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Effect of Nurse Staffing and Education on the Outcomes of Surgical Patients With Comorbid Serious Mental Illness

The authors are affiliated with the Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, 418 Curie Blvd., 3R NEB, Philadelphia, PA 19104-6096 (e-mail: akutney{at}nursing.upenn.edu).

OBJECTIVE: This study of surgical patients compared outcomes of those with and those without serious mental illness and examined effects of patient-to-nurse ratios and nurses' education levels on outcomes, including death within 30 days of admission, failure to rescue (death resulting from surgery complication), and length of stay. METHODS: Cross-sectional data from a nurse survey and from patient and administrative records were linked. Data for 9,989 nurses and 228,433 surgical patients discharged from 157 Pennsylvania hospitals were analyzed by using generalized estimating equations. RESULTS: Records indicated that 4.7% (N=10,666) of the sample had a diagnosis of serious mental illness. A higher level of nurse staffing had a stronger effect on prevention of death among patients with serious mental illness than among those without it. Length of stay for patients with serious mental illness was shorter in hospitals with higher proportions of baccalaureate-prepared nurses. CONCLUSIONS: Better nurse staffing and higher education level mitigated poor patient outcomes among highly vulnerable patients with serious mental illness.

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