Nurse value-added and patient outcomes in acute care

Health Serv Res. 2014 Dec;49(6):1767-86. doi: 10.1111/1475-6773.12236. Epub 2014 Sep 25.


Objective: The aims of the study were to (1) estimate the relative nurse effectiveness, or individual nurse value-added (NVA), to patients' clinical condition change during hospitalization; (2) examine nurse characteristics contributing to NVA; and (3) estimate the contribution of value-added nursing care to patient outcomes.

Data sources/study setting: Electronic data on 1,203 staff nurses matched with 7,318 adult medical-surgical patients discharged between July 1, 2011 and December 31, 2011 from an urban Magnet-designated, 854-bed teaching hospital.

Study design: Retrospective observational longitudinal analysis using a covariate-adjustment value-added model with nurse fixed effects.

Data collection/extraction methods: Data were extracted from the study hospital's electronic patient records and human resources databases.

Principal findings: Nurse effects were jointly significant and explained 7.9 percent of variance in patient clinical condition change during hospitalization. NVA was positively associated with having a baccalaureate degree or higher (0.55, p = .04) and expertise level (0.66, p = .03). NVA contributed to patient outcomes of shorter length of stay and lower costs.

Conclusions: Nurses differ in their value-added to patient outcomes. The ability to measure individual nurse relative value-added opens the possibility for development of performance metrics, performance-based rankings, and merit-based salary schemes to improve patient outcomes and reduce costs.

Keywords: Nurse value-added; nurse education; patient outcomes.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease / nursing
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Nursing Care / statistics & numerical data*
  • Patient Outcome Assessment*
  • Retrospective Studies
  • Treatment Outcome*