Nurses' Influence on Patient Outcomes in U.S. Army Hospitals

The aim of this study was to describe patient outcomes in active duty personnel, military retirees, and military dependents, and associated nursing organizational structures and processes in two U.S. Army hospitals. A total of 4 mixed-bed and 4 specialty units were studied. Patient outcomes included (a) adverse event occurrence, (b) length of stay, (c) severity-adjusted acuity, (d) patient satisfaction with nursing care, and (e) health status. Organizational structures included nursing practice model used, nursing skill mix, and the education and experience of the nurses. Nursing organizational processes included (a) autonomy, nurse-physician relationship, and control over practice; (b) nursing expertise; and (c) the extent to which an ethical work environment was present.

More than 400 medical records and 200 patient surveys were completed. Both chief nursing administrators and the 8 unit heads responded to the interviews and questionnaires. Staff nurse response rate was 56%.

Patients had few adverse events and were highly satisfied with nursing care and pain management. Functional health status shortly after discharge was lower than in myocardial infarction patients hospitalized within the past year. Mental health subscale scores were fairly high, however, and mental status has been associated with positive overall health outcomes.

Nursing organizational structures promoted good communication, and units used an array of nursing practice models. Educational and experiential differences were found between military and civilian nurses.

Nurses were satisfied with their jobs overall. Scores on nurse-physician relationships were particularly high. Differences between mixed-bed and specialty units were found for autonomy, control over practice, and ethical work environment.

Overall, the hospitals and the units were quite similar. The implication is that quality of care is fairly evenly distributed across hospitals and units. The differences between military and civilian nurses may be complementary for each group. The excellent nurse-physician relationships should be beneficial in recruitment.

Final Report is available on NTRL at: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2007107...