The Impact of Nurse Staffing and Education on 30‐Day Mortality Among Patients Hospitalized for Acute Kidney Injury

Acute kidney injury (AKI) affects approximately 20% of hospitalized patients and is associated with higher mortality, extended hospital stay, and increased costs. While various strategies have been proposed to improve AKI management, the impact of nursing resources on AKI outcomes has not been explored. We sought to examine the association between nursing resources and 30-day mortality among patients hospitalized with AKI. Using a cross-sectional study design, we linked data from the CMS Medicare Provider Analysis and Review file, American Hospital Association Annual Survey, and RN4CAST-NY/IL survey of registered nurses. We identified 24,368 Medicare beneficiaries aged 18-99 years with a primary diagnosis of AKI hospitalized in 155 hospitals in New York and Illinois in 2021. The primary outcome was 30-day mortality. Key independent variables included nurse staffing (patient-to-nurse ratio) and nurse education (proportion of nurses holding a bachelor's degree or higher). Covariates were patient demographics, comorbidities, and hospital characteristics. The 30-day mortality rate was 10.5%. In adjusted logistic regression models, each additional patient per RN increased the odds of 30-day mortality by 7% (OR = 1.07, 95% CI [1.01-1.13], p < 0.05). For each 10-point increase in the proportion of nurses with a bachelor's degree or higher, the odds of 30-day mortality decreased by 9% (OR = 0.91, 95% CI [0.88-0.95], p < 0.001). Better nurse staffing and higher proportions of nurses with a bachelor's degree or higher are associated with lower 30-day mortality among patients hospitalized with AKI. These findings underscore the significance of nursing in AKI outcomes and suggest that hospitals should prioritize investing in nursing resources to enhance AKI outcomes.