Nurse turnover affects heart care at hospitals

Lower nursing turnover and better practice environments can help rural hospitals ensure high-quality care for heart failure patients, according to a study.

Heart failure affects more than 5.8 million Americans, and rural hospitals discharge nearly a quarter of all heart failure patients. But patients in these rural settings are least likely to get the recommended care, according to background information in the study, which was funded by the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative. These patients also have little choice regarding where they get care.

As reported in the May issue of the journal Medical Care, rural hospitals with lower nurse turnover are more likely to implement all four measures that are central to optimal care for heart failure patients: providing counseling on smoking cessation, providing adequate instructions to patients at discharge, assessing left ventricular ejection fraction and ensuring the patient receives angiotensin-converting enzyme inhibitors at discharge.

The researchers tested a quality collaborative intervention in 23 rural hospitals in the eastern United States. The intervention included in-person meetings, an evidence-based toolkit and monthly group teleconference calls between the site coordinators and the team conducting the study. One group of hospitals used the intervention for six months while the other did not. After six months the second group also began using the intervention.

The researchers found no significant difference in implementation of the four core measures as a result of the intervention, but hospitals with lower nurse turnover and better practice environments implemented more of the measures. Better practice environments, as measured by survey responses, specifically were associated with better assessment of left ventricular ejection fraction.

“The results of this study really speak to the central role nurses play in almost any quality improvement effort,” Robin Newhouse, RN, PhD, NEA-BC, FAAN, a co-leader of the study and chair and professor of Organizational Systems and Adult Health at the University of Maryland School of Nursing, said in a news release. “Appropriate practice environments and keeping turnover low are important factors in hospitals’ ability to implement quality initiatives and adopt best practices.”