What’s the real value of nurses?
Nurses are patient advocates
What other profession has a duty to advocate for patients which is enshrined in law? MN Statute 148.171 Subd. 15 (9) specifies that nurses are responsible for “advocating for the best interests of individual patients.” Patient advocacy is also required by nurses’ professional code of ethics. With 2.4 million in their ranks, nurses constitute the largest healthcare profession. Thus, efforts to improve the efficiency and effectiveness of the healthcare system must “take into account nurses’ contribution to ensuring cost-effective, high-quality care.” Patterson C. The economic value of nursing. Nurs Econ. 1992;10:193–204
Nurses increase patients’ survival rates
Proper RN staffing is associated with reduced “hospital-related mortality, hospital-acquired pneumonia, unplanned extubation, failure to rescue, nosocomial bloodstream infections, and length of stay (LOS),” according to a meta-analysis of nurse staffing studies. Kane RL, Shamliyan TA, Mueller C, et al. The association of registered nurse staffing levels and patient outcomes: systematic review and meta-analysis. Med Care. 2007;45:1195–1204.
Nurses also save the healthcare system money. One study found that the economic value of adding one additional nurse on a unit staffed at the level of providing 7.8 hours of nursing care per patient day is $60,000 per year: “annual medical savings per RN include $7400 from preventing nursing sensitive adverse events (91% of which are reduced hospital costs and 9% are reduced costs for professional services and other postdischarge costs); and $38,100 for hospital-related savings and $2500 for professional services savings related to reduced LOS unassociated with preventing adverse events. Productivity benefits to society per additional FTE RN include $10,300 for reduced patient mortality, and $1800 from faster recovery.” Dall TM, Chen YJ, Seifert RF, Maddox PJ, Hogan PF. The economic value of professional nursing. Med Care. 2009 Jan;47(1):97-104
Nurses save hospitals money
That same study also found that adding 133,000 nurses to the hospital workforce would save the healthcare system $6.1 billion dollars: “Estimates from this study suggest that adding 133,000 FTE RNs to the acute care hospital workforce [the estimated number of RNs needed to increase those hospitals below 9.1 HPPD (75th percentile) up to 9.1 HPPD] would save 5900 lives per year. The productivity value of total deaths averted is equivalent to more than $1.3 billion per year, or about $9900 per additional RN per year.Adding 133,000 RNs nationally would decrease hospital days by 3.6 million. The value of national productivity when nurses help patients recover more rapidly is conservatively estimated at $231 million (or $1700 per additional RN per year).Medical savings (before increased nursing labor costs) is estimated at $6.1 billion (or $46,000 per additional RN per year). Combining medical savings with increased productivity, these partial estimates of economic value average $57,700 for each of the additional 133,000 RNs. Although this national scenario highlights the potential impact of improved staffing in acute care hospitals, we acknowledge the challenges faced by the nation to meet the current and growing demand for RNs just to maintain current staffing levels. Also, improved nurse staffing is one of several factors needed to improve quality of care—including the contribution of other clinician specialties, and advances in training, processes, and technology.” Dall TM, Chen YJ, Seifert RF, Maddox PJ, Hogan PF. The economic value of professional nursing. Med Care. 2009 Jan;47(1):97-104
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Nurses fight for everyone’s health
It is notable that the profession is not just focused on patient health, but also on external societal factors which impact patient health as well. Likewise, it is notable that the practice of nursing is not limited to the care of individual patients, but is concerned with the health and well-being of entire populations. As the nurse practice act puts it, nurses are responsible for the “management and implementation of care within and across care settings and communities.”
A policy brief from The Robert Wood Johnson Foundation found that nurses are transforming care across the care continuum:
o Nurse innovators in the primary care arena are transforming communities by stepping outside the clinic to engage clients in healthy activities.
o Nurses are reducing the use of emergency care by helping vulnerable individuals manage their chronic conditions, receive appropriate care for non-emergency health events, and connect with preventive and social services.
o School nurses play a pivotal role in creating healthy school environments and bridging the gaps between education, health care, and public health.
o Nurses sit at the helm of roughly one-third of local and county health departments, and some of them have risen to become leaders at the state and national levels.
The Value of Nursing in Building a Culture of Health: Reaching Beyond Traditional Care Settings to Promote Health Where People Live, Learn, and Play. RWJF, Charting Nursing’s Future, available at http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2015/rwjf419194
The public trusts nurses. In the annual Gallup Poll looking at the honesty and ethical standards within a range of professions, nurses repeatedly have ranked as the most trustworthy. National Harris polls yield similar results. And it is with good reason. The public knows that we will look after their best interests and the best interests of their loved ones– as mentioned supra, our code of ethics states that our “primary commitment is to the patient.”
Nurses treat the whole patient. A comprehensive nursing assessment assesses not just current health status, but also physical, spiritual, emotional, and psycho-social needs.
Nurses are taught to communicate with patients in language they understand. What this means is that we often coordinate care, interpreting for patients complex health information received from pharmacists, laboratory technicians, physicians, and other members of the healthcare team. We explain diagnostic tests, treatments, diagnoses, and the maze that is the health care system.
No one spends more time with patients
Hospital nurses spend an average of 37% of their time with patients, compared to the next highest caregiver, physicians, who spend 12% of their time with a higher number of patients. Westbrook JI1, Duffield C, Li L, Creswick NJ. How much time do nurses have for patients? A longitudinal study quantifying hospital nurses’ patterns of task time distribution and interactions with health professionals. BMC Health Serv Res. 2011 Nov 24;11:319; and Block L1, Habicht R, Wu AW, Desai SV, Wang K, Silva KN, Niessen T, Oliver N, Feldman L. In the wake of the 2003 and 2011 duty hours regulations, how do internal medicine interns spend their time? J Gen Intern Med. 2013 Aug;28(8):1042-7.
Nursing’s main tenets
o Nursing is founded on specific human values.
o Nursing is a scientific knowledge.
o Nursing is a technical skill.
These tenets are based on specific nursing values which have been extensively studied, and include:
o Family values
o Sense of accomplishment
o Human dignity
o Prevention of suffering