Nurse experience linked to shorter hospital patient stays

The more experience a nurse has and the longer his or her tenure in a hospital unit, the shorter the length of stay for the patients they care for, finds a new study looking at the effect of nursing team structure on the quality of care a patient receives.

When making staffing decisions, management should be aware that certain disruptions in skill set can lead to decreases in productivity and poorer outcomes for patients, researchers say.

Patients who received care in hospital units in which more registered nurses and licensed practical nurses were on staff, had shorter hospital stays than patients who received care in units staffed by more unlicensed assistive personnel, or UAP, such as hospital aides. For each day a patient was hospitalized, each hour of increase in work by RNs decreased the length of stay by 3.4%. The stay decreased by 2.9% for patients cared for by LPNs and 1.5% for patients cared for by a UAP, found the study published in the American Economic Journal: Applied Economics.

The investigation also found that performance declined in a unit when an experienced nurse was away from work—such as on vacation, sick leave or had quit, for example. However, outcomes were better when the absences were filled with full-time staffers working overtime, as opposed to when contractors, who may be less familiar with the common practices and procedures, were brought in.

“The staff nurses have knowledge of how work is done on the unit, whereas the contract nurse may have the general skills, but may not have the knowledge that is specific to the culture of the unit,” explained Ann Bartel, the Merrill Lynch professor of workforce transformation at Columbia Business School and lead author of the study.

Contract nurses work independently, often treating patients at several different hospitals or medical facilities. They are not directly employed by a healthcare provider, but are often hired to cover staff shortages, which Bartel says makes them less privy to day-to-day operations and can lead to gaps in care.

“It's beneficial to the patients if the unit fills the shortfall by using regular staff,” Bartel said. Hiring contractors is certainly better than not filling the void at all, she said, especially when a unit does not have the flexibility to fill the spots with a staff nurse. The study suggests managers might want to be wary of “excessive use of contract nurses,” she said.

Researchers looked at a data set that included 907,993 patients who were admitted to 151 acute-care units in 76 VA-operated hospitals between October 2002 and September 2006. The coding system used by the Veterans Affairs Department allowed the researchers to link patients to the types of units in which they were treated. A health economist from Stanford University and an independent contract nurse also contributed to the study.

When a team of nurses has worked together over long periods of time, they develop rhythms and routines that result in more efficient care, said Patricia Stone, the senior author and Centennial professor of health policy at Columbia University's School of Nursing, in a news release.

“Reducing length of stay is the holy grail of hospital management because it means patients are getting higher quality, more cost-effective care,” she said. “Hospitals need to keep this in mind when making staffing decisions—disrupting the balance of a team can make quality go down and costs go up.”

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