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How Nurse Burnout Affects Hospital-Acquired Infections

How Nurse Burnout Affects Hospital-Acquired Infections

Previous research has linked invasive devices and clinical practice to hospital-acquired infections (HAIs). There is now evidence suggesting that elements of nursing care are also linked to the prevalence of HAIs. Few studies have rigorously examined the possible underlying mechanisms of the relationship between nurse staffing and HAIs. In the American Journal of Infection Control, my colleagues and I had a study published that assessed job-related burnout among registered nurses to determine its accountability for the relationship between nurse staffing and infections acquired during hospital stays. Burnout Affects Infection Rate Our findings show that job-related burnout among nurses appears to be a plausible explanation for some HAIs. Nurses had an average total of 17 years experience, caring for an average of about six patients. Almost 37% reported high levels of burnout. At the hospitals involved in the study, 16 of 1,000 patients acquired some type of infection, particularly urinary tract infections (UTIs), surgical site infections (SSIs), and gastrointestinal infections, as well as pneumonia. For modeling and further analysis, we limited the types of infection to UTIs and SSIs. As patient loads escalated, the number of UTIs and SSIs increased significantly. In additional modeling, nurse burnout was highly associated with these infections, a finding that hasn’t been reported in previous research. A 10% increase in a hospital’s composition of high-burnout nurses was linked to an increase of nearly one UTI and two SSIs per 1,000 patients. Perhaps the most important finding from our model was that reducing nurse burnout by 30% could prevent more than 4,000 UTIs and more than 2,200 SSIs each year and save up to $69 million...

Do BSN Nurses Provide Better Care?

A paper entitled “An increase in the number of nurses with baccalaureate degrees is linked to lower rates of postsurgery mortality” appeared in Health Affairs in March and generated quite a lot of buzz on the Internet. Its major finding was that hospitals in Pennsylvania that had 10% more nurses with BSN degrees were found to have 2.12 fewer deaths per 1,000 postop patients than those that did not. The authors extrapolated this, saying that if all the hospitals they surveyed had the same percentage of BSN nurses as the best performers, 500 deaths may have been avoided. The reduction in mortality rates was not significantly affected by staffing levels, skill mix, or years of experience as a nurse. The mechanism for the decrease in death rates was not explained but assumed to be better rates of “rescue” after the development of complications, which also was significantly associated with the presence of more BSN nurses and not staffing levels, skill mix, or years of experience as a nurse. The abstract concludes, “The findings provide support for efforts to increase the production and employment of baccalaureate nurses.” The math in the paper is confusing. In 2006, 25,000 nurses responded and a third of them were staff nurses in general hospitals. The information from those nurses (presumably about 8,333 of them) was the basis of the study. They go on to say that there were 134 hospitals with an average of 48 respondents; that computes to 6,432 — a discrepancy of over 2,000. A cliché that is often used in comments about research papers is: “the study raises more questions than...
Male Nurses Up 7% – And Earning 19% More Than Women

Male Nurses Up 7% – And Earning 19% More Than Women

The influx of patients spurred by healthcare reform as well as today’s shortage of primary care physicians is creating enormous demands on an unprepared healthcare system. In the wake of nurses redefining and expanding their roles, more men are entering the profession — and earning higher salaries than their female counterparts. While nursing still remains predominately female, accounting for 91% of all nurses, the number of male registered nurses has more than tripled to 9.6% in 2011, up from 2.7% in 1970. And the proportion of male licensed practical and licensed vocational nurses has more than doubled, to 8.1% But despite the majority, men outearned women, with an average of $60,700, compared with $51,100 for female nurses. Although the Census Bureau notes that the gender pay gap is smaller in nursing than in other professions, medical professionals are still disturbed by the continued salary disparity between sexes. Other highlights from the study include: Of all employed nurses, 78% were registered nurses, 19% were licensed practical and licensed vocational nurses, 3% were nurse practitioners, and 1% were nurse anesthetists. While most registered nurses (72%) left home for work between 5am and 11:59am, a sizable minority (19%) worked the evening or night shifts. The majority of registered nurses (64%) worked in hospitals. Men’s representation was highest among nurse anesthetists at 41%. Male nurse anesthetists earned more than twice as much as the male average for all nursing occupations: $162,900 vs $60,700. Physician’s Weekly wants to know… While gender disparity in salary is not a new issue, do you think that its occurrence in a profession that has been predominantly women is...
NPs Practicing Independently? AAFP Says No

NPs Practicing Independently? AAFP Says No

The idea of advanced practice nurses directing primary care practices on their own without a physician on staff has been a hot topic of discussion lately among the healthcare and public policy communities. The rationale behind most of these proposals stems from the U.S. shortage of primary care physicians. So is substituting nurse practitioners for doctors the answer? According to an article published in the July issue of Medical Care, the number of NPs could grow by 94% by the year 2025, and they will likely provide increasingly more healthcare services as demand rises during implementation of the Affordable Care Act. The move toward nurses practicing independent of physicians is coming at a time when medical practice itself is evolving into an integrated, team-based approach that includes physicians and other health professionals, according to the AAFP. This approach is generally known as the patient-centered medical home (PCMH). Studies show the ideal practice ratio of NPs to physicians is approximately 4 to 1. PCMHs built around that ratio provide patients with a primary care doctor and the benefits of team-based care. Successfully piloted in several locations, the PCMH model facilitates improved primary care and will likely become a reality for most Americans in some form in the next decade. The medical home is a team-based approach to healthcare touted by reformers for its potential to improve quality while lowering costs. The AAFP report, released yesterday, said that although NPs are valuable members of the medical home team, they are not qualified to head the “household.” It notes that family physicians receive 11 years of college and graduate-level education, including residencies,...
1 in 5 Hospital Nurses Depressed

1 in 5 Hospital Nurses Depressed

A new study published in the May/June issue of Clinical Nurse Specialist found that 18% of hospital-employed nurses experience depressive symptoms – that is twice the rate of the general public. According to the study, nurses with depression are not only likely to suffer themselves, but their illness may have an impact on their coworkers and potentially the quality of care they provide. In a survey of nearly 1,200 hospital-employed nurses, the researchers used the PHQ-9, a nine-item self-reporting tool developed for use in primary care. In addition to identifying the prevalence of depression, the researchers also found that factors such as body mass index, job satisfaction, and having other of health problems had a significant relationship to a higher total depression score. Susan Letvak, PhD, RN, one of the researchers on the study, said that while she knows that nursing is a tough job, she was still “really surprised” by the study results. Findings concluded that advanced practice nurses can assist with educating nurses on recognizing depression and confidential interventions, including the use of computerized cognitive-based therapy. Physician’s Weekly wants to know…are you surprised by these...
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