The Effects of Nurse
Staffing on Patient Safety
Evidence and Methodology
• Our goal is clearly defined---- To assess whether nurse staffing effects patient safety in the form of inpatient hospital mortality and patient safety
• Our studies are observational and taken from random samples adjusted for risk and hospital characteristics----Data was obtained from nurse surveys and risk-adjusted 30-day inpatient mortality and failure to rescue. Pt discharge data was obtained from the state agencies.
• Our articles are peer reviewed
• Our articles have credentialed authors related to the research subject
• Our articles have few assumptions and uses statistics and risk adjustments to rule out variables and bias’s
• Ethical review approval
Implementation and Risk Adjustments
Things to rule out confounding, lurking variables, and bias’s in order to make studies and research more accurate
1. Content Validity Index was used to assess reliability and validity of the nurse surveys 2. Cronbach’s alpha statistics was used to account for variables and test the interal reliability of study results
3. Descriptive statistics were used to assess extreme or outliers 4. Elixhauser’s and Carlson index was used for clinical prognosis and comorbidity adjustments 5. C-statistic risk-adjustment was used for hospital quality, characteristics, and performance 6. Practice Environment Scale of the Nursing Work Index(PES-NWI) was used as a control variable that gauge’s the quality of the nursing practice environment 7. In order to account for clustering of patients common with randomized observational studies, the Huber-White estimates were used.
The first two studies compared nurse staffing levels to patient outcomes. The third study looked at nurses’ subjective assessment based on their staffing levels and resource adequacy
Validity of the first two studies are good because they were based on direct measurements of mortality. The third study seemed to have less validity as it was based on nurses opinion of patient safety.
• Ethical approval was given prior to research.
• Relevance is important because nursing is one of the largest categories in the hospital and makes up 25% of annual operating expenses and as much as 40% of direct costs.
• Good scientific evidence of an association between lower nurse work loads and better patient outcomes, including lower hospital mortality. • A case for the cost effectiveness of these investments has been made
In addition to better staffing, evidence suggests higher educated nurses and better work environments effect patient mortality. Better work environment are those where: Doctors and nurses have good working relationships
Nurses are involved in hospital affairs
Management listens and responds to patient care problems
Management institutes and invests in continued learning and quality improvements/safety
• Increased workloads increases the odds of
patient deaths and failure to rescue by 3%
Better work environments and better educated nurses
decrease the odds of patients dying by 8%
Higher patient to nurse ratio’s on deaths in hospitals with poor environments is none Higher patient to nurse ratio’s on deaths in hospitals with average work environments is 4% Hospitals with the best environments have a 10% increase on patient deaths when staffing is inadequate
In the poorest staffed hospitals, better
environments decrease the odds of mortality and
failure-to-rescue by 2-3%
So…. BEST STAFFED
HOSPITALS AND BEST
ODDS OF MORTALITY BY 14%
• Hospitals with high nurse staffing had 25% lower odds of being penalized for readmissions of Medicare patients
• Adding 133,000 RNs to the acute care hospital workforce across the US would produce medical savings estimated at 6.1 billion in...
References: Aiken, L. H., Cimiotti, J. P., Sloane, D. M., Smith, H. L., Flynn, L., & Neff, D. F. (2011, Dec). The Effects of Nurse Staffing
and Nurse Education on Patient Deaths in Hospital with different Nurse Work Envirnments. Med Care, 49(12), 10471053. http://dx.doi.org/10.1097/MLR.ObO13e318233Ob6e
Aiken, L. H., Sloane, D. M., & Bruyneel, L. (2014, May 24th). Nurse Staffing and Education and hospital Mortality in Nine
European Countries: A Retrospective Observational Study. The Lancet, 383(9931). http://dx.doi.org/10.1016/S01406736(13)62631-8
Alenius, L. S., Tishelman, C., Runesdotter, S., & Lindqvist, R. (2013, Oct 14th). Staffing and resource adequacy strongly
related to RNs assessment of patient safety: a national study of RNs working in acute care hospitals in Sweden. BMJ
Quality Safety, 23, 242-249. http://dx.doi.org/10.1136/bmjqs-2012-001734
Needleman, J., Buerhaus, P., Pankratz, V. S., Leibson, C. L., Stevens, S. R., & Harris, M. (2011, March 17). Nurse Staffing
and Inpatient Hospital Mortality. New England Journal of Medicine, 364, 1037-1045.
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