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PHILADELPHIA – As hospital managers well know, overworked nurses often are unable to tick off every task on their list before a shift ends. The question is how that failure to complete nursing care affects the patient experience.
A study published recently in BMJ Quality & Safety sought to quantify the answer by describing the prevalence and patterns of missed nursing care and looking at the impact on patient satisfaction.
The study team, led by researchers from the University of Pennsylvania and McKinsey & Company, suggests, “As nurses are the principal care provider in the hospital setting, the completion or omission of nursing care is likely to have a sizable impact on the patient care experience. However, this relationship has not been explored empirically.”
Using secondary nurse and patient survey data from 409 adult non-federal acute care U.S. hospitals in four states, the researchers found that, in an average hospital, nurses missed 2.7 of 12 required care activities per shift.
In fact, 73.4% of nurses reported missing at least one activity on their last shift. The percentage ranged from 25 to 100 across hospitals. Most commonly, nurses reported they had been unable to comfort or talk with patients, 47.6%, or plan care, 38.5%.
At the same time, 6 out of 10 patients rated hospitals highly, ranging from 33% to 90% across the facilities, according to the report.
Yet, at hospitals where nurses missed more care, 2.2% fewer patients rated the hospital highly, according to the report.
That’s especially important, the researchers note, now that CMS is tying reimbursements to scores on instruments such as the Hospital Consumer Assessment of Healthcare Providers and Systems survey (HCAHPS).
“Patients have poorer care experiences in hospitals where more nurses miss required nursing care,” the authors write. “Supporting nurses’ ability to complete required care may optimize the patient care experience. As hospitals face changing reimbursement landscapes, ensuring adequate nursing resources should be a top priority.”
With HCAHPS, patients rate their inpatient stay in 27 categories, including communication with nurses and nursing care. The scores factor into whether hospitals gain or lose up to 1.5% of their Medicare payments in fiscal year 2015, rising to 2% by fiscal year 2017.