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Better Nurse Staffing Improves Outcomes in Children, Too

Rosenberg, Karen

AJN The American Journal of Nursing: August 2013 - Volume 113 - Issue 8 - p 19
doi: 10.1097/01.NAJ.0000432952.80515.f2
In the News

Four patients or fewer per RN reduces the likelihood of readmission.



Staffing levels affect the amount of time bedside nurses can devote to monitoring patients during their inpatient stay, educating patients and families on home care, and easing the transition from inpatient to outpatient care. In adults, hospital patient-to-nurse staffing ratios have been shown to affect hospital readmission rates, an increasingly important measure of hospital quality. A new study has shown for the first time that in children, too, better nurse staffing levels are associated with better outcomes.

The cross-sectional, observational study analyzed 2006 data from surveys of RNs, patient discharge data, and an American Hospital Association survey. A total of 14,194 RNs providing direct patient care and 90,459 children hospitalized in 225 hospitals for common medical and surgical conditions were included in the study.

Higher nurse staffing ratios (more patients per nurse) were significantly associated with greater odds of readmission 15 to 30 days after discharge among both medical and surgical patients. Each one-patient increase in a hospital's average pediatric staffing ratio increased the likelihood of readmission between 15 and 30 days by 11% in a child with a medical condition and by 48% in a child with a surgical condition. Treatment in a hospital that met the pediatric staffing benchmark of no more than four patients per nurse reduced the risk of readmission 15 to 30 days after discharge by as much as 63%. No significant relationship was found between staffing ratios and readmission within 14 days of discharge.

Lead author Heather L. Tubbs-Cooley, assistant professor at Cincinnati Children's Hospital Medical Center, said these results “align with the results of many other studies looking at the relationship between nurse staffing ratios and patient outcomes.” The results are preliminary, she noted, adding, “We encourage confirmatory testing.”

Marcelline Harris, associate professor of nursing at the University of Michigan, commented: “Going forward, we need systems that balance staffing and workload with patient needs, based on the evidence indicating that poor nurse staffing causes patient harms. Developing and testing solutions to these persistent problems is an essential next step.” (See this month's AJN Reports for coverage of RN-to-patient staffing ratios in other settings.) —Karen Rosenberg

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Tubbs-Cooley HL, et al. BMJ Qual Saf. 2013 May 7. [Epub ahead of print].
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