Nursing Skill Mix, Nurse Staffing Level, and Physical Restraint Use in US Hospitals: a Longitudinal Study

Abstract

BackgroundAlthough it is plausible that nurse staffing is associated with use of physical restraints in hospitals, this has not been well established. This may be due to limitations in previous cross-sectional analyses lacking adequate control for unmeasured differences in patient-level variables among nursing units.ObjectiveTo conduct a longitudinal study, with units serving as their own control, examining whether nurse staffing relative to a unit’s long-term average is associated with restraint use.DesignWe analyzed 17 quarters of longitudinal data using mixed logistic regression, modeling quarterly odds of unit restraint use as a function of quarterly staffing relative to the unit’s average staffing across study quarters.Subjects3101 medical, surgical, and medical-surgical units in US hospitals participating in the National Database of Nursing Quality Indicators during 2006–2010. Units had to report at least one quarter with restraint use and one quarter without.Main MeasuresWe studied two nurse staffing variables: staffing level (total nursing hours per patient day) and nursing skill mix (proportion of nursing hours provided by RNs). Outcomes were any use of restraint, regardless of reason, and use of restraint for fall prevention.Key ResultsNursing skill mix was inversely correlated with restraint use for fall prevention and for any reason. Compared to average quarters, odds of fall prevention restraint and of any restraint were respectively 16 % (95 % CI: 3–29 %) and 18 % (95 % CI: 8–29 %) higher for quarters with very low skill mix.ConclusionsIn this longitudinal study there was a strong negative correlation between nursing skill mix and physical restraint use. Ensuring that skill mix is consistently adequate should reduce use of restraint.

Physical restraint: perceptions of nurse managers, registered nurses and healthcare assistants

“…Skill mix coupled with ability to respond to changing needs of patients is an important factor in intent to use restraint and not total staffing levels (Staggs et al. ). Staff are more likely to use restraints when there is a greater ratio of healthcare assistants to registered nurses (Staggs et al.…”

“…Staff are more likely to use restraints when there is a greater ratio of healthcare assistants to registered nurses (Staggs et al. ). Registered nurses have a key role in attaining patient safety (Griffiths et al.…”

German nursing shortage in hospitals – Homemade by Profititis?

“…The real interesting point in California calculations were the follow-up calculations and step-by-step modifications [76][77][78][79][80][81][82][83][84][85][86][87][88][89]. Such a long-term goal of continuous research of patient outcome together with professional satisfaction is urgently needed in Europe for every country in terms of nurses and physicians.…”

Decreasing Duration of Mechanical Restraint Episodes by Increasing Registered Nurse Assessment and Surveillance in an Acute Psychiatric Hospital

“…Other common themes are the use of policies and administrative oversight (Masters, 2017) and staff training (Ye et al, 2017;CPI, 2018). There is some evidence that having more registered nurses on duty and requiring more nurses to provide care during restraint episodes may decrease the likelihood that patients will be restrained (Staggs, et al, 2017). None of these studies, however, measured variables in relation to duration of restraint episodes.…”