Factors Associated With the Implementation of a Nurse Staffing Directive (original) (raw)

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.

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

How Do Hospital Nurse Staffing Strategies Affect Patient Satisfaction?

Industrial and Labor Relations Review, 2016

In this article, the authors evaluate the role of the nurse staffing mix on hospital patient satisfaction. using three years (2009 to 2011) of hospital patient satisfaction data linked to data on the productive staffing hours of registered nurses, licensed vocational nurses, nurse's aides, and contract nurses for 311 california hospitals, the authors analyze how nurse staffing levels affect 10 dimensions of patient satisfaction. The findings indicate that a higher level of registered nurses per bed appears to increase overall patient satisfaction. conversely, hospitals with a higher proportion of nursing hours provided by contract nurses have significantly lower levels of patient satisfaction on scores related to overall patient satisfaction and nurses' communication with the patient. The results have implications for RN staffing strategies and inform the broader literature on worker skill mix and employment arrangements. R ecognition has been growing that focusing on the frontline hospital staff (i.e., nursing staff), rather than strict hierarchal structures of authority within the hospital organization in the provision of care, has positive impacts on organizational performance. for example, kane and colleagues (2007) showed that hospital nurse staffing is positively related to patient outcomes. Other evidence has suggested that patient-centered approaches to human resource management can improve safety, in part through maintaining a culture that leads to reduced turnover (Avgar, givan, and liu 2011). In fact, the recognition of the importance of nursing for better patient care led california to legislate mandatory nurse staffing levels for its acute-care hospitals in 1999 (Mark, Harless, and spetz 2009; Donaldson and shapiro 2010; kc and Terwiesch 2011), with several states subsequently following california's initiative (Aiken et al. 2011).

Hospital staffing, organization, and quality of care: cross-national findings

International Journal for Quality in Health Care, 2002

Objective: To examine the effects of nurse staffing and organizational support for nursing care on nurses' dissatisfaction with their jobs, nurse burnout, and nurse reports of quality of patient care in an international sample of hospitals. Design: Multisite cross-sectional survey Setting: Adult acute-care hospitals in the U.S. (Pennsylvania), Canada (Ontario and British Columbia), England and Scotland. Study Participants: 10319 nurses working on medical and surgical units in 303 hospitals across the five jurisdictions. Interventions: None Main outcome measures: Nurse job dissatisfaction, burnout, and nurse-rated quality of care. Results: Dissatisfaction, burnout and concerns about quality of care were common among hospital nurses in all five sites. Organizational/managerial support for nursing had a pronounced effect on nurse dissatisfaction and burnout, and both organizational support for nursing and nurse staffing were directly, and independently, related to nurse-assessed quality of care. Multivariate results imply that nurse reports of low quality care were three times as likely in hospitals with low staffing and support for nurses as in hospitals with high staffing and support. Conclusion: Adequate nurse staffing and organizational/managerial support for nursing are key to improving the quality of patient care, to diminishing nurse job dissatisfaction and burnout and, ultimately, to improving the nurse retention problem in hospital settings.

Hospitalists staffing levels and hospital performance

Health Services Research, 2019

Understanding appropriate staffing levels and skill mix is an essential prerequisite in the quest for better quality, patient safety, patient experience, and efficiency. Most of the literature on staffing levels has focused on the nursing staff. Registered nurse (RN) staffing levels are associated with lower readmission rates, 1 lower mortality rates, 2 lower hospital-acquired infections rates, 3 and higher patient satisfaction. 4 Kane et al performed a meta-analysis on RN staffing levels and concluded that higher RN staffing levels are associated with better patient outcomes and quality. 5 Little, however, is known on the association between physician staffing

The Effects of Nurse Staffing on Adverse Events, Morbidity, Mortality, and Medical Costs

Nursing Research, 2003

Dean G. Smith Background: Nurse staffing levels are an important working condition issue for nurses and believed to be a determinant of the quality of nursing care and patient outcomes. Objectives: To examine the effects of nurse staffing on adverse events, morbidity, mortality, and medical costs. Methods: Using two existing databases, the study sample included 232 acute care California hospitals and 124,204 patients in 20 surgical diagnosis-related groups. The adverse events included patient fall/injury, pressure ulcer, adverse drug event, pneumonia, urinary tract infection, wound infection, and sepsis. Multilevel analysis was employed to examine, simultaneously, the effects of nurse staffing and patient and hospital characteristics on patient outcomes. Results: Three statistically significant relationships were found between nurse staffing and adverse events. An increase of 1 hour worked by registered nurses (RN) per patient day was associated with an 8.9% decrease in the odds of pneumonia. Similarly, a 10% increase in RN Proportion was associated with a 9.5% decrease in the odds of pneumonia. Providing a greater number of nursing hours per patient day was associated with a higher probability of pressure ulcers. The occurrence of each adverse event was associated with a significantly prolonged length of stay and increased medical costs. Patients who had pneumonia, wound infection or sepsis had a greater probability of death during hospitalization. Conclusion: Patients are experiencing adverse events during hospitalization. Care systems to reduce adverse events and their consequences are needed. Having appropriate nurse staffing is a significant consideration in some cases.

Nurse staffing models in acute care: A descriptive study

Nursing Open, 2019

Staffing is a cornerstone of human resource management. The performance of any healthcare organization depends primarily on the continuous availability of enough qualified workers, judiciously deployed and operating in a work environment that enhances their productivity. Studies showed the importance of adequate staffing for optimizing both patient outcomes and the quality and security of care. In many industrialized countries, healthcare systems are facing a rising demand for hospital care (Australian Institute of Health &

Nurse Staffing and Patient Care Quality and Safety

2008

The importance of nurse staffing to the delivery of high-quality patient care was a principal finding in the landmark report of the Institute of Medicine's (IOM) Committee on the Adequacy of Nurse Staffing in Hospitals and Nursing Homes: "Nursing is a critical factor in determining the quality of care in hospitals and the nature of patient outcomes" 1 (p. 92). Nurse staffing is a crucial health policy issue on which there is a great deal of consensus on an abstract level (that nurses are an important component of the health care delivery system and that nurse staffing has impacts on safety), much less agreement on exactly what research data have and have not established, and active disagreement about the appropriate policy directions to protect public safety.