The relationship between nurse staffing and patient outcomes: A case study (original) (raw)
Related papers
International journal of …, 2009
Background: Studies have linked nurse staffing levels (number and skill mix) to several nurse-sensitive patient outcomes. However, evidence from European countries has been limited. Objectives: This study examines the association between nurse staffing levels (i.e. acuity-adjusted Nursing Hours per Patient Day, the proportion of registered nurses with a Bachelor's degree) and 10 different patient outcomes potentially sensitive to nursing care. Design-setting-participants: Cross-sectional analyses of linked data from the Belgian Nursing Minimum Dataset (general acute care and intensive care nursing units: n = 1403) and Belgian Hospital Discharge Dataset (general, orthopedic and vascular surgery patients: n = 260,923) of the year 2003 from all acute hospitals (n = 115). Methods: Logistic regression analyses, estimated by using a Generalized Estimation Equation Model, were used to study the association between nurse staffing and patient outcomes. Results: The mean acuity-adjusted Nursing Hours per Patient Day in Belgian hospitals was 2.62 (S.D. = 0.29). The variability in patient outcome rates between hospitals is considerable. The inter-quartile ranges for the 10 patient outcomes go from 0.35 for Deep Venous Thrombosis to 3.77 for failure-to-rescue. No significant association was found between the acuity-adjusted Nursing Hours per Patient Day, proportion of registered nurses with a Bachelor's degree and the selected patient outcomes. Conclusion: The absence of associations between hospital-level nurse staffing measures and patient outcomes should not be inferred as implying that nurse staffing does not have an impact on patient outcomes in Belgian hospitals. To better understand the dynamics of the nurse staffing and patient outcomes relationship in acute hospitals, further analyses (i.e. nursing unit level analyses) of these and other outcomes are recommended, in addition to inclusion of other study variables, including data about nursing practice environments in hospitals. #
Nurse Staffing and Patient Outcomes (Articles)
2000
Background: Nursing studies have shown that nursing care delivery changes affect staff and organizational outcomes, but the effects on client outcomes have not been studied sufficiently. Objective: To describe, at the level of the nursing care unit, the relationships among total hours of nursing care, registered nurse (RN) skill mix, and adverse patient outcomes. Methods: The adverse outcomes included unit rates of medication errors, patient falls, skin breakdown, patient and family complaints, infections, and deaths. The correlations among staffing variables and outcome variables were determined, and multivariate analyses, controlling for patient acuity, were completed. Results: Units with higher average patient acuity had lower rates of medication errors and patient falls but higher rates of the other adverse outcomes. With average patient acuity on the unit controlled, the proportion of hours of care delivered by RNs was inversely related to the unit rates of medication errors, decubiti, and patient complaints. Total hours of care from all nursing personnel were associated directly with the rates of
Hospital nurse-staffing models and patient- and staff-related outcomes
The Cochrane library, 2019
Background Nurse staffing interventions have been introduced across countries in recent years in response to changing patient requirements, developments in patient care, and shortages of qualified nursing staff. These include changes in skill mix, grade mix or qualification mix, staffing levels, nursing shifts or nurses' work patterns. Nurse staffing has been closely linked to patient outcomes, organisational outcomes such as costs, and staff-related outcomes. Objectives Our aim was to explore the effect of hospital nurse staffing models on patient and staff-related outcomes.
International Journal of Nursing Studies, 2021
Background: Worldwide, hospitals face pressure to reduce costs. Some respond by working with a reduced number of nurses or less qualified nursing staff. Objective: This study aims at examining the relationship between mortality and patient exposure to shifts with low or high nurse staffing. Methods: This longitudinal study used routine shift-, unit-, and patient-level data for three years (2015-2017) from one Swiss university hospital. Data from 55 units, 79,893 adult inpatients and 3646 nurses (2670 registered nurses, 438 licensed practical nurses, and 538 unlicensed and administrative personnel) were analyzed. After developing a staffing model to identify high-and low-staffed shifts, we fitted logistic regression models to explore associations between nurse staffing and mortality. Results: Exposure to shifts with high levels of registered nurses had lower odds of mortality by 8.7% [odds ratio 0.91 95% CI 0.89-0.93]. Conversely, low staffing was associated with higher odds of mortality by 10% [odds ratio 1.10 95% CI 1.07-1.13]. The associations between mortality and staffing by other groups was less clear. For example, both high and low staffing of unlicensed and administrative personnel were associated with higher mortality, respectively 1.03 [95% CI 1.01-1.04] and 1.04 [95% CI 1.03-1.06]. Discussion and implications: This patient-level longitudinal study suggests a relationship between registered nurses staffing levels and mortality. Higher levels of registered nurses positively impact patient outcome (i.e. lower odds of mortality) and lower levels negatively (i.e. higher odds of mortality). Contributions of the three other groups to patient safety is unclear from these results. Therefore, substitution of either group for registered nurses is not recommended.
Medical care, 2007
Objective: To examine the association between registered nurse (RN) staffing and patient outcomes in acute care hospitals. Study Selection: Twenty-eight studies reported adjusted odds ratios of patient outcomes in categories of RN-to-patient ratio, and met inclusion criteria. Information was abstracted using a standardized protocol. Data Synthesis: Random effects models assessed heterogeneity and pooled data from individual studies. Increased RN staffing was associated with lower hospital related mortality in intensive care units (ICUs) ͓odds ratios (OR), 0.91; 95% confidence interval (CI), 0.86 -0.96͔, in surgical (OR, 0.84; 95% CI, 0.80 -0.89), and in medical patients (OR, 0.94; 95% CI, 0.94 -0.95) per additional full time equivalent per patient day. An increase by 1 RN per patient day was associated with a decreased odds ratio of hospital acquired pneumonia (OR, 0.70; 95% CI, 0.56 -0.88), unplanned extubation (OR, 0.49; 95% CI, 0.36 -0.67), respiratory failure (OR, 0.40; 95% CI, 0.27-0.59), and cardiac arrest (OR, 0.72; 95% CI, 0.62-0.84) in ICUs, with a lower risk of failure to rescue (OR, 0.84; 95% CI, 0.79 -0.90) in surgical patients. Length of stay was shorter by 24% in ICUs (OR, 0.76; 95% CI, 0.62-0.94) and by 31% in surgical patients (OR, 0.69; 95% CI, 0.55-0.86). Conclusions: Studies with different design show associations between increased RN staffing and lower odds of hospital related mortality and adverse patient events. Patient and hospital characteristics, including hospitals' commitment to quality of medical care, likely contribute to the actual causal pathway.
A Longitudinal Examination of Hospital Registered Nurse Staffing and Quality of Care
Health Services Research, 2004
Objective. To evaluate previous research findings of the relationship between nurse staffing and quality of care by examining the effects of change in registered nurse staffing on change in quality of care. Data Sources/Study Setting. Secondary data from the American Hospital Association (AHA)(nurse staffing, hospital characteristics), InterStudy and Area Resource Files (ARF) (market characteristics), Centers for Medicare and Medicaid Services (CMS) (financial performance), and Healthcare Cost and Utilization Project (HCUP) (quality measures--in-hospital mortality ratio and the complication ratios for decubitus ulcers, pneumonia, and urinary tract infection, which were risk-adjusted using the Medstat s disease staging algorithm). Study Design. Data from a longitudinal cohort of 422 hospitals were analyzed from 1990-1995 to examine the relationships between nurse staffing and quality of care. Data Collection/Extraction Methods. A generalized method of moments estimator for dynamic panel data was used to analyze the data. Principal Findings. Increasing registered nurse staffing had a diminishing marginal effect on reducing mortality ratio, but had no consistent effect on any of the complications. Selected hospital characteristics, market characteristics, and financial performance had other independent effects on quality measures. Conclusions. The findings provide limited support for the prevailing notion that improving registered nurse (RN) staffing unconditionally improves quality of care.
Nurse Staffing Level and Length of Stay in the General Ward: A Correlation Study
Zenodo (CERN European Organization for Nuclear Research), 2023
Adequate nurse staffing levels play a critical role in ensuring high-quality patient care and optimizing healthcare outcomes. The length of stay (LOS) in the general ward is an important indicator of hospital efficiency and patient satisfaction. This study aimed to examine the correlation between nurse staffing levels and length of stay in the general ward, providing valuable insights into the impact of nursing resources on patient outcomes. A correlational study design was employed to investigate the relationship between nurse staffing levels and length of stay in the general ward. Data were collected from multiple hospitals, including nurse staffing data (such as nurse-to-patient ratios) and patient LOS records. Statistical analysis, including correlation analysis and regression analysis, was used to assess the association between nurse staffing levels and length of stay. The results indicated a significant correlation between nurse staffing levels and length of stay in the general ward. Hospitals with higher nurse-to-patient ratios were associated with shorter lengths of stay, indicating that adequate nurse staffing positively influenced patient outcomes. Regression analysis further revealed that nurse staffing levels significantly predicted the length of stay, even after controlling for potential confounding factors. This correlation study provides evidence of the relationship between nurse staffing levels and length of stay in the general ward. The findings suggest that adequate nurse staffing is crucial for efficient patient care and can contribute to shorter lengths of stay. Healthcare institutions should prioritize appropriate nurse staffing levels to enhance patient outcomes, improve resource utilization, and promote overall hospital efficiency.