Nurses’ work atmosphere linked to readmission rates

( Medicare patients treated in hospitals with a good work environment for nurses had up to 10% lower odds of readmission than those treated in hospitals with a poor work environment, according to a study.

The study authors noted Medicare has begun penalizing hospitals with excessive readmission rates (

After examining data from more than 200,000 nurses and 412 hospitals in California, Pennsylvania and New Jersey, researchers with the University of Pennsylvania School of Nursing determined that the likelihood of readmission within 30 days among Medicare patients older than 65 with heart failure, myocardial infarction and pneumonia was 7%, 6% and 10% lower, respectively, among patients treated in hospitals with good work environments based on nurse survey responses.

“Our results suggest that improving nurses’ work environment and reducing nurses’ workload are organization-wide reforms that could result in fewer readmissions for Medicare beneficiaries with common medical conditions,” Matthew D. McHugh, CRNP, PhD, JD, MPH, a health policy expert at Penn Nursing, reported in the January issue of the journal Medical Care.

“This is consistent with the evidence showing significant associations between the nurse work environment, staffing and other patient outcomes.”

The researchers said system-based interventions to improve care should begin within the nursing care environment. All hospitalized patients are exposed to bedside nursing throughout their stay, and combining targeted transitional care with high-quality inpatient nursing care would produce more positive outcomes for all patients, they wrote.

Hiring more staff nurses to cut down on current patient workloads could help the nursing work environment, McHugh said. Hospitals may be able to make up for the additional cost with increased productivity, reduced costs lost to turnover and retraining, improved patients outcomes and reductions in readmissions and post-discharge services.

“To work effectively, nurses must practice in an environment that reinforces their professional role and autonomy, provides adequate resources, demonstrates consistent and high-quality managerial support and leadership, and includes nursing in institutional decision-making,” McHugh said. “The challenge of readmissions will require a range of interventions. One potentially effective means of reducing overall readmissions may come through improving the organization and delivery of hospital nursing services.”