Demanding safe staffing levels to ensure quality nursing care

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How skill mix affects quality of care
While the media has reported failings in care as failures in nursing, it has not distinguished between care delivered by nurses and that delivered by unregistered healthcare assistants and other support staff. This article examines the role of nurses in an evolving healthcare climate.

Outcomes of variation in hospital nurse staffing in English hospitals: Cross-sectional analysis of survey data and discharge records
Context : Despite growing evidence in the US, little evidence has been available to evaluate whether internationally, hospitals in which nurses care for fewer patients have better outcomes in terms of patient survival and nurse retention. Objectives : To examine the effects of hospital-wide nurse staffing levels (patient-to-nurse ratios) on patient mortality, failure to rescue (mortality risk for patients with complicated stays) and nurse job dissatisfaction, burnout and nurserated quality of care. Design and setting : Cross-sectional analysis combining nurse survey data with discharge abstracts.

Nurse Staffing Models, Nursing Hours, and Patient Safety Outcomes
Background Data : Limited research has been conducted examining the effect of nurse staffing models on costs and patient outcomes. Objective : The objective of this study was to evaluate the effect of different nurse staffing models on costs and the patient outcomes of patient falls, medication errors, wound infections, and urinary tract infections. Methods : A descriptive correlational study was conducted in all of the 19 teaching hospitals in Ontario, Canada. The sample comprised hospitals and adult medical, surgical, and obstetric inpatients within those hospitals.

Nurse Staffing Effects on Patient Outcomes
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 Health System Consortium.

Is ‘‘failure to rescue’’ derived from administrative data in England a nurse sensitive patient safety indicator for surgical care? Observational study
Background: 'Failure to rescue' - death after a treatable complication - is used as a nursing sensitive quality indicator in the USA. It is associated with the size of the nursing workforce relative to patient load, for example patient to nurse ratio, although assessments of nurse sensitivity have not previously considered other staff groups. This study aims to assess the potential to derive failure to rescue and a proxy measure, based on long length of stay, from English hospital administrative data. By exploring change in coding practice over time and measuring associations between failure to rescue and factors including staffing, we assess whether two measures of failure to rescue are useful nurse sensitive indicators. Design: Cross sectional observational study of routinely collected administrative data. Participants : Discharge data from 66,100,672 surgical admissions to 146 general acute hospital trusts in England (1997-2009).

Do staffing levels predict missed nursing care?
Objective . To examine whether actual nurse staffing predicts missed nursing care, controlling for other unit characteristics. Design . This study utilized a cross-sectional, descriptive design. Setting . Ten hospitals in the Midwestern region of the USA. Participants . Nursing staff members with direct care responsibilities (n ¼ 4288) on 110 care units.

ICU nurse-to-patient ratio is associated with complications and resource use after esophagectomy
Objective : To determine if having a night-time nurse-to-patient ratio (NNPR) of one nurse caring for one or two patients (> 1:2) versus one nurse caring for three or more patients (< 1:2) in the intensive care unit (ICU) is associated with clinical and economic outcomes following esophageal resection. Design : State-wide observational cohort study. Hospital discharge data was linked to a prospective survey of ICU or- ganizational characteristics. Multi- variate analysis adjusting for case- mix, hospital and surgeon volume was used to determine the association of NNPR with in-hospital mortality, length of stay (LOS), hospital cost and specific postoperative complications.

Effects of Hospital Staffing and Organizational Climate on Needlestick Injuries to Nurses
Exposures of health care workers to bloodborne pathogens through accidental contact with sharp instruments have been widely publicized, and the prevention and control of exposure to sharp instruments is a high-profile issue. Estimates from the University of Virginia's Exposure Prevention Information Network (EPINet) surveillance system for 1996 placed the number of the percutaneous injuries to US health workers in that year at almost 6000001 In the largest study of needlesticks to date based on nurse reports (as opposed to institutional surveillance), we reported a startlingly high rate of nearly 1 injury per nurse-year using data from a national nurse survey in 1991.

The Association of Shift-Level Nurse Staffing With Adverse Patient Events
Objective : The objective of this study was to demonstrate the association between nurse staffing and adverse events at the shift level. Background : Despite a growing body of research linking nurse staffing and patient outcomes, the relationship of staffing to patient falls and medication errors remains equivocal, possibly due to dependence on aggregated data. Methods : Thirteen military hospitals participated in creating a longitudinal nursing outcomes database to monitor nurse staffing, patient falls and medication errors, and other outcomes. Unit types were analyzed separately to stratify patient and nurse staffing characteristics. Bayesian hierarchical logistic regression modeling was used to examine associations between staffing and adverse events.

Achieving safe staffing for older people in hospital
Hospitals provide care for older people who are the frailest, most acutely ill and have the most complex needs, yet older people's wards in many hospitals are poorly staffed.The Royal College of Nursing (2012) has published summary guidance and recommendations on safe staffing for older people's wards. The guidance and recommendations were developed as part of a project that explored staffing and factors underpinning good quality nursing care for older people in hospital. The full report of the project will be published later this year.This article presents further data from the project exploring the relationship between staffing levels and care delivery, as well as staff views on the adequacy of staffing and approaches to workforce planning at ward level. It also explores the practical implications for nurses working on older people's wards.

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Evidence Safe level How often Patients

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