Nurse value-added and patient outcomes in acute care

Abstract

Objective: The aims of the study were to (1) estimate the relative nurse effectiveness, or individual nurse value-added (NVA), to patients' clinical condition change during hospitalization; (2) examine nurse characteristics contributing to NVA; and (3) estimate the contribution of value-added nursing care to patient outcomes.

Data sources/study setting: Electronic data on 1,203 staff nurses matched with 7,318 adult medical-surgical patients discharged between July 1, 2011 and December 31, 2011 from an urban Magnet-designated, 854-bed teaching hospital.

Study design: Retrospective observational longitudinal analysis using a covariate-adjustment value-added model with nurse fixed effects.

Data collection/extraction methods: Data were extracted from the study hospital's electronic patient records and human resources databases.

Principal findings: Nurse effects were jointly significant and explained 7.9 percent of variance in patient clinical condition change during hospitalization. NVA was positively associated with having a baccalaureate degree or higher (0.55, p = .04) and expertise level (0.66, p = .03). NVA contributed to patient outcomes of shorter length of stay and lower costs.

Conclusions: Nurses differ in their value-added to patient outcomes. The ability to measure individual nurse relative value-added opens the possibility for development of performance metrics, performance-based rankings, and merit-based salary schemes to improve patient outcomes and reduce costs.

Keywords: Nurse value-added; nurse education; patient outcomes.

© Health Research and Educational Trust.

Figures

Figure 1

Sample Selection

Figure 2

Frequency Distribution of Nurse Value-Added (NVA), N = 1,203 Note. The figure shows a frequency histogram of the standardized nurse fixed effect estimates, using change in patient condition as the dependent variable and a covariate adjusted value-added modeling (VAM) regression with nurse fixed effects. Other controls include patient characteristics and diagnosis, unit, care team, and calendar fixed effects. The superimposed distribution is normal with the same first and second moments.