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Nurse staffing and patient outcomes
M A Blegen1, C J Goode, L Reed
1College of Nursing, University of Iowa, Iowa City, USA.
Nursing Research
|March 21, 1998
Summary
Higher registered nurse (RN) staffing ratios correlate with fewer adverse patient events. However, excessive RN care hours may increase negative outcomes, indicating an optimal RN skill mix is crucial for patient safety.
Area of Science:
- Nursing research
- Healthcare quality improvement
- Patient safety
Background:
- Nursing care delivery models significantly impact staff and organizational results.
- The influence of these changes on patient outcomes requires further investigation.
Purpose of the Study:
- To examine the association between nursing care hours, the skill mix of registered nurses (RNs), and adverse patient outcomes at the nursing unit level.
- To identify optimal staffing configurations for enhancing patient safety.
Main Methods:
- Data collected on unit rates of medication errors, patient falls, skin breakdown, complaints, infections, and mortality.
- Correlational and multivariate analyses were performed, controlling for patient acuity.
Main Results:
- Higher patient acuity was linked to fewer medication errors and falls but more other adverse events.
- Increased proportion of RN care hours correlated with decreased medication errors, decubiti, and complaints, up to 87.5% of total nursing hours.
- Total nursing hours showed a direct association with decubiti, complaints, and mortality.
- An optimal RN skill mix demonstrated a curvilinear relationship with adverse outcomes.
Conclusions:
- A higher proportion of registered nurses in the skill mix is associated with reduced adverse events in inpatient settings.
- There is an optimal threshold for RN care hours beyond which adverse outcomes may increase.