Nurse Staffing, Work Environment Linked to Lower Hospital Readmissions

As policy makers and institutions clamor for a way to increase quality of care during these transitional phases, one study suggest that improving nurses’ work environments and staffing may be effective in preventing readmissions.  

Nurse staffing levels and work environment were found to have a significant impact among Medicare patients readmitted for various heart ailments and pneumonia, according to a study released in a January issue of Medical Care

Compiling data from California, New Jersey and Pennsylvania, the study analyzed nurses’ work environment, patient-to-nurse ratios, proportion of nurses with college degrees, and also patient discharge data to estimate the relationship between nursing and 30-day readmission.


Factoring the average nurse’s workload in terms of patient-to-nurse ratio, the chances of readmission increased with every added patient for each ailment.

Each additional patient per nurse was associated with a 7% higher odds of readmission for heart failure, 6% for pneumonia patients, and 9% for myocardial infarction patients (heart attacks) within the 30-day readmission period, according to the data.

Work environment also played a role in reducing the chances of readmissions among patients with these ailments.


In terms of nurse satisfaction, work environments considered “good” were associated with readmission odds that were 7% lower for heart failure patients, 10% lower for pneumonia, and 6% lower for heart attack patients.

The roles nurse staffing and environment play in care outcomes is significant as hospitals with higher than expected readmission rates have come under fire from Medicare for their number of re-hospitalizations, and post-acute care is also under the microscope.

In October, Medicare began reducing reimbursement payments by as much as 1% in an effort to pressure hospitals into paying closer attention to patients post-discharge, coinciding with a similar study from the Journal of the American Medical Association (JAMA).

Analyzing data from 2007-2009 Medicare fee-for-service claims, the JAMA study found that 61% of heart failure patients, 67.6% of myocardial infarction patients, and 62.6% of pneumonia patients had been readmitted within 15 days of hospitalization.

When a hospital discharges a patient, the transition from institution to home (in settings that could include nursing homes or assisted living communities) is often a delicate period for patients requiring increased attention.

“The timing of 30-day readmissions highlights the importance of both transitional care and longitudinal strategies that are effective for at least the full month following hospitalization,” writes the study’s lead author Kumar Dharmarajan, MD, MBA.

While strategies that target specific diseases might be one preventative measure in curbing hospital readmissions, Dharmarajan warns they may only address a fraction of patients at risk for re-hospitalization.

In recent months, the Centers for Medicare and Medicaid Services (CMS) has announced several initiatives seeking to improve care coordination and transitions among acute and post-acute settings in efforts to save Medicare money by reducing the number of hospital readmissions. Skilled nursing facilities and other senior living and care providers are participating in many of these initiatives. 

Written by Jason Oliva