Renal Transplant Nurse Expertise and Patient Satisfaction, Mortality and Length of Stay

Purpose:
The goal of the study is to identify a difference in renal transplant patient satisfaction, mortality and length of stay (LOS) before as compared to after a nurse competency training program focused on renal transplant concepts.

Background/Significance:
Leading health care authorities/leaders postulate that nurse expertise leads to improved patient satisfaction, quality of care and patient safety. Nurse expertise such as academic preparation, national specialty certification and/or internally based competency programs is perceived to improve patient outcomes. Limited research studies substantiate that relationship. In the current climate of accountability and cost reduction, nurse expertise strategies that improve outcomes would be valuable.

Methods:
The study was a retrospective before and after design. The sample of convenience constituted 187 renal transplant patients on a transplant unit during the study timeframe. Satisfaction data from the internal satisfaction survey,(PRC tool)captured eleven nursing sensitive indicators rated on a 1-5 Likert-like scale. Mortality and LOS data were retrieved from internal financial and quality tools. Fisher's Exact testing was utilized for the satisfaction data and analysis included number of excellent score comparison and group comparison and proportions. Pearson Chi Square analysis was utilized for LOS and mortality data.

Results:
Results indicated no difference in inpatient mortality, 90-day mortality or LOS after the program. A statistically significant difference was found in excellent responses for patient satisfaction after the educational program in the discharge process indicator (before = 58/117 or 49%; after = 39/70 or 56%; p < 0.025). In addition, when all favorable response categories were grouped, significant differences were noted in pain management (before = 102/117 or 87%; after = 70/70 or 100%; p < 0.016), nursing quality of care (before = 110/117 or 94%; after = 70/70 or 100%; p < .035) and nursing friendliness and courtesy (before = 115/117 or 98%; after = 70/70 or 100%; p < .035).

Conclusions and Implications for Practice:
Nurse expertise in the form of competency training for transplant patients improves patient satisfaction with the discharge process, pain management, overall nursing quality of care, friendlines and courtesy. These satisfaction indicators represent an emerging trend for patient valued outcomes.