections
The better the working conditions for registered nurses the less chance there is that an elderly person in an intensive care unit (ICU) will develop a hospital-associated infection. This finding comes from a study and report recently complied by the Columbia University School of Nursing.
Hospital-associated infections are the 6 highest cause of death in the United States as reported by the Centers for Disease Control in March 2007. “Nurses are the hospitals’ safety officers,” said Columbia’s assistant professor of nursing Patricia W. Stone. “However, nursing units that are understaffed and that have overworked nurses are shown to have poor patient outcomes. Improvements in nurse working conditions are necessary for the safety of our nation’s sickest patients.”
The study looked into the records of 15,846 patients who received treatment in 51 intensive care units in 31 hospitals. A total of 1,095 nurses were surveyed. A wide variety of working conditions for nurses were taken into consideration including hospital organization, staffing, overtime and wages. Also considered was hospital profitability and Magnet Accreditation (a national program recognizing excellence in nursing working conditions in hospitals). The Centers for Disease Control, the National Nosocomial Infection Surveillance System and Medicare files were studied for patient data. (Nosocomial means taking place or originating in a hospital.)
The findings revealed that hospital ICUs with higher staffing had lower incidence of infections that are the common cause of mortality in intensive care settings. Additionally, patient problems such as ventilator-associated pneumonia and skin ulcers, which are common among hospitalized patients who cannot be moved regularly, were also reduced in units with high staffing levels. Patients were also less likely to die within 30 days in these higher-staffed units. Finally, with increased overtime hours in ICUs, increased rates of additional problems occurring through catheter-associated urinary tract infections were also noted.
“Our careful analysis found that decisions related to staffing, overtime, and overall work environment directly affected patient safety outcomes,” said Andrew W. Dick, a senior health economist at the RAND Corporation and a co-author of this study. “Involvement from hospital administrators, staffing professionals, legislators and consumers is needed in order to address problems in the ICU work environment. Our hope is that with concentrated efforts, we can prevent hospital infections and improve patient safety in ICUs.”
The report suggested that adding a trained and qualified “float nurse” could be a way to relieve pressure on the nursing staff. It also called for a systematic improvement in working conditions in all ICUs that could have a direct and positive affect on safe and effective patient care.