Nurses' assessment of hospital quality often on the button

Perceptions from nurses -- the healthcare providers most familiar with the patient experience -- about hospital quality of care closely matches the quality indicated by patient outcomes and other long-standing measurements.

"For a complete picture of hospital performance, data from nurses is essential," said lead author Matthew D. McHugh, a public health policy expert at Penn Nursing. "Their assessments of quality are built on more than an isolated encounter or single process -- they are developed over time through a series of interactions and direct observations of care."

Nurse-reported quality accurately correlated with outcome measures including death and life-threatening post-surgical complications, and patients' reports of the care experience, wrote Dr. McHugh.

This study, published online in Research in Nursing and Health, included more than 16,000 nurses in nearly 400 hospitals in California, Florida, New Jersey, and Pennsylvania, four of the nation's largest states accounting for more than 20 percent of hospitalizations annually. The researchers examined the relationship between nurses' reports of quality and hospitals known for nursing excellence. Higher proportions of nurses working in hospitals with good practice environments and in Magnet-recognized hospitals (nationally noted for outstanding nursing care) reported that the quality of care in their workplace was excellent.

"Obtaining information from nurses takes advantage of their unique perspective within the caregiving context," said Dr. McHugh. "Nurses have insights -- patient-provider interactions, integration of technology, patient and family education -- that are not always documented in the medical record but often make the difference between good and bad outcomes."

Healthcare quality measures are integral to decision-making among regulators, consumers, and purchasers, with the potential to affect policy, quality improvement, efforts, and insurance. "Although the patient's perspective is the most relevant quality-of-care indicator," said Dr. McHugh, "nurse-reported quality-of-care is clearly a valuable indicator of hospital quality."

The study was funded by the Robert Wood Johnson Foundation Nurse Faculty Scholars program and the National Institute of Nursing Research. Dr. McHugh is an RWJF Nurse Faculty Scholar, and was one of only 12 nurse educators across the country selected last year to participate in the program and to receive a three-year $350,000 grant to conduct research.