WASHINGTON -- Surgical patients in hospitals with more nurses were less likely to get infections, pneumonia and other complications, a study finds.
The research, published Friday, offers a rare statistical look at the emotional debate over how many nurses a hospital needs and how much can be done by other health care workers.An extra hour of nursing attention per surgical patient each day cut the risk the patient would get a urinary tract infection by nearly 10 percent and the risk of pneumonia by 8 percent. The chances of developing other lung-related problems and blood clots also dropped with extra nursing, although not as dramatically, the study showed.
The research, published in the nursing journal Image, compared the number of hours worked by registered nurses at a hospital with the health of patients there, focusing on complications that are particularly sensitive to nursing care.
Hospitals' efforts to reduce costs by replacing RNs with less-skilled workers "have stimulated extensive debate but little evaluation," note the authors, who worked for the Agency for Health Care Policy and Research, an arm of the Health and Human Services Department.
Registered nurses have complained loudly when hospitals have replaced their positions with lesser-skilled workers, but there is no evidence that the number of RNs working at hospitals has dropped nationally.
Nurses represent about one-quarter of a typical hospital's workforce and are the single largest labor cost. A hospital typically would have to increase its nurse staffing levels by 17 percent to add one extra hour of care for each surgical patient.
Earlier research found a clear relationship between nurse staffing levels and patient deaths, but the authors wanted to focus on complications directly related to nursing care. Nurses are responsible for urinary catheter care, for instance, and sloppy or hurried work can lead to urinary tract infections.
In addition, nurses can help prevent complications by getting patients out of bed and walking after surgery and monitoring them closely.
The study looked at 1993 data from 506 hospitals in 10 states, comparing the number of patients who developed certain complications with the number of nurses working in those hospitals. The staffing levels were taken from data compiled by the American Hospital Association.
The number of complications came from a government database, and researchers used every state with complete information: California, Colorado, Connecticut, Florida, Maryland, Massachusetts, New Jersey, New York, Pennsylvania and Wisconsin.
The authors controlled for several factors, including the hospital's size, ownership and region and whether it was a teaching institution.
Nursing levels could explain a considerable part of the difference in complication rates, but not all of it, the analysis found. Indeed, the quality of the surgery itself and the size of other staffs at the hospital could also affect the patient's health.