Post-operative mortality, missed care and nurse staffing in nine countries: A cross-sectional study

Ball, Jane; Bruyneel, Luk; Aiken, Linda H.; Sermeus, Walter; Sloane, Douglas M.; Rafferty, Anne Marie; Lindqvist, Rikard; Tishelman, Carol; Griffiths, Peter

doi:10.1016/j.ijnurstu.2017.08.004

Cited by 392 publications

(462 citation statements)

References 31 publications

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“…Our findings enrich the empirical evidence that nurse staffing and missed care impact patient safety, quality of care, and patient and nurse outcomes (Ball et al, 2014;Ball et al, 2017;Cho et al, 2016;Jones et al, 2015;Lake et al, 2016;Recio-Saucedo et al, 2017;Tschannen et al, 2010). The finding that perceived staffing adequacy had significant relationships with all dependent variables, unlike the patient-to-RN ratio, indicates that perceived staffing adequacy may be more sensitive to the overall workload than the staffing ratio, because it reflects the effect of additional factors other than the staffing ratio.…”

Section: Extensive Family Involvement In Inpatient Care As In Korea Andsupporting

confidence: 77%

Nurse staffing, nurses prioritization, missed care, quality of nursing care, and nurse outcomes

Cho

Lee

You

et al. 2019

Int J of Nursing Practice

135

148

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Aim:To examine the relationships among nurse staffing, nurses prioritization of nursing activities, missed care, quality of nursing care, and nurse outcomes.Background: Inadequate staffing is associated with increased missed care, which threatens the quality of care and nurse outcomes. Methods:The study sample included 2114 staff nurses from 156 medical or surgical units of 49 general hospitals who had participated in a cross-sectional survey conducted in 2015. Nurse staffing was measured using the patient-to-nurse ratio and perceived staffing adequacy. The Missed Nursing Care Survey was used to measure how frequently nurses had missed each of 24 activities. Multilevel regression analyses were employed to examine the relationships among variables. Results:The prevalence of missed care differed by nursing activity. Poorer staffing was associated with an increased number of missed activities. A higher number of missed activities and poorer staffing were associated with poorer patient safety, quality of nursing care and job satisfaction, and a higher intent to leave. Nurses gave the highest priority to focused patient reassessments, timely medications, and patient teaching, under hypothetical conditions of improved staffing. Conclusion:Adequate staffing is required to reduce missed care and to improve quality of care and nurse outcomes. K E Y W O R D SJob satisfaction, missed nursing care, nurse staffing, quality, safety SUMMARY STATEMENTWhat is already known about this topic?• Low nurse staffing is associated with a high prevalence of missed care, which has negative effects on patient and nurse outcomes.• Nurses are known to prioritize their nursing tasks in the face of time scarcity. However, insufficient studies have investigated how nurses prioritize nursing care and, further, how their prioritization would be modified if nurse staffing were to improve.What is already known about this topic?• Poorer perceptions of staffing adequacy and the patient-to-RN ratio had a significant association with a higher number of missed nursing activities.

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Section: Extensive Family Involvement In Inpatient Care As In Korea Andsupporting

confidence: 77%

Nurse staffing, nurses prioritization, missed care, quality of nursing care, and nurse outcomes

Cho

Lee

You

et al. 2019

Int J of Nursing Practice

135

148

View full text Add to dashboard Cite

show abstract

“…Some studies point out that the analysis of NCLU due to lack of time can be an important indicator to identify emerging problems prior to the occurrence of serious consequences, thus allowing managers, regulators or others to detect possible problems that may put at risk the lives of the patients. [2,23] It is also important to check the link between NCLU and cost-benefits and outcomes for the patients. [24] If, on one hand, it seems obvious that work overload may result in activities that are not performed by nurses, on the other hand, other factors such as professional development, staff involvement, teamwork, work engagement, burnout and social representation of the profession need to be further studied.…”

Section: Discussionmentioning

confidence: 99%

RN4Cast Study in Portugal: Nurses and care left undone

Braga

Jesus

Araújo

2018

JHA

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Background: Over the past decades, nursing in Portugal has evolved greatly both academically and professionally and this evolution brought along growing concerns about the quality of the healthcare provided. Due to lack of time or poor organization of the workload, nurses are often faced with the need to choose between what must be done and what will have to be postponed or even not be done at all. Objective: To investigate the care activities that are most frequently left undone or are postponed by nurses working in medical and surgical inpatient units in Portugal. Methods: A descriptive, cross-sectional, quantitative study that follows the RN4CAST (Nurse Forecasting in Europe) methodology was carried out from October 2013 to April 2014. A total of 31 hospitals and a random sample of adult medical-surgical units were involved. The data were collected using a socio-demographic questionnaire and a nursing questionnaire that included the identification of the nursing activities of surveillance and direct patient care that were necessary but postponed or not performed by nurses in their most recent shift. Results: A total of 2,235 nurses participated. Almost all participants had a nursing bachelor degree (98.2%). The most frequently left undone or postponed care items were "Educating patients and family" (50.2%) and "Comfort/talk with patients" (50.1%); the least frequently left undone items were "Treatments and procedures" (3.9%) and "Pain management" (5.6%). Nurses in the North and Center regions of the country were the ones who reported less care left undone due to lack of time. Nurses under the age of 40 were those who reported a highest number of activities left undone. Conclusions: Nurses make selective choices about the care activities that are crucial for the patient. Some activities that may not have an immediate impact on the health of the patients are sidelined, although they may have an impact on other important healthcare quality indicators.

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“…Working on a two‐shift system eliminated the long overlap between early and late shifts, offering potential efficiency savings without compromising the nurse‐to‐patient ratio available throughout the day (Ganong, Ganong, & Harrison, ). As nurse‐to‐patient ratios are widely acknowledged as important for patient safety (Aiken et al., ; Ball et al., ; Griffiths et al., ), it appears that safety could be maintained with fewer total care hours.…”

Section: Introductionmentioning

confidence: 99%

Association between 12‐hr shifts and nursing resource use in an acute hospital: Longitudinal study

et al. 2018

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Aim To evaluate whether ≥12‐hr shifts are associated with a decrease in resource use, in terms of care hours per patient day and staffing costs per patient day. Background Nurses working long shifts may become less productive and no research has investigated whether potential cost savings are realized. Method A retrospective longitudinal study using routinely collected data from 32 wards within an English hospital across 3 years (1 April 2012–31 March 2015). There were 24,005 ward‐days. Hierarchical linear mixed models measured the association between the proportion of ≥12‐hr shifts worked on a ward‐day, care hours per patient day and staffing costs per patient day. Results Compared with days with no ≥12‐hr shifts, days with between 50% and 75% ≥12‐hr shifts had more care hours per patient day and higher costs (estimate for care hours per patient day: 0.32; 95% CI: 0.28–0.36; estimate for staffing costs per patient day: £8.86; 95% CI: 7.59–10.12). Conclusions We did not find reductions in total care hours and costs associated with the use of ≥12‐hr shifts. The reason why mixed shift patterns are associated with increased cost needs further exploration. Implications for Nursing Management Increases in resource use could result in additional costs or loss of productivity for hospitals. Implementation of long shifts should be questioned.

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Post-operative mortality, missed care and nurse staffing in nine countries: A cross-sectional study

Cited by 392 publications

References 31 publications

Nurse staffing, nurses prioritization, missed care, quality of nursing care, and nurse outcomes

Nurse staffing, nurses prioritization, missed care, quality of nursing care, and nurse outcomes

RN4Cast Study in Portugal: Nurses and care left undone

Association between 12‐hr shifts and nursing resource use in an acute hospital: Longitudinal study

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