Introduction Threats to quality and patient safety may exist when necessary nursing care is omitted. Empirical research is needed to determine how missed nursing care is associated with patient outcomes. Aim The aim of this study was to examine the relationship between missed nursing care and hospital readmissions. Methods Cross-sectional examination, using three linked data sources—(1) nurse survey, (2) patient discharge data from three states (California, New Jersey and Pennsylvania) and (3) administrative hospital data— from 2005 to 2006. We explored the incidence of 30-day readmission for 160 930 patients with heart failure in 419 acute care hospitals in the USA. Logistic regression was used to assess the effect of missed care on the odds of readmission, adjusting for patient and hospital characteristics. Results The most frequently missed nursing care activities across all hospitals in our sample included talking to and comforting patients (42.0%), developing and updating care plans (35.8%) and educating patients and families (31.5%). For 4 of the 10 studied care activities, each 10 percentage-point increase in the number of nurses reporting having missed the activity was associated with an increase in the odds of readmission by 2–8% after adjusting for patient and hospital characteristics. However, missed nursing care was no longer a significant predictor of readmission once adjusting for the nurse work environment, except in the case of the delivery of treatments and procedures (OR 1.08, 95% CI 1.02 to 1.14). Conclusions Missed care is an independent predictor of heart failure readmissions. However, once adjusting for the quality of the nurse work environment, this relationship is attenuated. Improvements in nurses’ working conditions may be one strategy to reduce care omissions and improve patient outcomes.

Background: Burnout among nurses is associated with lower patient satisfaction, yet few system-level solutions have been identified to improve outcomes. Purpose: The purpose of this study was to examine the relationship between nurse burnout and patient satisfaction and determine whether work environments are associated with these outcomes. Methods: This study was a cross-sectional analysis of 463 hospitals in 4 states. Burnout was defined using the Maslach Burnout Inventory. Patient satisfaction was obtained from the Hospital Consumer Assessment of Healthcare Providers and Systems survey. Results: Fifty percent of hospitals where burnout is high have poor work environments, which is strongly related to lower patient satisfaction. Conclusions: High levels of nurse burnout are associated with lower patient satisfaction. Our findings demonstrate that hospitals can improve outcomes through investments in work environments.

Background Nurse engagement is a modifiable element of the work environment and has shown promise as a potential safety intervention. Purpose Our study examined the relationship between the level of engagement, staffing, and assessments of patient safety among nurses working in hospital settings. Methods A secondary analysis of linked cross-sectional data was conducted using survey data of 26,960 nurses across 599 hospitals in 4 states. Logistic regression models were used to examine the association between nurse engagement, staffing, and nurse assessments of patient safety. Results Thirty-two percent of nurses gave their hospital a poor or failing patient safety grade. In 25% of hospitals, nurses fell in the “least” or only “somewhat” engaged categories. A 1-unit increase in engagement lowered the odds of an unfavorable safety grade by 29% (p <.001). Hospitals where nurses reported higher levels of engagement were 19% (p<.001) less likely to report that mistakes were held against them. Nurses in poorly staffed hospitals were 6% more likely to report that important information about patients “fell through the cracks” when transferring patients across units (p<.001). Conclusions Interventions to improve nurse engagement and adequate staffing serve as strategies to improve patient safety.

The growing nurse practitioner (NP) workforce represents a significant supply of primary care providers, who if optimally utilized, are well-positioned to improve access to health care for racial and ethnic minorities. However, many barriers affect the optimal utilization of NPs in primary care delivery. These barriers may also prevent NPs from maximally contributing to efforts to reduce racial and ethnic health disparities. Our review of the empirical and health policy literature sought to elucidate factors that affect NPs' potential and ability to narrow or eliminate health disparities. We found that restrictive state scope of practice regulations, disparate reimbursement policies, lack of NP workforce diversity, and poor organizational structures in NP practices may limit NPs' contributions to current efforts to reduce disparities. Our results led to the development of the nurse practitioner health disparities model which identifies barriers to and opportunities for optimal use of NPs in reducing racial and ethnic disparities. State and federal policymakers and administrators in health-care settings should take actions to remove legislative and organizational barriers to enable NPs to deliver high-quality care to racial and ethnic minorities. Researchers can use the nurse practitioner health disparities model to produce empirical evidence to reduce health disparities and improve population health.

Objectives The purpose of this study was to identify common components of diversity pipeline programs across a national sample of nursing institutions and determine what effect these programs have on increasing underrepresented minority enrollment and graduation. Design Linked data from an electronic survey conducted November 2012 to March 2013 and American Association of Colleges of Nursing baccalaureate graduation and enrollment data (2008 and 2012). Participants Academic and administrative staff of 164 nursing schools in 26 states, including Puerto Rico in the United States. Methods Chi-square statistics were used to (1) describe organizational features of nursing diversity pipeline programs and (2) determine significant trends in underrepresented minorities’ graduation and enrollment between nursing schools with and without diversity pipeline programs Results Twenty percent (n = 33) of surveyed nursing schools reported a structured diversity pipeline program. The most frequent program measures associated with pipeline programs included mentorship, academic, and psychosocial support. Asian, Hispanic, and Native Hawaiian/Pacific Islander nursing student enrollment increased between 2008 and 2012. Hispanic/Latino graduation rates increased (7.9%–10.4%, p = .001), but they decreased among Black (6.8%–5.0%, p = .004) and Native American/Pacific Islander students (2.1 %–0.3%, p ≥ .001). Conclusions Nursing diversity pipeline programs are associated with increases in nursing school enrollment and graduation for some, although not all, minority students. Future initiatives should build on current trends while creating targeted strategies to reverse downward graduation trends among Black, Native American, and Pacific Island nursing students.

OBJECTIVES To explore differences in the incidence of postoperative complications among three racial/ethnic groups (white, black and Hispanic) before and after taking into account potentially confounding patient and hospital characteristics. DESIGN A cross-sectional study using 2006–2007 administrative patient discharge data from hospitals in four states (CA, PA, NJ, FL), linked to American Hospital Association Annual Survey data, and data from the U.S. Census. Risk-adjusted logistic regression models were used in the analyses. SETTING Six hundred U.S. adult nonfederal acute care hospitals. PARTICIPANTS Five hundred eighty seven thousand three hundred fourteen individuals, ages 65 and over, undergoing general, orthopedic or vascular surgeries (86% white, 6% black and 8% Hispanic). MEASUREMENTS Thirteen frequent postoperative complications. RESULTS When considered without controls, black patients had significantly higher odds than white patients of developing 12 of the 13 complications, by factors (ORs) ranging from 1.09 to 2.69. Hispanic patients had significantly higher odds than white patients on 9 of the 13 complications (ORs range from 1.11 to 1.82) and significantly lower odds than white patients on 2 of the other 4 (ORs = 0.84 in both cases).The fully adjusted models that accounted for hospital and especially patient characteristics substantially diminish the number of complications for which black and Hispanic patients had significantly higher odds than white patients. Many of the significant differences between blacks, Hispanics and white patients that persisted after controls were different for male and female patients. CONCLUSION Older black and Hispanic patients have higher odds than white patients of developing a vast majority of postoperative complications. Differences in postoperative complication risk are largely explained by procedure type and health status, and are frequently conditional on sex.

No abstract

Beginning in 2009, the Centers for Medicare & Medicaid Services started publicly reporting hospital readmission rates as part of the Hospital Compare website. Hospitals will begin having payments reduced if their readmission rates are higher than expected starting in fiscal year 2013. Value-based purchasing initiatives including public reporting and pay-for-performance incentives have the potential to increase quality of care. There is concern, however, that hospitals providing service to minority communities may be disproportionately penalized as a result of these policies due to higher rates of readmissions among racial and ethnic minority groups. Using 2008 Medicare data, we assess the risk for readmission for minorities and discuss implications for minority-serving institutions.