What would a hospital be without its nurses? Not only are they responsible for a patient’s medical wellbeing, they are also round-the-clock caregivers that attend to the mental and emotional health of their patients, and those patients’ family members as well. You can ask almost anyone, and they will tell you about especially attentive nurses who went above and beyond to make their hospital stay a million times better. Now, a new study shows something most patients already know: nurses are essential to the success of a hospital. Without them, patients suffer.

Researchers from the University of Pennsylvania, knowing that nurses could make or break a hospital, sought to study what kind of effects a bigger, happier nursing staff had on the proceedings of a hospital. In order to do this, they looked to the Kaiser Permanente health care system, a health network present in eight states that integrates hospitals, insurance, and doctors’ offices into one system. Kaiser is known to be an exemplary health care organization that many other hospitals have tried to replicate, but with little success. Researchers believe this is most likely due to one key difference: its nurses.

When conducting their study, researchers from UPenn looked at 550 hospitals in California, New Jersey, Pennsylvania, and Florida, including 25 Kaiser Permanente hospitals in California and 56 Magnet hospitals. Magnet hospitals are also known as exemplary health care systems, recognized by the American Nurses Credentialing Center as a great place for nurses to work.

Researchers then administered a survey to nurses, asking them about their work environment, level of education, job satisfaction, and the typical number of patients they see each day. In addition to this, they checked mortality data from each hospital.

“It turns out that, by and large, nursing differences accounted for much of the mortality difference that we saw in Kaiser Permanente hospitals,” Matthew McHugh, a registered nurse and professor at UPenn’s School of Nursing told Yahoo.

Interestingly enough, mortality rates decreased by as much as 20 percent in Kaiser and Magnet hospitals compared to their opponents, and the nursing staff made for “a sizeable portion of the advantage,” the study said.

“It turns out that these differences we see in nursing, in terms of work environment, staffing levels, investment in nursing around a highly educated workforce, those things translate to better outcomes,” McHugh said.

McHugh and his team found that there were a few differences that accounted for this result. The first was that nurses who claimed they enjoyed their work environments were also better at taking care of patients. “We find that places where nurses have a good experience working are places where nurses are better able to do their jobs,” McHugh said. “They’re more autonomous, they’re supported by management, and they’re integrated into hospital decision making.”

Empowering nurses is also essential to creating a better working environment; nurses need to be taken seriously, and feel comfortable telling a physician when something is being handled incorrectly. If nurses are also given the opportunity to make more decisions, patients can receive faster and higher quality care. A study published last year in the Journal of Nursing Administration found that when nurses have more authority within their units, those units report having more effective patient care.

Another way to empower nurses is to show a willingness to make tangible changes that will make their jobs easier. For instance, during the nursing shortage of the early 2000s, Kaiser Permanente worked to make its hospitals cater to the needs of its nursing staff. After investing in research efforts regarding nursing, Kaiser found in studies conducted in both 2005 and 2006 that nurses spent 35 percent of their time documenting patient records. In order to reduce this, Kaiser switched to an electronics-based system for medical records in 2005. It also found that nurses spent a fair amount of time searching for equipment and information, like whether or not a patient’s medication was ready. So it responded by giving nurses electronic notifications for when medications are ready for pick-up.

“We wanted to make sure that we were a place that nurses wanted to work,” said registered nurse Marilyn Chow, vice president of Patient Care Services and Innovation for Kaiser Permanente. “If you have nurses who are happy and joyful at work, they will definitely pass that on and be caring and compassionate.”

Researchers also found that Kaiser and Magnet hospitals were hiring more nurses with Bachelor’s degrees. According to Chow, the nursing field is more complex and demanding than it ever has been before. “The role is not only surveillance, but facilitating and coordinating the care, and not just for one patient, but for four to five patients,” Chow said. “There are so many things to take care of.”

Chow and McHugh also noted that many patients are arriving at hospitals in worse conditions, but leaving hospitals more quickly. Because the length of their stay is shortened, there is more pressure on nurses to spend enough time with patients and their families in order to teach them how to care for themselves when they arrive home.

“Hospitals are very complex, and integrating all of that information requires a certain set of skills and requires you have a pool of knowledge within the overall nursing staff,” McHugh said. When nurses were less educated, the study noted, there were more mistakes being made.

Finally, the study found that the more nurses there are, the better. Kaiser Permanente hospitals are known to have four patients for every one nurse, while non-Magnet hospitals have about a five to one ratio. Quite simply, when there are more nurses, there are more people to care for patients, and those patients receive more personalized, specified attention.

“Nurses are at the bedside and are working with all the other providers,” McHugh explained. “They’re the essential person for monitoring patient condition, and if something bad does happen, intervening and mobilizing the intervention response.”

So, when it comes down to it, a happy hospital means happy nurses. Nurses have always been the lifeblood of hospitals; now, there’s just a study to prove it.

Source: McHugh M, Aiken L, Burns L, et al. Achieving Kaiser Permanente quality. Healthcare Manage Rev. 2015.

Read E, Laschinger H, Finegan J, et al. The influence of nursing unit empowerment and social capital on unit effectiveness and nurse perceptions of patient care quality. Journal of Nursing Administration. 2015.