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Acuity, nurse staffing and workforce, missed care and patient outcomes: A cluster-unit-level descriptive comparison
Maria-Eulàlia Juvé-Udina1,2,3, Maribel González-Samartino1,2,4, Maria Magdalena López-Jiménez1,4
1Nursing Research Group, IDIBELL, Bellvitge Biomedical Research Institute, Barcelona, Spain.
Aim:
To compare the patient acuity, nurse staffing and workforce, missed nursing care and patient outcomes among hospital unit-clusters.
Background:
Relationships among acuity, nurse staffing and workforce, missed nursing care and patient outcomes are not completely understood.
Method:
Descriptive design with data from four unit-clusters: medical, surgical, combined and step-down units. Descriptive statistics were used to compare acuity, nurse staffing coverage, education and expertise, missed nursing care and selected nurse-sensitive outcomes.
Results:
Patient acuity in general (medical, surgical and combined) floors is similar to step-down units, with an average of 5.6 required RN hours per patient day. In general wards, available RN hours per patient day reach only 50% of required RN hours to meet patient needs. Workforce measures are comparable among unit-clusters, and average missed nursing care is 21%. Patient outcomes vary among unit-clusters.
Conclusion:
Patient acuity is similar among unit-clusters, while nurse staffing coverage is halved in general wards. While RN education, expertise and missed care are comparable among unit-clusters, mortality, skin injuries and risk of family compassion fatigue rates are higher in general wards.
Implications For Nursing Management:
Nurse managers play a pivotal role in hustling policymakers to address structural understaffing in general wards, to maximize patient safety outcomes.
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