Center for Health Outcomes and Policy Research, The University of Pennsylvania School of Nursing.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.
Med Care. 2021 Oct 1;59(10):857-863. doi: 10.1097/MLR.0000000000001628.
Evidence indicates hospitals with better registered nurse (RN) staffing have better patient outcomes. Whether involving more nurse practitioners (NPs) in inpatient care produces better outcomes is largely unknown.
The objective of this study was to determine whether the presence of more NPs produces better inpatient outcomes net of RN staffing.
This was a 2015-2016 cross-sectional data on 579 hospitals linked from: (1) RN4CAST-US nurse surveys; (2) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient surveys; (3) surgical patient discharge abstracts; (4) Medicare Spending per Beneficiary (MSPB) reports; (5) American Hospital Association (AHA) Annual Survey. Hospitals were grouped according to their NP/beds ratios [<1 NP/100 beds (N=132), 1-2.99 NPs/100 beds (N=279), and 3+ NPs/100 beds (N=168)].
RNs randomly sampled nurses from licensure lists yielded 22,273 RNs in study hospitals; discharge data for 1.4 million surgical patients; HCAHPS data for 86% of study hospitals.
Mortality, readmissions, lengths of stay, MSPB, patient experience, and quality reported by patients and nurses.
After adjustments, patients in hospitals with 3+ NPs/100 beds had lower odds than patients in hospitals with <1 NP/100 beds of 30-day mortality [odds ratio (OR)2=0.76; 95% confidence interval (CI)=0.67-0.82; P<0.001] and 7-day readmissions (OR2=0.90; 95% CI=0.86-0.96; P<0.001), shorter average length of stay (incident rate ratio2=0.92; 95% CI=0.88-0.96; P<0.001) and 5.4% lower average MSPB (95% CI=3.8%-7.1%). Patients and nurses in the hospitals with higher NP/bed ratios were significantly more likely to report better care quality and safety, and nurses reported lower burnout, higher job satisfaction, greater intentions of staying in their jobs.
Having more NPs in hospitals has favorable effects on patients, staff nurse satisfaction, and efficiency. NPs add value to existing labor resources.
有证据表明，注册护士（RN）配备更好的医院拥有更好的患者治疗效果。在住院患者护理中增加更多执业护士（NP）是否能产生更好的治疗效果，目前尚不清楚。
本研究旨在确定在考虑 RN 人员配备的情况下，更多 NP 的存在是否会产生更好的住院治疗效果。
这是一项 2015-2016 年涉及 579 家医院的横断面数据，这些数据来自：（1）RN4CAST-US 护士调查；（2）医院消费者评估医疗保健提供者和系统（HCAHPS）患者调查；（3）手术患者出院摘要；（4）医疗保险受益人均支出（MSPB）报告；（5）美国医院协会（AHA）年度调查。医院根据其 NP/床位比进行分组[<1 NP/100 张床位（N=132）、1-2.99 NP/100 张床位（N=279）和 3+ NP/100 张床位（N=168）]。
从执照名单中随机抽取护士的注册护士，研究医院中有 22273 名注册护士；140 万例手术患者的出院数据；86%的研究医院有 HCAHPS 数据。
死亡率、再入院率、住院时间、MSPB、患者体验和患者及护士报告的治疗质量。
调整后，与<1 NP/100 张床位的医院相比，3+ NP/100 张床位的医院的患者 30 天死亡率（优势比[OR]2=0.76；95%置信区间[CI]=0.67-0.82；P<0.001）和 7 天再入院率（OR2=0.90；95%CI=0.86-0.96；P<0.001）、平均住院时间（发生率比[IRR]2=0.92；95%CI=0.88-0.96；P<0.001）和平均 MSPB 低 5.4%（95%CI=3.8%-7.1%）的可能性较低。床位比例较高的医院的患者和护士更有可能报告治疗质量和安全性更高，护士报告倦怠程度更低、工作满意度更高、留职意愿更强。
医院拥有更多的 NP 对患者、护士满意度和效率都有积极影响。NP 为现有劳动力资源增加了价值。
