Patient turnover and the relationship between nurse staffing and patient outcomes

Park, Shin Hye; Blegen, Mary A.; Spetz, Joanne; Chapman, Susan; Groot, Holly De

doi:10.1002/nur.21474

Cited by 68 publications

(81 citation statements)

References 37 publications

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“…Daha önce-ki çalışmalarda da benzer bulgular mevcuttur, yoğun bakım hekimi bulunan kliniklerde ortalama YBÜ yatış süresinin kısaldığı bildirilmiştir (17)(18)(19). Ayrıca kalış süresi kısa olan ünitelerde, hasta giriş-çıkışı daha fazla olduğundan hemşirelik iş yükünün belirgin olarak arttığı bildirilmektedir (20). DYBÜ'deki TISS-28 skorunun yüksek bulunmasının bir nedeni de hasta döngüsünün daha fazla olması nedeni ile olabilir.…”

Section: Discussionunclassified

The Relationship between Nurse Workload and Mortality in Two Different ICUs

Ergan¹,

Tokur²,

Coban³

et al. 2016

Yoğun Bakim Derg

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Section: Discussionunclassified

The Relationship between Nurse Workload and Mortality in Two Different ICUs

Ergan¹,

Tokur²,

Coban³

et al. 2016

Yoğun Bakim Derg

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“…Four studies showed significant associations between lower nurse staffing (RN or all nursing staff) and higher rates of death (Blegen et al, 2011, Needleman et al, 2011, Sales et al, 2008. Two studies showed significant associations between lower staffing and higher rates of failure to rescue (Park et al, 2012, Twigg et al, 2013. While results from other studies were not statistically significant (e.g.…”

Section: O U T C O M E S a S S O C I A T E D W I T H N U R S E S T A mentioning

confidence: 95%

“…Eight mostly weak studies gave no strong evidence of beneficial associations between nursing support worker staffing and patient safety. Studies found no association with mortality (Unruh et al, 2007), failure to rescue (Park et al, 2012), length of stay (Unruh et al, 2007), venous thromboembolism (Ibe et al, 2008), or missed care . However, higher assistant staffing was associated with higher rates of falls (Hart andDavis, 2011, Lake et al, 2010), pressure ulcers (Seago et al, 2006), readmission rates (Weiss et al, 2011), medication errors (Seago et al, 2006), use of physical restraints M a n u s c r i p t…”

Section: O U T C O M E S a S S O C I A T E D W I T H N U R S I N G A mentioning

confidence: 99%

Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development

Griffiths

Ball

Drennan

et al. 2016

International Journal of Nursing Studies

226

216

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What is already known? A number of high quality reviews establish an association between lower registered nurse staffing levels, increased mortality rates and other adverse outcomes  Careful analysis of this evidence suggests that it is consistent with a causal relationship  Translation of this evidence into practice is disputedWhat this paper adds  This paper summarises and extends a recent systematic review on nurse staffing and outcomes undertaken for England's National Institute for Health and Care Excellence  Methodological limitations mean that existing studies may not give unbiased estimates of the benefits from increased nurse staffing, with over and underestimation of benefit both possible, which makes it difficult to directly translate evidence into guidance for practice. We identify avenues for progressing this important research so that future studies might be better able to provide the evidence needed to inform policy and practice, and provide a checklist to aid future study development AbstractA large and increasing number of studies have reported a relationship between low nurse staffing levels and adverse outcomes, including higher mortality rates. Despite the evidence being extensive in size, and having been sometimes described as "compelling" and "overwhelming", there are limitations that existing studies have not yet been able to address. One result of these weaknesses can be observed in the guidelines on safe staffing in acute hospital wards issued by the influential body that sets standards for the National Health Service in England, the National Institute for Health and Care Excellence (NICE), which concluded there is insufficient good quality evidence available to fully inform practice.In this paper we explore this apparent contradiction. After summarising the evidence review that informed the NICE guideline on safe staffing and related evidence, we move on to discussing the complex challenges that arise when attempting to apply this evidence to practice. Among these, we introduce the concept of endogeneity, a form of bias in the estimation of causal effects. Although current evidence is broadly consistent with a cause and effect relationship, endogeneity means that estimates of the size of effect, essential for building an economic case, may be biased and in some cases qualitatively wrong. We expand on three limitations that are likely to lead to endogeneity in many previous studies: omitted variables, which refers to the absence of control for variables such as medical staffing and patient case mix; simultaneity, which occurs when the outcome can influence the level of staffing just as staffing influences outcome; and common-method variance, which may be present when both outcomes and staffing levels variables are derived from the same survey.Thus while current evidence is important and has influenced policy because it illustrates the potential risks and benefits associated with changes in nurse staffing, it may not provide operational solutions. We conclude by posing a ser...

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“…Kalış süresi kısa olan ünitelerde, hasta giriş-çıkışı daha fazla olduğundan hemşirelik iş yükünün belirgin olarak arttığı bildirilmektedir (14). Bizim çalışmamızda yoğun bakımlar arasında yatış süreleri anlamlı olarak farklı olmasa da YBÜ-3 te diğer YBÜ'lere göre yoğun bakım yatış süre ortalaması yüksek bulundu.…”

Section: Discussionunclassified

Evaluation of Nursing Workload in Intesive Care Unit

Ersoy¹,

Abdulkerim²,

Oz³

et al. 2017

Yoğun Bakim Derg

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Objective: Nursing workload affects patient outcomes in intensive care units (ICUs). The effective use of resources requires planning of nursing workload. We aimed to determine nursing workload, the required number of nurses in ICUs, and differences in nursing workload among ICUs using Therapeutic Intervention Scoring System-28 (TISS-28). Material and Methods:The study was retrospectively performed in medical ICUs of the Medical Faculty, Division of Medical Intensive Care between September 1 and September 19, 2016.Results: TISS-28 scores were calculated in 39 patients for 19 days. There were 17 patients (43.6%) in ICU-1 (9 beds), 13 patients (33.3%) in ICU-2 (8 beds), and 9 patients (23.1%) in ICU-3 (6 beds). The mean age of the patients was 66.8±17.3 years, and the mean APACHE II score was 23±7.5. The mean TISS-28 score was 27.6±5.6. APACHE II scores, TISS-28 scores, and length of ICU stay were not different among the ICUs. The number of nurses required to work in each 8-h shift was 5.1±1.2 in ICU-1, 3.6±0.5 in ICU-2, and 3.3±1 in ICU-3 (p<0.001). During the study period, the number of nurses actively working per shift was lower than the required number of nurses and the mean number of working nurses were 3, 3.3, and 2.3, respectively. TISS-28 scores and nursing workload for patients who died were higher than those for patients who survived (p=0.007 and p=0.043, respectively). Conclusion:Nursing workload can be different in different ICUs, and current nursing planning is not consistent with the required numbers according to nursing workload. The number of nurses should be planned according to nursing workload rather than bed numbers or empirical values. Bulgular: Üç yoğun bakımda 19 gün boyunca 39 hastaya TISS-28 değeri hesaplandı. YBÜ-1'de (9 yataklı) 17 hasta (%43,6), YBÜ-2'de (8 yataklı) 13 hasta (%33,3) ve YBÜ-3'de (6 yataklı) 9 hasta (%23,1) takip edildi. Hastaların yaş ortalamaları 66,8± 17,3, APACHE II ortalamaları 23±7,5 idi. TISS-28 ortalaması 27,6±5,6 olarak hesaplandı. Yoğun bakım-lar arasında APACHE II, TISS-28 ve yoğun bakım kalış süresi açısından fark izlenmedi. Yoğun bakımlarda her 8 saatlik vardiyada çalışması gereken hemşire sayısı YBÜ-1'de 5,1±1,2, YBÜ-2'de 3,6±0,5 ve YBÜ-3'de 3,3±1 olarak hesaplandı (p<0,001). Bu dönemde vardiya başına çalışan hemşire sayısı olması gereken sayılardan düşük olup, ortalamalar yoğun bakım üniteleri için sırasıyla 3, 3,3 ve 2,3 idi. Ölen hastaların TISS-28 değerleri ve iş yükü süresinin yaşayan hastalardan fazla olduğu izlendi (sırasıyla p=0,007, p=0,043).Sonuç: Farklı yoğun bakım ünitelerinde hemşire iş yükü ağırlığının farklı olabileceği, ancak filli planlamaların olması gereken sayılara uymadığı saptanmıştır. Yoğun bakım ünitelerinde hemşire sayısının yatak sayısı ve ampirik parametrelerden çok, iş yükü ve ihtiyaca göre düzenlenmesi gerekmektedir.

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Patient turnover and the relationship between nurse staffing and patient outcomes

Cited by 68 publications

References 37 publications

The Relationship between Nurse Workload and Mortality in Two Different ICUs

The Relationship between Nurse Workload and Mortality in Two Different ICUs

Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development

Evaluation of Nursing Workload in Intesive Care Unit

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