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Hospitals that had a lower proportion of licensed nurses in the 1990s had higher rates of patient bed sores and pneumonia

Hospital cost concerns during the 1990s led to reductions in nurse staffing and less use of licensed nurses for patient care. At the same time, the patients being hospitalized were sicker and needed more intensive nursing care. The result was heavy patient loads for nurses, nurse burnout and dissatisfaction, and alarm about declining quality of hospital care. A new study of Pennsylvania hospitals confirms increased patient load among licensed nurses in the 1990s as well as a greater incidence of bed sores and pneumonia in hospitals with a lower proportion of licensed nurses, that is, registered nurses (RNs) and licensed practical nurses (LPNs).

Ensuring adequate licensed nurse staffing should be an area of major concern to hospital management, according to Lynn Unruh, Ph.D., R.N., of the College of Health and Public Affairs in Orlando, FL. Her work was supported in part by the Agency for Healthcare Research and Quality (HS09991). Dr. Unruh used a sample of all Pennsylvania acute care hospitals from 1991 to 1997 to examine the changes in licensed nursing staff and to assess the relationship of licensed nursing staff with hospital patient problems that are sensitive to nursing care: lung collapse, decubitus ulcers (pressure sores or bed sores), falls, pneumonia, post-treatment infections, and urinary tract infections.

Because hospital patient acuity increased 21 percent from 1991 to 1997, licensed nursing staff per 1,000 acuity-adjusted patient days of care fell nearly every year, for a total of 14.2 percent. Thus, the intensity of nursing care increased, while at the same time the proportion of licensed nurses to total nursing staff fell 2 percent. Hospitals with more licensed nurses had significantly lower incidences of lung collapse, decubitus ulcers, falls, and urinary tract infections. Hospitals with a greater proportion of licensed nurses/total nursing staff had significantly lower rates of decubitus ulcers and pneumonia. These results support the use of team nursing when there is an adequate number of licensed nurses.

More details are in "Licensed nurse staffing and adverse events in hospitals," by Dr. Unruh, in the January 2003 Medical Care 41(1), pp. 142-152.

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