Better-staffed hospitals before pandemic had better outcomes after it began

According to a new study published in Nursing Outlook, the journal of the American Academy of Nursing, chronic hospital nurse understaffing and poor hospital work environments that predated the COVID-19 pandemic largely explain the disruptions in nursing care seen during the pandemic and continuing today.

Researchers at Penn Nursing's Center for Health Outcomes and Policy Research (CHOPR) conducted a large study of 151,335 registered nurses practicing in 357 hospitals in New York state and Illinois in early 2020 before the COVID-19 pandemic and mid-2021, well into the second year of the pandemic. Prior to the pandemic, 57% of nurses reported that there were not enough staff to care for patients, which rose to 67% of nurses reporting not enough staff during the pandemic.

Even before the pandemic in early 2020, 22% of bedside care nurses said they intended to leave their hospital employer within the year, and this figure rose to 25% in the second year of the pandemic. The percentage of bedside care nurses giving their hospitals an unfavorable grade on patient safety was high immediately prior to the pandemic, at 34%, and increased to 47% during the pandemic.

Lead author Linda Aiken, Ph.D., Professor of Nursing and Sociology, Founding Director of the Center for Health Outcomes and Policy Research, and Senior Fellow of the Leonard Davis Institute for Health Economics at the University of Pennsylvania, said, "One of the most shocking findings from our study is that most clinical nurses employed by hospitals lack confidence that management will respond to and try to resolve problems in patient care they identify. It is not surprising that nurse burnout is the highest ever recorded and that so many nurses say they intend to leave their employers."

The study showed that lack of confidence in hospital management is not a new problem, but a worsening one, with 69% of bedside care nurses lacking confidence in management to address patient care problems before the pandemic rising to 78% during the pandemic. In a related finding, more than half of nurses reported that the actions of management show patient safety is not a top priority. The paper cites other published research documenting that patient safety has declined since the advent of the pandemic.

"The good news from the study is that hospitals reported by their nurses prior to the pandemic to have evidence-based nurse staffing and good work environments fared significantly better during the pandemic in terms of their nurses reporting less burnout, less job dissatisfaction, less intent to leave, and better quality and safety of patient care," said Aiken.

The study's authors say that their findings suggest that continuing disruptions in hospital care can be successfully addressed by hospital leadership by offering sufficient numbers of budgeted permanent registered nurse positions to provide evidence-based safe nurse staffing levels and by improving work environments. However, since hospital nurse understaffing was a chronic problem even before the pandemic, the authors point to promising public policy solutions by states and Medicare to require hospitals to meet minimum safe nurse staffing standards.

The study was carried out by Penn Nursing's Center for Health Outcomes and Policy Research, in partnership with the National Council of State Boards of Nursing.