The Hard Dollar Costs of Not Investing in Our Nurses

A research study conducted by the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing and published in the American Journal of Infection Control links higher infection rates with nurse burnout.

If you’ve happened upon the media this morning, you may have heard yet another, peer-reviewed study has been published in a professional journal linking the care of our nation’s nurses with the care of our nation.  For nurses, this isn’t breaking news, but something that’s been thrust upon them for years.  When we were canvasing the research in 2009 while creating The Emotionally Resilient Nurse program we suspended our research once we had discovered more than two dozen research studies drawing similar conclusions regarding the value of cultivating emotional intelligence skills in nurses and the impact of nurse-to-patient staffing ratios.  The evidence is in.  Not caring for our nurses has serious economic and clinical repercussions throughout our health care system.

The study merged infection rates in Pennsylvania hospitals with research into the level of job-related stress with 7,000 Pennsylvania nurses practicing in 161 hospitals.  Jeannie P. Cimiotti, the study’s lead author was shocked to discover more than a third of the nurses tested (using  the Maslach Burnout Inventory, a recognized scale that tracks factors like emotional exhaustion, depersonalization and whether an individual feels any personal sense of accomplishment) displayed high levels of burnout.  The average staffing levels observed were 5.7 patients per nurse.  An increase in the average by just one patient was shown to increase actual infections in an additional 1,351 patients in the study’s population.

Just as importantly, the study also points to the tenor of the work environment as a driver of nurse burnout and resulting lapses in patient care.  The report identified if the level of nurse burnout in Pennsylvania hospitals is drawn down to 10%, they would prevent 4,160 cases of surgical site and catheter infections, two of the most common hospital-acquired infections, and save the health care system a minimum of $41 million annually.  From my experience working in the infection prevention field, this is a very conservative figure.  Surgical site infections can cost anywhere from $5,000 to more than $25,000 to treat in a hospital setting (annual surgical site infection rates average between 2% and 5%, depending on the hospital).

Commenting on the study, Nancy Foster, V.P. of Quality and Patient Safety Policy for the American Hospital Association said the research, “Raises an interesting question about exactly how can we look at nursing burnout and its impact on patient safety.”  Speaking to NBC News, Cimiotti added, “Now that we see that burnout is playing a role in this relationship, we have to look at more than just the staffing.  We have to look at the system, the organizational structure where the nurses provide care.  Ms. Cimiotti also commented on hospital leadership, “It doesn’t cost them anything to improve the organizational climate.”

In an earlier study published in March, 2012 in the British Medical Journal and conducted by lead author, Linda H. Aiken, who is the Director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing, demonstrated similar issues in both the U.S. and European health care delivery systems.  This study concluded, “Improvement of hospital work environments might be a relatively low cost strategy to improve safety and quality in hospital care and to increase patient satisfaction.”

The conclusions are irrefutable.  Yes, improving the organizational culture and embracing a shift in leadership perspective from transactional to transformational, provides a remarkable return on investment.  When we looked into the impact of emotional intelligence training has on turnover rates alone (burnout is a key driver of turnover), we can demonstrate a 10% reduction in turnover leads to a 380% return on investment for the training.  The so-called soft skills in nursing are the key to saving hard dollars in our delivery system.

© 2012, Terry Murray.

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