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/nna.0b013e318221c260

Cited by 78 publications

(90 citation statements)

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“…In a recent study, Aiken et al 1 link adequate nurse staffing and better-educated nurses in combination with a good work environment to decreased patient mortality, whereas hospitals with poor work environments were found to have the opposite outcome. In line with our study results, good nurse–physician relations and teamwork have been shown in a number of other studies to be positively related to patient safety outcomes 7 30…”

Section: Discussionsupporting

confidence: 92%

Staffing and resource adequacy strongly related to RNs’ assessment of patient safety: a national study of RNs working in acute-care hospitals in Sweden

et al. 2013

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IntroductionAlthough registered nurses (RNs) are central in patient care, we have not found prior research that specifically addresses how RNs assess the safety of patient care at their workplace and how factors in RNs’ work environment are related to their assessments. This study aims to address these issues.Methods9236 RNs working with inpatient care in 79 acute-care hospitals in Sweden completed a national population-based survey, including Practice Environment Scale of the Nursing Work Index—Revised and items from Agency for Healthcare Research and Quality's Hospital Survey on Patient Safety Culture. Correlation coefficients (Pearson and Spearman) and proportional odds regression were used for analysis.ResultsNursing work environment factors were strongly related to RNs’ assessments of patient safety. RNs’ perception of having adequate staffing and resources improved their assessment of patient safety by at least two and a half times (OR 2.74 CI 2.52 to 2.97). RNs with a higher level of involvement in direct patient care gave a better patient safety grade than RNs with a more supervisory role. Most, but not all, patient safety culture items were related to RNs’ assessed patient safety grade. We found that work experience seemed to have no influence on RNs’ patient safety assessment.ConclusionsWhile previous research emphasises patient-to-nurse ratios in strengthening patient safety practices, this study complements this by emphasising RNs’ own perception of having enough staff and resources to provide quality nursing care, as well as having good collegial nurse–physician relations and the presence of visible and competent nursing leadership—all factors highly related to RNs’ assessment of the safety of patient care at their workplace.

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Section: Discussionsupporting

confidence: 92%

Staffing and resource adequacy strongly related to RNs’ assessment of patient safety: a national study of RNs working in acute-care hospitals in Sweden

et al. 2013

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“…18 34 39–40 The finding that staffing adequacy was the only process measure of significance in the present study may be attributable to several factors. First, we used a selection of organisational process measures identified in a previous study; the measures used in other studies may not be compatible with our complex parameter.…”

Section: Discussionmentioning

confidence: 61%

An observational study: associations between nurse-reported hospital characteristics and estimated 30-day survival probabilities

et al. 2014

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BackgroundThere is a growing body of evidence for associations between the work environment and patient outcomes. A good work environment may maximise healthcare workers’ efforts to avoid failures and to facilitate quality care that is focused on patient safety. Several studies use nurse-reported quality measures, but it is uncertain whether these outcomes are correlated with clinical outcomes. The aim of this study was to determine the correlations between hospital-aggregated, nurse-assessed quality and safety, and estimated probabilities for 30-day survival in and out of hospital.MethodsIn a multicentre study involving almost all Norwegian hospitals with more than 85 beds (sample size=30, information about nurses’ perceptions of organisational characteristics were collected. Subscales from this survey were used to describe properties of the organisations: quality system, patient safety management, nurse–physician relationship, staffing adequacy, quality of nursing and patient safety. The average scores for these organisational characteristics were aggregated to hospital level, and merged with estimated probabilities for 30-day survival in and out of hospital (survival probabilities) from a national database. In this observational, ecological study, the relationships between the organisational characteristics (independent variables) and clinical outcomes (survival probabilities) were examined.ResultsSurvival probabilities were correlated with nurse-assessed quality of nursing. Furthermore, the subjective perception of staffing adequacy was correlated with overall survival.ConclusionsThis study showed that perceived staffing adequacy and nurses’ assessments of quality of nursing were correlated with survival probabilities. It is suggested that the way nurses characterise the microsystems they belong to, also reflects the general performance of hospitals.

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“…[11][12][13][14][15] Several studies have presented associations between nurses' work environment and patient outcomes like adverse events, risk-adjusted mortality and patient satisfaction. [15][16][17][18][19][20][21] These are important studies identifying associations between patient outcome and features of the healthcare organisation. However, the way healthcare workers perceive and report patient safety serve as essential information to investigate how processes and structures support patient safe healthcare organisations.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

A cross-sectional study to identify organisational processes associated with nurse-reported quality and patient safety

et al. 2012

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ObjectivesThe purpose of this study was to identify organisational processes and structures that are associated with nurse-reported patient safety and quality of nursing.DesignThis is an observational cross-sectional study using survey methods.SettingRespondents from 31 Norwegian hospitals with more than 85 beds were included in the survey.ParticipantsAll registered nurses working in direct patient care in a position of 20% or more were invited to answer the survey. In this study, 3618 nurses from surgical and medical wards responded (response rate 58.9). Nurses' practice environment was defined as organisational processes and measured by the Nursing Work Index Revised and items from Hospital Survey on Patient Safety Culture.Outcome measuresNurses' assessments of patient safety, quality of nursing, confidence in how their patients manage after discharge and frequency of adverse events were used as outcome measures.ResultsQuality system, nurse–physician relation, patient safety management and staff adequacy were process measures associated with nurse-reported work-related and patient-related outcomes, but we found no associations with nurse participation, education and career and ward leadership. Most organisational structures were non-significant in the multilevel model except for nurses’ affiliations to medical department and hospital type.ConclusionsOrganisational structures may have minor impact on how nurses perceive work-related and patient-related outcomes, but the findings in this study indicate that there is a considerable potential to address organisational design in improvement of patient safety and quality of care.

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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 78 publications

References 0 publications

Staffing and resource adequacy strongly related to RNs’ assessment of patient safety: a national study of RNs working in acute-care hospitals in Sweden

Staffing and resource adequacy strongly related to RNs’ assessment of patient safety: a national study of RNs working in acute-care hospitals in Sweden

An observational study: associations between nurse-reported hospital characteristics and estimated 30-day survival probabilities

A cross-sectional study to identify organisational processes associated with nurse-reported quality and patient safety

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