According to a new study, hospitals staffed with more registered nurses (RN) the most highly skilled kind - save more lives from deadly complications, and researchers say in a study that is likely to intensify worries about the nation's growing nursing shortage.``Will we see more of these adverse outcomes because we don't have the knowledge of the registered nurses in the clinical setting?'' asked Patricia Rowell, a research analyst at the American Nurses Association.
The researchers, whose findings were published in Thursday's New England Journal of Medicine, analyzed 6.2 million patients released from 600 hospitals in 8 states in 1995. The patients accounted for about a quarter of those who were discharged nationwide.
The researchers at Harvard and Vanderbilt universities compared the 20 percent of general medical and surgical patients who got the most nursing care with the 20 percent who got the least. They broke down the nursing care by the number of hours and the amount provided by registered nurses, licensed practical nurses, and nursing aides.
RNs have college degrees in nursing and are often allowed to develop nursing plans and coordinate care by therapists and other specialists. Licensed practical nurses (LPN) generally have a year of formal training but no degree. Nursing aides often have minimal training.
In some of the most striking findings, medical patients with the greatest proportion of RN care - relative to LPNs and aides - were 9 percent less likely to suffer shock or cardiac arrest, or to get a urinary tract infection. Medical patients with more hours of RN care also spent 5 percent less time in the hospital.
Surgical patients with more hours of RN care were 6 percent less likely to die from pneumonia, shock or cardiac arrest, upper gastrointestinal bleeding, blood poisoning, or clotting. However, the researchers found no health benefit from more care by either LPNs or aides. That finding brings into question the cost-cutting practice at some hospitals of replacing RNs with less skilled nursing staff.
``There's a tremendous amount of judgment and understanding of the courses of illness that RNs bring to the bedside,'' said Jack Needleman, the Harvard health policy researcher who led the study. ``It's not just a matter of having more bodies.'' He said hundreds of patients - possibly thousands - die each year from lack of advanced nursing care.
The average vacancy rate for RN jobs is 13 percent, according to a report commissioned by the American Hospital Association. And many expect the shortage to grow with the aging of the nursing work force and the general population. The Harvard study, which was funded by the government, is meant to give direction to policy makers on medical costs and nurse staffing.