Hospital nurses are an “underused resource” for informing policy decisions on quality and safety, according to Swedish researchers, who carried out a major study into assessments of care by staff.
The researchers said reports on quality and safety by registered nurses could be “valid indicators” of overall hospital quality and patient safety, after finding they were linked to hospital mortality rates.
“Nurse reports pertaining to quality and safety can be valid indicators of overall hospital quality and patient safety”
They highlighted that nurses held a “central position” in inpatient care, which gave them a “unique perspective” of the patient care experience and putting them at the “sharp end” of patient safety.
However, the nurse researchers from the Karolinska Institutet in Stockholm argued that nursing staff were currently an “underutilised” resource for measuring quality and safety in hospital settings.
As a result, they set out to investigate relationships between registered nurse assessments of care quality and patient safety, and 30-day inpatient mortality post-surgery in acute-care hospitals.
In what they said was a unique study, the researchers compared data on over 200,000 surgical procedures performed in 67 hospitals throughout Sweden with survey data from over 10,000 nurses working in the same inpatient settings.
The survey of nurses working in medical and surgical departments, which was carried out in 2010, asked more than a hundred questions on work environment, latest work shift, quality, and safety.
Respondents had a mean age of 39.7 years, and had worked in the profession for a mean of 11.4 years and at their current workplace for a mean of 9.6 years. Nearly two-thirds had a nursing degree.
The researchers said they found that nurse assessments of excellent patient safety and quality of care were related to significantly reduced odds of patients dying in hospital within 30 days of admission after general, vascular, or orthopaedic surgery.
Patients cared for in hospitals where a high proportion of nurses reported excellent quality of care –the highest third of hospitals – had 23% lower odds of 30-day inpatient mortality compared to patients cared for in hospitals in the lowest third, said the study authors, who were led by Lisa Smeds-Alenius.
Nurse views ‘underused’ as indicator of patient safety
Similarly, they found that patients in hospitals where a high proportion of nurses reported excellent patient safety – the highest third – had 26% lower odds of death.
“Registered nurse assessed excellent patient safety and quality of care are related to significant reductions in odds of 30-day inpatient mortality,” said the researchers.
“This study suggests that registered nurse’s positive assessments of quality of care and patient safety might be used as an indicator of overall hospital quality and safety,” they said in the International Journal of Nursing Studies.
They added: “Efforts to improve patient outcomes need to focus on the patient care environment where the registered nurse is a central actor, although not the only active professional.
“The use of registered nurses as informants about the organisation of patient care in hospitals can give us further clues as to what in the work/care environment facilitates or hinders the provision of safe, high quality care,” they said.