COVID-19 patients admitted to hospitals with fewer nursing resources prior to and during the early pandemic were significantly less likely to survive their illness, a recent study found.
Among nearly 88,000 Medicare patients discharged from 237 hospitals with COVID-19 between April and December 2020, nearly a quarter died during their hospitalization and almost a third died within the 30 days following their admission, researchers from the University of Pennsylvania wrote in the International Journal of Nursing Studies.
The rates were worse among the hospitals with reduced nurse staffing, according to the study. For example, a COVID-19 patient’s odds of in-hospital mortality rose by 20% for each additional patient a registered nurse had in their workload in the months just before the pandemic began (December 2019 to February 2020). Odds of 30-day mortality rose by 15% under the same circumstances.
The general trend extended to the hospitals that—either before or during the study period—had a lower proportion of registered nurses with a bachelor of science in nursing, did not have a Magnet recognition and had worse scores on a nurse-reported survey on the quality of their work environment.
“These findings demonstrate that hospital nursing resources are a cornerstone of public health emergency-preparedness that need to be well-funded in usual times in order for hospitals to be prepared for emergencies like the next pandemic,” Linda Aiken, Ph.D., senior author, professor of nursing and founding director of the University of Pennsylvania School of Nursing’s Center for Health Outcomes and Policy Research, said in a release.
The team’s study included hospitals in New York and Illinois. Its average patient was 78 years old. Among these, researchers saw the highest rates of mortality in April 2020, a dip during the summer and then a steady rise through the end of the year.
The team’s analysis also included models estimating “many thousands” of deaths could have been avoided with “superior nursing resources” both before and during the pandemic.
Specifically, they wrote that a uniform registered nurse-to-patient ratio of 4:1 would have reduced in-hospital mortality among the sample by 17%, or nearly 3,500 deaths.
The researchers said their work is among the few studies that have answered why COVID-19 mortality rates varied between hospitals during the pandemic. “Modifiable aspects” of a hospital’s workforce investments like these “are linked to more favorable patient outcomes during ordinary times and also represent important emergency-preparedness dashboard metrics that should be required in emergency preparedness plans,” they wrote.
Karen Lasater, Ph.D., the study’s lead author and an associate professor at the nursing school, said the findings and other nurse staffing and outcomes research from her and Aiken make the case for government intervention.
“It is in the public’s interest to establish state and federal policies that guarantee a minimum safe standard of hospital nurse staffing at all times,” Lasater said in a release. “Our team’s work shows that U.S. hospitals were already chronically understaffed prior to the pandemic and staffing worsened during the pandemic.”