Nurse Work Environment Affects Cardiac Arrest Survival

Higher nurse staffing levels and better working conditions have a direct relationship to in-hospital cardiac arrest (IHCA) patient survival, according to a new study.

Researchers at the University of Pennsylvania School of Nursing (Philadelphia, USA) conducted a study involving 11,160 adult patients in 75 hospitals in four US states (Pennsylvania, Florida, California, and New Jersey) to determine the association between nurse staffing, nurse work environments, and IHCA survival. Logistic regression models were used to determine the association of the features of nursing and IHCA survival to discharge, after adjusting for hospital and patient characteristics.

The results showed that only 15% of the patients with IHCA survived to hospital discharge after the event. Most of the IHCAs occurred in an intensive care unit (ICU), and 80% were witnessed, with 88% of patients on cardiac monitoring equipment when their cardiac arrest occurred. The researchers found that while nurse staffing levels in the ICUs did not significantly affect the chances of survival after IHCA, staffing levels in medical-surgical units did, with a 5% lower likelihood of surviving IHCA to discharge for each additional patient per nurse.

In addition, patients cared for in hospitals with poor work environments had a 16% lower likelihood of IHCA survival than patients cared for in hospitals with better work environments. The researchers hypothesized that having too many patients that needed managing on the ward interfered with the nurses' ability to effectively monitor each patient closely, identify changes in the patient’s condition, and intervene with lifesaving efforts quickly when every second counts. The study was published in the January 2016 issue of Medical Care.

“Adequate hospital nurse staffing may be an important strategy in efforts aimed at achieving excellent patient outcomes,” concluded lead author Matthew McHugh, PhD, JD, MPH, RN. “These results add to a large body of literature suggesting that outcomes are better when nurses have a more reasonable workload and work in good hospital work environments. Improving nurse working conditions holds promise for improving survival following IHCA.”

The treatment of IHCA accounts for a significant workload for nurses and physicians in most acute care hospitals. Factors affecting patient survival include rapid defibrillation, earlier recognition of cardiac arrest, quality of acute resuscitation, and post-resuscitation care, such as therapeutic hypothermia and early cardiac catheterization.

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University of Pennsylvania School of Nursing