Better Staffed Hospitals Before Pandemic Had Better Outcomes During It

Newswise — Philadelphia (December 13, 2022) – According to a new study published in Nursing Outlook, the journal of the American Academy of Nursing, chronic hospital nurse understaffing and poor hospital work environments that predated the Covid-19 pandemic largely explain the disruptions in nursing care seen during the pandemic and continuing today.

Researchers at Penn Nursing’s Center for Health Outcomes and Policy Research (CHOPR) conducted a large study of 151,335 registered nurses practicing in 357 hospitals in New York state and Illinois in early 2020 before the Covid-19 pandemic and mid-2021, well into the second year of the pandemic.  Prior to the pandemic, 57% of nurses reported that there were not enough staff to care for patients which rose to 67% of nurses reporting not enough staff during the pandemic. Even before the pandemic in early 2020, 22% of bedside care nurses said they intended to leave their hospital employer within the year which rose to 25% in the second year of the pandemic. The percent of bedside care nurses giving their hospitals an unfavorable grade on patient safety was high immediately prior to the pandemic at 34% and increased to 47% during the pandemic.

Lead author Linda Aiken, PhD, Professor of Nursing and Sociology, Founding Director of the Center for Health Outcomes and Policy Research, and Senior Fellow of the Leonard Davis Institute for Health Economics at the University of Pennsylvania said, “One of the most shocking findings from our study is that most clinical nurses employed by hospitals lack confidence that management will respond to and try to resolve problems in patient care they identify. It is not surprising that nurse burnout is the highest ever recorded and that so many nurses say they intend to leave their employers.”  The study showed that lack of confidence in hospital management is not a new problem but a worsening one with 69% of bedside care nurses lacking confidence in management to address patient care problems before the pandemic rising to 78% during the pandemic. In a related finding, more than half of nurses reported that the actions of management show patient safety is not a top priority. The paper cites other published research documenting that patient safety has declined since the advent of the pandemic.

“The good news from the study is that hospitals reported by their nurses prior to the pandemic to have evidence-based nurse staffing and good work environments fared significantly better during the pandemic in terms of their nurses reporting less burnout, less job dissatisfaction, less intent to leave, and better quality and safety of patient care,” said Aiken.

The study’s authors say that their findings suggest that continuing disruptions in hospital care can be successfully addressed by hospital leadership by offering sufficient numbers of budgeted permanent registered nurse positions to provide evidence-based safe nurse staffing levels and by improving work environments. However, since hospital nurse understaffing has been a chronic problem even before the pandemic, the authors point to promising public policy solutions by states and Medicare to require hospitals to meet minimum safe nurse staffing standards.   

The study was carried out by Penn Nursing’s Center for Health Outcomes and Policy Research, in partnership with the National Council of State Boards of Nursing. Funding for the study was from the National Council of State Boards of Nursing, the National Institute of Nursing Research/NIH, the Agency for Healthcare Research and Quality, and Penn’s Leonard Davis Institute of Health Economics.   

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Study Citation

Aiken, LH, Sloane, DM, McHugh MD, Pogue CA, Lasater KB. Nursing Outlook. December 2022 https://doi.org/10.1016/j.outlook.2022.11.007  Open access. 

Other recent publications on this topic by the Center for Health Outcomes and Policy Research 

Lasater KB, Aiken LH, Sloane DM, French R, Martin B, Reneau K, Alexander M, McHugh MD. (2020). Chronic Hospital Nurse Understaffing Meets COVID-19: An Observational Study. BMJ Q&S. doi: 10.1136/bmjqs-2020-011512  

Lasater, K.B., Aiken, L.H., Sloane, D.M., French, R., Martin, B., Alexander, M., McHugh, M.D. (2021). Patient outcomes and cost savings associated with hospital safe nurse staffing legislation: an observational study. BMJ  Open, 11(12) p.e052899. 

Lasater, K.B., Aiken, L.H., Sloane, D.M., French, R., Anusiewicz, C.V., Martin, B., Alexander, M., McHugh, M.D. (2021). Is hospital nurse staffing legislation in the public’s interest? An observational study in New York State. Medical Care, 59(5): 444-450.

Lasater, K.B., Sloane, D.M., McHugh, M.D., Cimiotti, J.P., Riman, K.A., Martin, B., Alexander, M., Aiken, L.H. (2020). Evaluation of hospital nurse-to-patient staffing ratios and sepsis bundles on patient outcomes. American Journal of Infection Control, 49(7): 868-873.

About the University of Pennsylvania School of Nursing

The University of Pennsylvania School of Nursing is one of the world’s leading schools of nursing. For the seventh year in a row, it is ranked the #1 nursing school in the world by QS University. In a first for any undergraduate Bachelor of Science in Nursing (BSN) program in the country, our BSN program is ranked # 1 in the 2022 U.S. News & World Report’s Best Colleges rankings. Penn Nursing is also consistently ranked highly in the U.S. News & World Report annual list of best graduate schools and is ranked as one of the top schools of nursing in funding from the National Institutes of Health. Penn Nursing prepares nurse scientists and nurse leaders to meet the health needs of a global society through innovation in research, education, and practice. Follow Penn Nursing on: Facebook, Twitter, LinkedIn, & Instagram.   

About the National Council of State Boards of Nursing

The National Council of State Boards of Nursing (NCSBN) is a non-profit organization based in Chicago whose US members include the nurse regulatory bodies in the 50 states, the District of Columbia, and four US territories. NCSBN administers the national registered nurse licensure and other exams and led the development and implementation of the Nurse Licensure Compact that allows a nurse to have one multi-state licensure and practice in the other 34 states that to date have passed the Nurse Licensure Compact.