Nurse Staffing and Patient Outcomes: A Call to Action for Chronic Wound Care Policy Reform

Objective: Patients with complex chronic wounds are at high risk for poor outcomes. This study assessed the relationship between nurse staffing and outcomes among patients with complex and noncomplex chronic wounds. [Figure: see text] Approach: This cross-sectional study linked three 2021 datasets: RN4CAST survey, Medicare Provider Analysis and Review claims, and American Hospital Association data. Nurse staffing was derived from the RN4CAST item asking nurses whether "there are enough nurses to get the work done." We calculated the hospital-level percentage of nurses who reported staffing inadequacy. Multilevel statistical modeling measured the association between staffing and in-hospital mortality and length of stay, adjusted for patient and hospital covariates and stratified among patients with complex and noncomplex chronic wounds. We followed STROBE criteria. Results: The sample included 19,027 patients with chronic wounds (66.7% complex) in 216 hospitals. Every 10% increase in nurses reporting staffing inadequacy was associated with 6% higher odds of in-hospital mortality among patients with complex wounds, with no significant relationship among patients with noncomplex wounds. Every 10% increase in staffing inadequacy was associated with longer lengths of stay, by a factor of 1.04, for patients with both complex and noncomplex wounds. Innovation: By linking nurse-reported staffing to outcomes for patients with chronic wounds, this study identifies a policy-relevant pathway to improve outcomes, particularly for those with complex wounds. Conclusion: Nurse staffing adequacy is consequential for patients with chronic wounds as it relates to length of stay and is particularly important in preventing in-hospital mortality among the highest-risk patients-those with complex wounds.