News
April 28, 2010
NEWS RELEASE -- More than 30 years ago, researchers noticed that patients admitted to hospitals during "off-peak" hours, like evenings and weekends, experienced more health problems. Their study showed that patients admitted at night or on weekends were less likely to survive in-hospital cardiac arrest and that newborns born on weekends were more likely to die than babies born during the week.
Numerous studies have verified this phenomenon, but none have ascertained the causes or suggested ways to reverse the trend, until now. An interdisciplinary team of health researchers, including two nurses, has identified the causes of some of these disparities and made preliminary recommendations for changes in nursing administration that could help.
Their preliminary results, published in the March 2010 Journal of Nursing Administration ("Expanding What We Know About Off-peak Mortality in Hospitals"), show that nurses' "off-peak" work environments play a significant role in the increased patient mortality during these time periods. In particular, the researchers found that nurses who participate in hospital plans that allow them to work only weekend shifts for full pay and benefits are less familiar with their institutions' initiatives and priorities that govern policies, procedures, principles and regulations for providing care, because those initiatives and priorities are stressed more during peak periods.
"The majority of hours worked by nurses are off-peak, so understanding their experiences is crucial to understanding – and thereby addressing – the disparities in patients' experiences during those hours," said Patti Hamilton, R.N., Ph.D., principal investigator, Dean of Graduate Studies and the Wilson Professor of Nursing at Midwestern State University. "As the health care providers who work most often at the bedside and provide much of the hands-on care, nurses play an important role in providing care and in improving the quality of care. Already, we have identified some ways in which nurse administrators can mitigate the possible reasons for these disparities."
The researchers' preliminary recommendations for nurse administrators include:
- Being conscious of the fact that the majority of hours nurses work are "off-peak" and ensuring that institutions' efforts and programs include peak and "off-peak" times;
- Knowing that implementing a solution for a problem that occurs during peak hours may unintentionally create a problem for those nurses who work "off-peak" and involving nurses from every shift in planning and evaluating work processes;
- Collecting performance data in a way that allows for comparing that data across days of the week and times (both peak and "off-peak"), rather than aggregating data over 24 hours or over an entire week; and
- Proactively addressing nurse-physician relations in the hospital.
The researchers assert that they suspect that nurse-physician relations may have a great impact on the quality of patient care and safety in hospitals and is often strained during "off-peak" times.
The study was funded by the Robert Wood Johnson Foundation's Interdisciplinary Nursing Quality Research Initiative (INQRI). INQRI's goal is to generate, disseminate and translate research to build understanding about how nurses contribute to, and can improve the quality of, patient care. INQRI supports interdisciplinary teams of nurse scholars and scholars from other disciplines to address gaps in knowledge about the relationship between nursing and health care quality. The Initiative was created as a national effort to support research to reduce medical errors, improve patient care and identify solutions for health care systems and professionals to ensure the best quality possible. More information is available on the website of the Interdisciplinary Nursing Quality Research Initiative.
More information about the study is available at Nursing Open.