Improving hospital nurses' work environment and staffing levels may reduce 30-day readmission rates for Medicare patients with heart failure, myocardial infarction and pneumonia, according to a study from the Center for Health Outcomes and Policy Research published in Medical Care. Each additional patient per nurse in an average nurse's workload was associated with 7 percent higher odds of readmission for heart failure patients, 6 percent higher odds of readmission for pneumonia patients and 9 percent higher odds of readmission for myocardial infarction patients within 30 days of discharge.

Care in hospitals with good vs. poor work environments for nurses was associated with 7 percent lower odds of 30-day readmission for heart failure patients, 6 percent lower for myocardial infarction patients and 10 percent lower for pneumonia patients. The nurse work environment was measured using the Practice Environment Scale of the Revised Nursing Work Index, in which nurses state the degree to which their practice setting incorporates various organizational features. It consists of five subscales: nursing foundations for quality care; staffing and resource adequacy; nurse participation in hospital affairs; nurse manager ability, leadership and support; and nurse-physician relations.

"If a hospital with a poor work environment could improve to a good environment, we would expect its readmission rate to decline from roughly the 84th to 50th percentile or the 50th to the 16th percentile in this distribution of hospitals," the authors wrote. "A hospital that could change its work environment from poor to good and reduce nurse workloads from six to four patients per nurse would, all else being equal, see its readmission rates reduced from 25 to 21 percent."

The percentage of nurses with baccalaureate degrees in nursing also had a positive effect on readmissions, but only for patients with pneumonia.

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