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Med Care. 2011 Apr;49(4):406-14. doi: 10.1097/MLR.0b013e318202e129.

Nurse staffing effects on patient outcomes: safety-net and non-safety-net hospitals.

Author information

1
Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA. Mary.Blegen@nursing.ucsf.edu

Abstract

BACKGROUND:

Nurse staffing has been linked to hospital patient outcomes; however, previous results were inconsistent because of variations in measures of staffing and were only rarely specific to types of patient care units.

OBJECTIVE:

To determine the relationship between nurse staffing in general and intensive care units and patient outcomes and determine whether safety net status affects this relationship.

RESEARCH DESIGN:

A cross-sectional design used data from hospitals belonging to the University HealthSystem Consortium.

SUBJECTS:

Data were available for approximately 1.1 million adult patient discharges and staffing for 872 patient care units from 54 hospitals.

MEASURES:

Total hours of nursing care [Registered Nurses (RNs), Licensed Practical Nurses, and assistants] determined per inpatient day (TotHPD) and RN skill mix were the measures of staffing; Agency for Healthcare Research and Quality risk-adjusted safety and quality indicators were the outcome measures.

RESULTS:

TotHPD in general units was associated with lower rates of congestive heart failure mortality (P<0.05), failure to rescue (P<0.10), infections (P<0.01), and prolonged length of stay (P<0.01). RN skill mix in general units was associated with reduced failure to rescue (P<0.01) and infections (P<0.05). TotHPD in intensive care units was associated with fewer infections (P<0.05) and decubitus ulcers (P<0.10). RN skill mix was associated with fewer cases of sepsis (P<0.01) and failure to rescue (P<0.05). Safety-net status was associated with higher rates of congestive heart failure mortality, decubitus ulcers, and failure to rescue.

CONCLUSIONS:

Higher nurse staffing protected patients from poor outcomes; however, hospital safety-net status introduced complexities in this relationship.

PMID:
21407034
DOI:
10.1097/MLR.0b013e318202e129
[Indexed for MEDLINE]
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