Comparison of nursing aids and registered nurses mixed nursing staffing model with different ratios on the nursing outcomes and cost in Neurology and Neurosurgery Center

Abstract

Background This study aimed to investigate the effect of nursing aids (NAs) and registered nurses (RNs) mixed nursing staffing model with different ratios on the nursing outcomes and cost in China. Methods Five thousand and ninety-one patients treated at Neurology and Neurosurgery Center were consecutively recruited in this study and divided into three groups according to the proportion of NAs and RNs: 100% RN group (N = 1756), 90% RN group (N = 1654), and 75% RN group (N = 1681). Nursing outcomes including medication error, unplanned endotracheal tube extubation, bloodstream infection, respiratory tract infection, urinary tract infection, pressure ulcer, ventilator weaning, morality, hospital stay, and nursing cost were recorded. Results No difference of patients' characteristics or RNs' characteristics among three groups was observed. Three-group comparison disclosed that medication error, urinary tract infection, ventilator weaning, and nursing cost were different among three groups, while no difference of unplanned endotracheal tube extubation, bloodstream infection, respiratory tract infection, pressure ulcer, mortality, or hospital stay was found. Two-group comparison revealed that medication error and nursing cost were reduced in 75% RN group compared with 90% RN group and 100% RN group, but urinary tract infection was increased while ventilator weaning was decreased in 75% RN group and 90% RN group compared with 100% RN group. Multivariate logistic regression also validated 75% RNs independently correlated with decreased medication error, ventilator weaning, and increased urinary tract infection. Conclusions NAs and RNs mixed nursing staffing model with 75% RNs reduces medication error and nursing cost, while increasing urinary tract infection and decreasing ventilator weaning.

Nursing Assistant Staffing Model: Implementation and Outcome Evaluation in Taiwan Hospitals

“…Chang & Wang, 2013;L.-W. Lin et al, 2003) The results of this research revealed that, because of difficulties encountered in recruiting NAs, some Taiwan hospitals are willing to hire NAs without a high school diploma. Like other studies, this study found caregiver certification to be an essential qualification for NAs (L.-W. Lin et al, 2003;Pang et al, 2019;Yang et al, 2015), as differences in education and training significantly influence NA job performance. Lack of standardized education and training for NAs brings about inconsistent care quality and may increase RN workload, as RNs may assume the added burdens of training and supervising NAs (B.-Y.…”

“…A nationwide survey in the United States found unlicensed hospital personnel (ranked from most to least working hours) to include NAs, patient care technicians, surgical technicians, transporters, medical assistants, surgical aides, monitor technicians, and unlicensed graduate nurses (S. Li et al, 2017). Similarly, NAs in Taiwan are mainly responsible for general tasks that do not require a high level of skill or expertise, such as processing hospital admissions and providing physical help to patients (Huang & Lu, 2017;Pang et al, 2019;Yang & Chen, 2018). Employing unlicensed personnel lets professional nurses allocate more of their time to direct care, which pushes forward patient safety and healthcare quality (S. Li et al, 2017).…”

“…Despite the efforts of hospitals to recruit and train new nurses, staff shortages continue to destabilize the workforce and negatively affect healthcare quality (F. Liu et al, 2012; Pang et al, 2019). A multidimensional solution to the nursing workforce shortage is required.…”

“…Li et al, 2017). Similarly, NAs in Taiwan are mainly responsible for general tasks that do not require a high level of skill or expertise, such as processing hospital admissions and providing physical help to patients (Huang & Lu, 2017; Pang et al, 2019; Yang & Chen, 2018). Employing unlicensed personnel lets professional nurses allocate more of their time to direct care, which pushes forward patient safety and healthcare quality (S.…”

Review on Comfort Nursing Interventions for Patients Undergoing Neurosurgery and General Surgery

“…It should establish a solid foundation for the treatment and rehabilitation of medical patients. Patients in the neurology department are prone to tension, irritability, low self-esteem, fear of dragging family members, and other emotions as a result of their paralysis and the loss of their self-care abilities and language abilities [ 21 ], which makes them susceptible to anxiety, tension, and irritability [ 22 ]. These negative emotions will often lead patients to give up their treatment.…”