Patient Turnover and Nursing Staff Adequacy

Unruh, Lynn; Fottler, Myron D.

doi:10.1111/j.1475-6773.2005.00496.x

Cited by 76 publications

(77 citation statements)

References 27 publications

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“…While at times used interchangeably, the term patient churn intends to encompass both patient turnover and the nursing care involved in the inflow or outflow of each patient. Patient churn has been measured by adding a factor to midnight census equal to the inverse of the length of time (in days) a patient is on a unit (or in the hospital) (Unruh & Fottler 2006) and the number of patients per bed within a unit (Duffield et al 2009). Patient churn may place an additional burden on the workload of nurses (Duffield et al 2009, Needleman et al 2011, if not calculated into the workload estimation at the beginning of a shift.…”

Section: Overview Of the Literaturementioning

confidence: 99%

“…After the schedule is published, daily and shift-by-shift staffing are adjusted to match patient census. Fluctuations in the number of patients during the hours prior to midnight suggest increasing, decreasing or re-allocating nursing resources (Unruh & Fottler 2006, Kane et al 2007, Clements et al 2008. It is unknown if managers are consistently scheduling nurses appropriately.…”

Section: Overview Of the Literaturementioning

confidence: 99%

“…Three different metrics can be used to calculate nurse staffing requirements to meet unit-level workload on a daily and by shift basis: midnight census, the inverse of the LOS (Unruh & Fottler 2006), and the ADT Work Intensity Index (Wagner et al 2005, Suby 2008). Midnight census and/or nurse-to-patient ratios have been used as representative indicators of unit-level workload (Donaldson et al 2005), regardless of patient care needs, changes in patient status, and inflow and outflow during the 24 hours prior to midnight.…”

Section: Overview Of the Literaturementioning

confidence: 99%

“…The daily occurrence of patient churn impacts unit-level workload in hospitals (Unruh & Fottler 2006, Duffield et al 2009). Evidence is accumulating that higher nurse staffing is associated with better inpatient and post-discharge outcomes (Needleman et al 2011, Aiken et al 2012, McHugh & Ma 2013.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of nurse staffing based on changes in unit-level workload associated with patient churn

et al. 2013

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Aim: This analysis compares the staffing implications of three measures of nurse staffing requirements: midnight census, turnover adjustment based on length of stay, and volume of admissions, discharges and transfers. Background: Midnight census is commonly used to determine registered nurse staffing. Unit-level workload increases with patient churn, the movement of patients in and out of the nursing unit. Failure to account for patient churn in staffing allocation impacts nurse workload and may result in adverse patient outcomes.

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Section: Overview Of the Literaturementioning

confidence: 99%

Section: Overview Of the Literaturementioning

confidence: 99%

Section: Overview Of the Literaturementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparison of nurse staffing based on changes in unit-level workload associated with patient churn

et al. 2013

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“…The current trend towards shortening hospital stays can lead to faster patient turnover, complicating nursing demands and increasing workloads. [23][24][25] Patient turnover has also been linked to such outcomes as failure-to-rescue and mortality. [26,27] Another possible unit-level factor is safety climate.…”

Section: Introductionmentioning

confidence: 99%

Nurse staffing, patient turnover and safety climate and their association with in-patient falls and injurious falls on medical acute care units: a cross-sectional study

Hirsbrunner

Denhaerynck

Fierz

et al. 2015

JHA

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Objective: Falls and related injuries remain a considerable health risk for in-patients. Numerous studies link falls with nurse staffing levels, but the results are inconsistent. The purpose of this study was to explore the associations between fall prevalence and injurious falls on medical wards and three unit-level system factors: daily nurse staffing, patient turnover, and safety climate. Methods: Using a cross-sectional design, we conducted a secondary data analysis of data from the Patient Safety and Falls Project. Five medical units in a Swiss university hospital were included, resulting in a data set of 949 days, with daily measures of nurse staffing, patient turnover and falls. The safety climate was measured using a subscale of the Safety Attitudes Questionnaire and analyzed at the unit level including data from 154 nurses. Robust multivariate logistic regression was used to explore nurse staffing, patient turnover, and safety climate's associations with in-patient falls and fall injuries. Results: After controlling for patient age, length of stay and nursing fulltime equivalents, registered nurse experience showed a significant negative relationship with falls (OR = .83, p < .0001). Patient turnover and safety climate were not significantly associated to falls or fall injuries. Conclusions: By linking nurse staffing variables to in-patient falls and fall injuries, the current study's findings partly confirm those of previous research. Further investigation will be necessary to isolate key factors influencing the association at the unit level between safety climate and in-patient falls.

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Patient turnover and the relationship between nurse staffing and patient outcomes

Park

Blegen

Spetz

et al. 2012

Research in Nursing & Health

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High patient turnover (patient throughput generated by admissions, discharges, and transfers) contributes to increased demands and resources for care. We examined how the relationship between registered nurse (RN) staffing and failure-to-rescue (FTR) varied with patient turnover levels by analyzing quarterly data from the University HealthSystem Consortium. The data included 42 hospitals, representing 759 nursing units and about 1 million inpatients. Higher RN staffing was associated with lower FTR. When patient turnover increased from 48.6% to 60.7% on nonintensive units (non-ICUs), the beneficial effect of non-ICU RN staffing on FTR was reduced by 11.5%. RN staffing should be adjusted according to patient turnover because turnover increases patient care demand beyond that presented by patient count, and outcomes may be adversely affected.

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Patient Turnover and Nursing Staff Adequacy

Abstract: These results indicate that the assessment of unadjusted RN staffing by RN to patient ratios alone underestimates nursing workload and overstates RN staffing levels. Patient turnover, as well as severity, should be taken into account in staffing assessment and decision making.

Cited by 76 publications

References 27 publications

Comparison of nurse staffing based on changes in unit-level workload associated with patient churn

Comparison of nurse staffing based on changes in unit-level workload associated with patient churn

Nurse staffing, patient turnover and safety climate and their association with in-patient falls and injurious falls on medical acute care units: a cross-sectional study

Patient turnover and the relationship between nurse staffing and patient outcomes

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