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Variations in nursing care quality across hospitals
Robert J Lucero1, Eileen T Lake, Linda H Aiken
1Center for Evidence-Based Practice in the Underserved, Columbia University, New York, USA. rl2451@columbia.edu
Journal of Advanced Nursing
|September 10, 2009
Summary
Registered Nurses reported unmet care needs, indicating significant variations in nursing care quality across hospitals. These differences are linked to the care environment, highlighting the need for system improvements.
Area of Science:
- Healthcare Management
- Nursing Quality Improvement
- Hospital Administration
Background:
- Significant proportions of Registered Nurses (RNs) report unfinished care due to time constraints.
- Unmet nursing care needs can negatively impact overall care quality.
- Limited understanding exists regarding the extent of nursing care quality variation among hospitals.
Purpose of the Study:
- To describe RNs' reports of unmet nursing care needs.
- To examine the variation in nursing care quality across different hospitals.
Main Methods:
- Secondary analysis of a 1999 survey of 10,184 RNs conducted in 2008.
- Data from 168 inpatient staff nurses in acute care settings.
- Developed a hospital-level measure of nursing care quality based on unmet needs.
Main Results:
- Wide variation observed in the proportion of RNs reporting unmet nursing care needs across hospitals.
- RNs reported leaving an average of two out of seven necessary care activities undone per shift.
- Statistically significant variations in nursing care quality persisted across hospitals after controlling for nurse demographics.
Conclusions:
- Variations in nursing care quality are strongly associated with differences in hospital care environments.
- Identifying factors contributing to unmet nursing care needs can inform policy for systems and human resources management.
- Enhancing nurses' awareness of care practices and the care environment is crucial for quality improvement.
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