The Impact of Hospital Nursing Characteristics on 30-Day Mortality

Estabrooks, Carole A.; Midodzi, William K.; Cummings, Greta G.; Ricker, Kathryn L.; Giovannetti, Phyllis

doi:10.1097/00006199-200503000-00002

Cited by 388 publications

(247 citation statements)

References 28 publications

Supporting

Mentioning

220

Contrasting

Unclassified

Order By: Relevance

“…9,10,38 Cutting operating expenses may lead to deficiencies in the quality of care, which patients with more severe diseases, including pneumonia, may be less able to withstand, so they will have higher mortality rates 3,9,10 . Previous studies showed that decreased nursing staff, lower educational levels of nurses or higher proportions of casual/ temporary nurses were associated with higher mortality [39][40][41][42][43] .…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Pneumonia Outcomes: A Nationwide Population-Based Study over the 1997–2008 Period

Chang

Tung

2011

J GEN INTERN MED

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Factors Associated with Pneumonia Outcomes: A Nationwide Population-Based Study over the 1997–2008 Period

Chang

Tung

2011

J GEN INTERN MED

View full text Add to dashboard Cite

“…A number of these studies found an association between a nursing skill mix that has a higher proportion of RNs and better outcomes including lower mortality / failure to rescue (Blegen et al, 2011, Estabrooks et al, 2005, lower rates of infections (Blegen et al, 2011, Cho et al, 2003, McGillis Hall et al, 2004, falls (Blegen and Vaughn, 1998, Donaldson et al, 2005, Patrician et al, 2011, pressure ulcers (Blegen et al, 2011, Ibe et al, 2008, and higher patient satisfaction (Potter et al, 2003). The overall pattern of results is largely consistent, with the only significant contradictory evidence coming from one of the weaker studies which showed that a higher proportion of registered nurses was associated with a higher nurse reported incidence of pneumonia (Ausserhofer et al, 2013).…”

Section: March 2016mentioning

confidence: 99%

Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development

Griffiths

Ball

Drennan

et al. 2016

International Journal of Nursing Studies

219

216

View full text Add to dashboard Cite

What is already known? A number of high quality reviews establish an association between lower registered nurse staffing levels, increased mortality rates and other adverse outcomes  Careful analysis of this evidence suggests that it is consistent with a causal relationship  Translation of this evidence into practice is disputedWhat this paper adds  This paper summarises and extends a recent systematic review on nurse staffing and outcomes undertaken for England's National Institute for Health and Care Excellence  Methodological limitations mean that existing studies may not give unbiased estimates of the benefits from increased nurse staffing, with over and underestimation of benefit both possible, which makes it difficult to directly translate evidence into guidance for practice. We identify avenues for progressing this important research so that future studies might be better able to provide the evidence needed to inform policy and practice, and provide a checklist to aid future study development AbstractA large and increasing number of studies have reported a relationship between low nurse staffing levels and adverse outcomes, including higher mortality rates. Despite the evidence being extensive in size, and having been sometimes described as "compelling" and "overwhelming", there are limitations that existing studies have not yet been able to address. One result of these weaknesses can be observed in the guidelines on safe staffing in acute hospital wards issued by the influential body that sets standards for the National Health Service in England, the National Institute for Health and Care Excellence (NICE), which concluded there is insufficient good quality evidence available to fully inform practice.In this paper we explore this apparent contradiction. After summarising the evidence review that informed the NICE guideline on safe staffing and related evidence, we move on to discussing the complex challenges that arise when attempting to apply this evidence to practice. Among these, we introduce the concept of endogeneity, a form of bias in the estimation of causal effects. Although current evidence is broadly consistent with a cause and effect relationship, endogeneity means that estimates of the size of effect, essential for building an economic case, may be biased and in some cases qualitatively wrong. We expand on three limitations that are likely to lead to endogeneity in many previous studies: omitted variables, which refers to the absence of control for variables such as medical staffing and patient case mix; simultaneity, which occurs when the outcome can influence the level of staffing just as staffing influences outcome; and common-method variance, which may be present when both outcomes and staffing levels variables are derived from the same survey.Thus while current evidence is important and has influenced policy because it illustrates the potential risks and benefits associated with changes in nurse staffing, it may not provide operational solutions. We conclude by posing a ser...

show abstract

“…In Alberta, Canada, researchers studied data from approximately 4800 Canadian nurses in 49 hospitals 12 . Their findings that hospitals where a greater proportion of nurses were educated at the baccalaureate level, the skill mix contained a higher proportion of registered nurses, and nurses reported good working relationships with physicians were hospitals that had lower rates of mortality.…”

Section: Staffing Nurse Educational Level and Patient Mortalitymentioning

confidence: 99%

“…10,12,14,15 A pilot study conducted in Barcelona suggests that the Nursing Work Index is also applicable to hospitals in Spain 18 .…”

Section: Quantifying Organizational Attributesmentioning

confidence: 99%

Nursing care and patient outcomes: international evidence

et al. 2008

View full text Add to dashboard Cite

Countries across the globe are experiencing nursing shortages. In hospitals, supportive practice environments have positive effects on both nurse and patient outcomes. However, these relationships have been established primarily in the US. International studies of the effects of nurse staffing levels and the practice environment on nurse outcomes and the quality of care mirror the findings from the US, thus raising these issues to the international level. The solutions that have been successful in the US for improving practice environment and patient outcomes are solutions that should be successful in any country, thus putting them on a global scale. The Magnet hospital program is one model that has been shown to improve nurse and patient outcomes and is one solution to the shortage of hospital nurses.

show abstract

The Impact of Hospital Nursing Characteristics on 30-Day Mortality

Abstract: Hospital nursing characteristics are an important consideration in efforts to reduce the risk of 30-day mortality of patients.

Cited by 388 publications

References 28 publications

Factors Associated with Pneumonia Outcomes: A Nationwide Population-Based Study over the 1997–2008 Period

Factors Associated with Pneumonia Outcomes: A Nationwide Population-Based Study over the 1997–2008 Period

Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development

Nursing care and patient outcomes: international evidence

Contact Info

Product

Resources

About