A recent study funded by the Robert Wood Johnson Foundation (RWJF) Interdisciplinary Nursing Quality Research Initiative (INQRI) suggests that rural hospitals may be able to ensure more high-quality care to their patients if they are able to maintain a lower nurse turnover rate and better practice environments.
The study, published in the current issue of Medical Care, discovered that among the 23 rural hospitals studied, those with lower nurse turnover rate were more likely to implement the four core measures central to optimal care for heart failure patients. The 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.
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With more than 5.8 million Americans affected by heart failure currently, study author Robin Newhouse, PhD, chair and professor of Organizational Systems and Adult Health at the University of Maryland School of Nursing, said that rural hospitals discharge nearly a quarter of those patients. Unfortunately, the heart failure patients in these rural settings are least likely to get the recommended care they need and do not have nearly as many care options due to their rural locations, said Newhouse. Rural hospitals also account for about 40 percent of all hospitals in the country, she added.
Within the study, Newhouse and her research team tested a quality collaborative intervention for heart failure patients within the 23 rural hospitals that included in-person meetings, an evidence-based toolkit, and monthly group teleconference calls between the site coordinators and the team conducting the study.
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Newhouse said they found that there was no significant difference overall 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.
Additionally, those hospitals that were having more trouble with compliance with the quality measures prior to the intervention did see a significant difference when it came to the four core measures tested. This led Newhouse to the conclusion that for those hospitals struggling with compliance on the studied measures, it is worth the time and money to “invest in these initiatives that help with quality. We need to target the hospitals that need it most.”
However, Newhouse believes the overarching message from her study “tells the story of how nurse turnover affects the processes within the organization.”
“Rural hospitals have special circumstances in that they are physically remote from other places. For these hospitals, the issue is really about focusing on how to obtain and recruit nurses to the area. While the work of nurses is often similar in rural hospitals as it is in more urban hospitals, the organization may be very different. It’s a matter of trying to understand what about the rural environment is attractive to nurses – salaries? The work environment?” she said. “It’s important to understand that nurses are really central to all of the processes that occur in the acute care setting. And a stable environment promotes higher quality care. This makes sense because when different people are constantly coming into the practice environment, some of the care processes will not be as reliable as they would be if the work environments were more stable.”
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