The relationship between nurse staffing and patient outcomes: A case study

Shuldham, Caroline; Parkin, Claire; Firouzi, Ashi; Roughton, Michael; Lau-Walker, Margaret

doi:10.1016/j.ijnurstu.2008.06.004

Cited by 52 publications

(58 citation statements)

References 9 publications

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“…Two other studies (Frith et al, ; Mark & Harless, ) also found a nonsignificant relationship between the licensed practical nurse (LPN)/licensed vocational nurse (LVN) hours per patient day and hospital‐acquired conditions. Eight studies (Blegen et al, ; Dunton, Gajewski, Taunton, & Moore, ; Everhart et al, ; Kouatly, Nassar, Nizam, & Badr, ; Patrician et al, ; Shuldham, Parkin, Firouzi, Roughton, & Lau‐Walker, ; Staggs et al, ; Van den Heede et al, ) examined the relationship between nursing hours per patient day and seven hospital‐acquired conditions. Including hospital‐acquired pressure injury (HAPI), falls/unassisted falls, injury falls, central line‐associated blood stream infection (CLABSI) and catheter‐associated urinary tract infection (CAUTI) were found to have significant negative relationships.…”

Section: Resultsmentioning

confidence: 99%

Nurse staffing and hospital‐acquired conditions: A systematic review

Shin

Park

Bae

2019

Journal of Clinical Nursing

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Aims and Objectives To systematically review and synthesise primary studies on the relationship between nurse staffing and hospital‐acquired conditions. Background Research examining the association between nurse staffing and hospital‐acquired conditions is varied owing to the use of different definitions and methods. Design This study was conducted based on a systematic review of related nursing literature. Methods The CINAHL, Cochrane Library, DBpia, EBSCO, PubMed, PsycINFO and RISS databases were searched for either English or Korean language studies published between January 2000 and August 2018 that examined the association between nurse staffing and hospital‐acquired conditions. We used Preferred Reporting Items for Systematic Reviews and Meta‐Analyses check list. Results Totally, 19 published studies were included in the systematic review. Various measures were used to examine association between nurse staffing and hospital‐acquired conditions. The majority of the reviewed studies revealed negative relationships between nurse staffing levels and hospital‐acquired conditions. However, a substantial number of relationships were not significant. Conclusions There is a need for future studies to examine the differences in the relationship between nurse staffing and hospital‐acquired conditions and to use precise data collection on registered nurses’ hours per patient day and total hours per patient day, as it is difficult to collect data on these measures. The findings of this study suggest that sufficient nurse staffing is a strong indicator of the provision of quality patient care. However, continuous efforts are recommended to find more conclusive relationships between nurse staffing and hospital‐acquired conditions and to formulate guidelines regarding nurse staffing strategies. Relevance to clinical practice Nurse staffing is an important managerial strategy. Especially, given health policy changes, hospitals need to develop staffing strategies to prevent hospital‐acquired conditions.

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Section: Resultsmentioning

confidence: 99%

Nurse staffing and hospital‐acquired conditions: A systematic review

Shin

Park

Bae

2019

Journal of Clinical Nursing

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“…Lake and Cheung (2006) reviewed published literature through mid‐2005 and concluded that evidence of an effect of nursing hours or skill mix on patient falls was equivocal. Subsequently, six studies of nursing factors and patient falls were published using data from California (Burnes Bolton et al, 2007; Donaldson et al, 2005), the US (Dunton, Gajewski, Klaus, & Pierson, 2007; Mark et al, 2008), Switzerland (Schubert et al, 2008), and England (Shuldham, Parkin, Firouzi, Roughton, & Lau‐Walker, 2009).…”

Section: Introductionmentioning

confidence: 99%

“…Staffing and the practice environment were not significant predictors, perhaps because they operate through rationing. Shuldham et al (2009) studied staffing, the proportion of staff who was permanent employees, and patient falls in two English hospitals in 2006–2007. They reported null findings and noted that the study may not have been sufficiently robust to detect significant associations.…”

Section: Introductionmentioning

confidence: 99%

Patient falls: Association with hospital Magnet status and nursing unit staffing

Lake

Shang

Klaus

et al. 2010

Research in Nursing & Health

186

155

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Abstract:The relationships between hospital Magnet 1 status, nursing unit staffing, and patient falls were examined in a cross-sectional study using 2004 National Database of Nursing Quality Indicators (NDNQI 1 ) data from 5,388 units in 108 Magnet and 528 non-Magnet hospitals. In multivariate models, the fall rate was 5% lower in Magnet than non-Magnet hospitals. An additional registered nurse (RN) hour per patient day was associated with a 3% lower fall rate in ICUs. An additional licensed practical nurse (LPN) or nursing assistant (NA) hour was associated with a 2-4% higher fall rate in non-ICUs. Patient safety may be improved by creating environments consistent with Magnet hospital standards. ß

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“…Some researchers have included children within their adult study populations [6,22,23]; however, few have used administrative health data of paediatric populations [24,25]. Given the differences in casemix and risk profiles between paediatric and adult patients [26,27], it is questionable whether nursing-sensitive outcomes used with adults are applicable to paediatrics.…”

Section: Introductionmentioning

confidence: 99%

Identifying paediatric nursing-sensitive outcomes in linked administrative health data

Wilson

Bremner

Hauck

et al. 2012

BMC Health Serv Res

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BackgroundThere is increasing interest in the contribution of the quality of nursing care to patient outcomes. Due to different casemix and risk profiles, algorithms for administrative health data that identify nursing-sensitive outcomes in adult hospitalised patients may not be applicable to paediatric patients. The study purpose was to test adult algorithms in a paediatric hospital population and make amendments to increase the accuracy of identification of hospital acquired events. The study also aimed to determine whether the use of linked hospital records improved the likelihood of correctly identifying patient outcomes as nursing sensitive rather than being related to their pre-morbid conditions.MethodsUsing algorithms developed by Needleman et al. (2001), proportions and rates of records that identified nursing-sensitive outcomes for pressure ulcers, pneumonia and surgical wound infections were determined from administrative hospitalisation data for all paediatric patients discharged from a tertiary paediatric hospital in Western Australia between July 1999 and June 2009. The effects of changes to inclusion and exclusion criteria for each algorithm on the calculated proportion or rate in the paediatric population were explored. Linked records were used to identify comorbid conditions that increased nursing-sensitive outcome risk. Rates were calculated using algorithms revised for paediatric patients.ResultsLinked records of 129,719 hospital separations for 79,016 children were analysed. Identification of comorbid conditions was enhanced through access to prior and/or subsequent hospitalisation records (43% of children with pressure ulcers had a form of paralysis recorded only on a previous admission). Readmissions with a surgical wound infection were identified for 103 (4.8/1,000) surgical separations using linked data. After amendment of each algorithm for paediatric patients, rates of pressure ulcers and pneumonia reduced by 53% and 15% (from 1.3 to 0.6 and from 9.1 to 7.7 per 10,000 patient days) respectively, and an 84% increase in the proportion of surgical wound infection (from 5.7 to 10.4 per 1,000 separations).ConclusionsAlgorithms for nursing-sensitive outcomes used in adult populations have to be amended before application to paediatric populations. Using unlinked individual hospitalisation records to estimate rates of nursing-sensitive outcomes is likely to result in inaccurate rates.

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The relationship between nurse staffing and patient outcomes: A case study

Cited by 52 publications

References 9 publications

Nurse staffing and hospital‐acquired conditions: A systematic review

Nurse staffing and hospital‐acquired conditions: A systematic review

Patient falls: Association with hospital Magnet status and nursing unit staffing

Identifying paediatric nursing-sensitive outcomes in linked administrative health data

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