Medical Care

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Medical Care:
doi: 10.1097/MLR.0b013e318202e129
Original Articles

Nurse Staffing Effects on Patient Outcomes: Safety-Net and Non-Safety-Net Hospitals

Blegen, Mary A. PhD, RN, FAAN*; Goode, Colleen J. PhD, RN, FAAN; Spetz, Joanne PhD*; Vaughn, Thomas PhD; Park, Shin Hye MS, RN, PhD(c)*

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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.

© 2011 Lippincott Williams & Wilkins, Inc.


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