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Association of nurse staffing and nursing workload with ventilator-associated pneumonia and mortality: a prospective,
Miia M Jansson1, Hannu P Syrjälä2, Tero I Ala-Kokko3
1Research Group of Surgery, Anesthesiology and Intensive Care, Medical Research Center Oulu, Oulu, Finland.
Background:
Nurse understaffing and increased nursing workload have been associated with increased risk of adverse patient outcomes and even mortality.
Aim:
To determine whether nurse staffing and nursing workload are associated with ventilator-associated pneumonia and mortality.
Methods:
This prospective, observational cohort study was conducted in a single tertiary-level teaching hospital in Finland during 2014-2015. The association between nurse staffing, nursing workload and prognosis was determined using daily nurse-to-patient ratios, Therapeutic Intervention Scoring System and Intensive Care Nursing Scoring System scores, and Intensive Care Nursing Scoring System indices. Ventilator-associated pneumonia was defined according to the Centers for Disease Control and Prevention criteria.
Findings:
Evaluable data was available for 85 patients. The overall ventilator-associated pneumonia and 28-day mortality rates were 23.5% and 35.3%, respectively. Nurse staffing, measured as the daily lowest nurse-to-patient ratio (P = 0.006) and median Intensive Care Nursing Scoring System index (P = 0.046), were significantly lower in patients with ventilator-associated pneumonia. In addition, nursing workload, measured as median scores obtained by the Therapeutic Intervention Scoring System (P = 0.009) and Intensive Care Nursing Scoring System (P = 0.03), was significantly higher in infected patients. The median (P = 0.02) and daily highest (P = 0.03) Intensive Care Nursing Scoring System scores were significantly higher in non-survivors.
Conclusions:
Lower nurse staffing and increased nursing workload are associated with ventilator-associated pneumonia and mortality, demonstrating that adequate staffing is a prerequisite for the availability and quality of critical care services.
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