Nursing studies have shown that nursing care delivery changes affect staff and organizational out comes, but the effects on cli ent out comes have not been studied sufficiently. The pur pose of this study was thus to examine the effect of nurse staff ing variables - daily ave age hours of care, ratio of RNs to average patient census, work load, and skill mix- on patient out comes as mea sured by five adverse occurrences. The adverse patient occur rences included unit rates of patient falls, pressure ulcers, respiratory and urinary tract infections, and patient/family com plaints. Variables were mea sured retrospectively using consistently available data from each month of fiscal year 2000 from 21 medical-surgical nursing care units in a 1394-bed medical center in Taiwan. Data were analyzed by descriptive and multivariate inferential statistics while controlling for patient acuity level. Results showed that work load of nurses is the most powerful predictor of nosocomial infections and hours of care best predicted the five adverse patient out come indices. Lower adverse out come rates were more consistently related to a higher proportion of N3 level of RNs. Patients could fare better when N3s play a significant role in the staffing mix. The findings provide further empirical support for the context of implications that patient out comes are correlated to organizational structure. It obviously illustrates the relationships between nurse staff ing and the quality of nursing practice.
Author: Ke-Ping Yang
Journal: Journal of Nursing Research Vol. 11, No. 3, 2003
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