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ADVANCE Perspective: Nurses

Nurses Can't Seem to Escape Being Honest & Trustworthy

Published October 9, 2012 2:19 PM by Chuck Holt

As most everyone knows by now, nurses have for several years been ranked the "Most Trusted Profession" in an annual Gallup survey of Americans.

But now a new study reveals nurses are also very good at assessing the quality of care delivered in the hospital units in which they work. 

In short, it turns out nurses are not only trustworthy - they're pretty darned honest too.

The study, published online in the journal Research in Nursing and Health, was funded by the Robert Wood Johnson Foundation Nurse Faculty Scholars program and the National Institute of Nursing Research. 

As part of the study, University of Pennsylvania (UPenn) researchers surveyed nurses' responses to the question: "How would you describe the quality of nursing care delivered to patients in your unit?" Responses could be: Excellent, Good, Fair and Poor.

But instead of massaging their egos and fudging the facts as some professionals might be inclined to do, the nurse respondents to this survey laid it on the line, if you will. Or, as a Penn Nursing Science press release put it, these nurses were "extremely accurate."  

In fact, the researchers found nurses' reports that the quality of care was excellent at their hospital corresponded with

  • higher levels of patient satisfaction;
  • better scores for processes of care; and
  • better results for patients in the hospital with regard to mortality and failure to rescue.

To arrive at those comparisons and others, the researchers analyzed existing data for hospitals in California, Florida, New Jersey and Pennsylvania, which represent 20 percent of annual hospitalizations in the U.S. The data included:

  • nurses' reports on quality of care from the Multi-State Nursing Care and Patient Safety Study;
  • patient assessments of care from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) from the Centers for Medicare and Medicaid Services;
  • hospitals' reports on care measures for heart failure, pneumonia, heart attack and surgical care; and
  • administrative data on mortality and failure to rescue.

In another example from the survey, for every additional 10% in the proportion of nurses reporting that the quality of care on their unit was "excellent," there was a commensurate 3.7 point increase in the percentage of patients who would recommend the hospital and a 5% decrease in the odds of mortality and failure-to-rescue in surgical patients.

Perhaps not surprisingly, reports of "excellent quality of care" were higher in Magnet hospitals known to have good work environments and that support professional nursing practice as measured by the Practice Environment Scale of the Nursing Work Index developed at UPenn.  

The primary investigators for the study were Matthew McHugh, PhD, JD, MPH, RN, CRNP, and Amy Witkoski Stimpfel, PhD, MSN. McHugh is associate professor and Witkoski Stimpfel is a post-doctoral research fellow, both at the Penn School of Nursing in Philadelphia. 

"Nurses have insight into aspects of quality that aren't always documented, but which can make the all-important difference in patient outcomes," notes McHugh.  

How about you? How would you rate the quality of nursing care delivered to patients on your unit: Excellent, Good, Fair or Poor?

Be honest now. Not that you need to be told that apparently. 


Thanks for sharing these important findings.  I'm not surprised given our own research on trust in healthcare contexts, including the critical role nurses play on healthcare teams in improving patient outcomes.

Aneil Mishra, Ph.D.


Aneil Mishra October 10, 2012 9:07 AM

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