New Study Finds Nurse Staffing Plays Important Role in Implementation of Measures That Improve Care for Heart Failure Patients in Rural Hospitals

Ensuring that heart failure patients receive optimal care can be difficult, particularly in rural hospitals. Now a new study suggests that rural hospitals may be better able to ensure high-quality care if they have lower nursing turnover and better practice environments.

Heart failure affects more than 5.8 million Americans and rural hospitals discharge nearly a quarter of all heart failure patients, but patients in these rural settings are least likely to get the recommended care. These patients also have little choice when it comes to where they get care.

A new study, funded by the Robert Wood Johnson Foundation (RWJF) Interdisciplinary Nursing Quality Research Initiative (INQRI), in the current issue of Medical Care found that rural hospitals with lower nurse turnover are more likely to implement all four measures that are central to optimal care for heart failure patients. Metrics examined were: providing smoking cessation counseling; providing adequate instructions to patients being discharged from the hospital; assessing how well the heart pumps; and making sure the patient receives medication to help blood vessels relax. Better nurse practice environments were associated with better assessment of how well the heart pumps.

Robin Newhouse, PhD, RN, NEA-BC, FAAN, chair and professor of Organizational Systems and Adult Health at the University of Maryland School of Nursing, and Laura Morlock, PhD, professor and associate chair for Health Management Programs in the Department of Health Policy and Management at Johns Hopkins Bloomberg School of Public Health, led the interdisciplinary research team.

The team tested a quality collaborative intervention in 23 rural hospitals in the eastern United States. The intervention included in-person meetings, an evidence-based toolkit, and monthly group teleconference calls between the site coordinators and the team conducting the study. One group of hospitals used the intervention for six months while the other did not, then, after six months the second group also began using the intervention.

The researchers found that there was no significant difference in implementation of the four core measures as a result of the intervention, but hospitals with lower nurse turnover and better practice environments implemented more of the measures.

“The results of this study really speak to the central role nurses play in almost any quality improvement effort,” said Newhouse. “Appropriate practice environments and keeping turnover low are important factors in hospitals’ ability to implement quality initiatives and adopt best practices.”

The research team also included: Cheryl Dennison Himmelfarb, RN, ANP, PhD, FAAN, associate professor in the Department of Acute and Chronic Care at Johns Hopkins University School of Nursing and deputy director of the Johns Hopkins Institute for Clinical and Translational Research; Kevin Frick, PhD, professor in the Johns Hopkins School of Public Health; Peter Pronovost, MD, PhD, professor in the Armstrong Institute for Patient Safety and Quality, Departments of Anesthesiology, Critical Care Medicine, and Surgery at the Johns Hopkins University School of Medicine; and Yulan Liang, PhD, associate professor in the Department of Family and Community Health, University of Maryland School of Nursing.

More information about the study is available on the RWJF website.

INQRI supports interdisciplinary teams of nurse scholars and scholars from other disciplines to address the gaps in knowledge about the relationship between nursing and health care quality. It is helping to advance the recommendations of the Institute of Medicine’s landmark report The Future of Nursing: Leading Change, Advancing Health, which include fostering interprofessional collaboration and preparing and enabling nurses to lead change. By requiring research teams to include a nurse scholar and at least one scholar from another health care discipline, INQRI not only fosters interprofessional collaboration, it also ensures that diverse perspectives are brought to bear in research. 

The Interdisciplinary Nursing Quality Research Initiative is funded by the Robert Wood Johnson Foundation. To learn more, visit www.inqri.org, or follow on Twitter at @INQRIProgram.

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The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable, and timely change. For more than 40 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. For more information, visit www.rwjf.org. Follow the Foundation on Twitter www.rwjf.org/twitter or Facebook www.rwjf.org/facebook.