Nurse staffing and patient outcomes: a longitudinal study on trend and seasonality

Abstract

BackgroundTime trends and seasonal patterns have been observed in nurse staffing and nursing-sensitive patient outcomes in recent years. It is unknown whether these changes were associated.MethodsQuarterly unit-level nursing data in 2004–2012 were extracted from the National Database of Nursing Quality Indicators® (NDNQI®). Units were divided into groups based on patterns of missing data. All variables were aggregated across units within these groups and analyses were conducted at the group level. Patient outcomes included rates of inpatient falls and hospital-acquired pressure ulcers. Staffing variables included total nursing hours per patient days (HPPD) and percent of nursing hours provided by registered nurses (RN skill-mix). Weighted linear mixed models were used to examine the associations between nurse staffing and patient outcomes at trend and seasonal levels.ResultsAt trend level, both staffing variables were inversely associated with all outcomes (p < 0.001); at seasonal level, total HPPD was inversely associated (higher staffing related to lower event rate) with all outcomes (p < 0.001) while RN skill-mix was positively associated (higher staffing related to higher event rate) with fall rate (p < 0.001) and pressure ulcer rate (p = 0.03). It was found that total HPPD tended to be lower and RN skill-mix tended to be higher in Quarter 1 (January-March) when falls and pressure ulcers were more likely to happen.ConclusionsBy aggregating data across units we were able to detect associations between nurse staffing and patient outcomes at both trend and seasonal levels. More rigorous research is needed to study the underlying mechanism of these associations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12912-016-0181-3) contains supplementary material, which is available to authorized users.

Evidence on Nurse Staffing Ratios and Patient Outcomes in a Low‐Income Country: Implications for Future Research and Practice

“…A 48‐month prospective cross‐sectional study was conducted to determine the association between nurse staffing levels and NSOs that were found in previous studies to be affected by changes in nursing ratios (He et al., ; Needleman et al., ; Park, Blegen, Spetz, Chapman, & De Groot, ).…”

“…Likewise, He et al. () reported a strong relationship between increases in the proportion of RN staffing and decreases in patient falls and pressure ulcers.…”

“…Most reviews and studies have been conducted in the United States (He et al., ; Kane, Shamliyan, Mueller, Duval, & Wilt, ; McHugh et al., ), Australia (Twigg, Duffield, Bremner, Rapley, & Finn, ), China (Liu et al., ), England (Griffiths et al., ), Thailand (Sasichay‐Akkadechanu, Scalzi, & Jawad, ), and Europe (Aiken, Clarke, Sloane, Lake, & Cheney, ; Aiken et al., ). No studies to date have been conducted in the Middle East and very few looked at six NSOs which in this study included: total falls and injury falls per 1,000 patient days, prevalence of surveyed patients with hospital‐acquired pressure injuries (HAPI), catheter‐associated urinary tract infections (CAUTI), ventilator‐associated pneumonia (VAP), and central line‐associated bloodstream infections (CLABSI) per 1,000 patient days.…”

Evaluating fundamentals of care: The development of a unit‐level quality measurement and improvement programme

“…The importance of fundamental care is most evident when this care is suboptimal or missed and has been well described in cases of failure such as the Francis Inquiry () and also in studies demonstrating the relationship between nurse staffing levels and patient outcomes including length of stay, adverse events and readmissions. Studies on “care rationing” or “missed care” where care is omitted due to heavy workloads and low staffing levels indicate that it is often the fundamental aspects of nursing care such as comforting and talking to patients and providing hygiene cares, that are omitted when workloads intensify (Ausserhofer et al., ; Ball, Murrells, Rafferty, Morrow, & Griffiths, ; He, Staggs, Bergquist‐Beringer, & Dunton, ; Winters & Neville, ).…”

Perceptions of Nurses on Patient Outcomes Related to Nursing Shortage and Retention Strategies at a Public Hospital in the Coastal Region of Tanzania

“…Using data from the American National Database for Nursing Quality Indicator (NDINQI) to determine the link between total nursing staffing level, a recent study associated RN staffing levels and two specific patient outcomes (i.e., hospital acquired pressure ulcers, and falls) [22]. Other studies have been highly suggestive of work overload contributing to increased post-operative complications and lengths of hospital stay [19], and reduced compliance with hand washing (and therefore infection prevention) [23].…”