Nursing workload, patient safety incidents and mortality: an observational study from Finland

Abstract

ObjectiveTo investigate whether the daily workload per nurse (Oulu Patient Classification (OPCq)/nurse) as measured by the RAFAELA system correlates with different types of patient safety incidents and with patient mortality, and to compare the results with regressions based on the standard patients/nurse measure.SettingWe obtained data from 36 units from four Finnish hospitals. One was a tertiary acute care hospital, and the three others were secondary acute care hospitals.ParticipantsPatients’ nursing intensity (249 123 classifications), nursing resources, patient safety incidents and patient mortality were collected on a daily basis during 1 year, corresponding to 12 475 data points. Associations between OPC/nurse and patient safety incidents or mortality were estimated using unadjusted logistic regression models, and models that adjusted for ward-specific effects, and effects of day of the week, holiday and season.Primary and secondary outcome measuresMain outcome measures were patient safety incidents and death of a patient.ResultsWhen OPC/nurse was above the assumed optimal level, the adjusted odds for a patient safety incident were 1.24 (95% CI 1.08 to 1.42) that of the assumed optimal level, and 0.79 (95% CI 0.67 to 0.93) if it was below the assumed optimal level. Corresponding estimates for patient mortality were 1.43 (95% CI 1.18 to 1.73) and 0.78 (95% CI 0.60 to 1.00), respectively. As compared with the patients/nurse classification, models estimated on basis of the RAFAELA classification system generally provided larger effect sizes, greater statistical power and better model fit, although the difference was not very large. Net benefits as calculated on the basis of decision analysis did not provide any clear evidence on which measure to prefer.ConclusionsWe have demonstrated an association between daily workload per nurse and patient safety incidents and mortality. Current findings need to be replicated by future studies.

The qualitative dimension of Nursing workload: a measurement proposal

“…When investigating nurses’ daily workload using the RAFAELA system ( 10 ) , there was a greater chance of incidents (10% to 30%) and patient mortality (40%) when the values are above the ideal level and, conversely, this probability reduces 25%. It is inferred, therefore, that by assuming less workload, the nurse will have more time for care, preventing preventable clinical deterioration and patient incidents ( 10 ) .…”

“…It is inferred, therefore, that by assuming less workload, the nurse will have more time for care, preventing preventable clinical deterioration and patient incidents ( 10 ) .…”

“…Given these results, NWL measurement systems have been disseminated to determine the amount of personnel needed to meet the care demands ( 1 ) and thus allocate resources appropriately ( 10 ) . In addition to instrumentalizing nurses in daily staff sizing and administrative negotiations, they can also support clinical evaluations and decisions involving process improvement ( 13 ) .…”

Dificuldades para implantar estratégias de segurança do paciente: perspectivas de enfermeiros gestores

“…To explain the magnitude of this situation, a metanalysis of 87 studies explored the relationship between nursing human resources dimensioning and in-hospital mortality. This study found a reduction of 2% to 7% in the mortality rates in the institutions in which there was adequate dimensioning of the nursing team (12) . Another study, conducted in South Korea, corroborates the above-mentioned finding, upon concluding that an unsafe care has a direct relation with a reduced number of nurses (13) .…”

The Relationship between the Nursing Work Load and the Quality of Nursing Care at a Selected Hospital in Menofya Governorate

“…These results were contradicted by [25,26] , whose results indicated that there is no significant changes in patient safety associated with decreased nursing work load. Also these results assert a trusting relationship between employees and management (interpersonal factors) supports a healthy work environment enhancing staff retention and effective patient care (patient care dimension) not infection control dimensions.…”