The Association of Shift-Level Nurse Staffing With Adverse Patient Events

Patrician, Patricia A.; Loan, Lori A.; McCarthy, Mary S.; Fridman, Moshe; Donaldson, Nancy; Bingham, Mona; Brosch, Laura R.

doi:10.1097/nna.0b013e31820594bf

Cited by 77 publications

(89 citation statements)

References 13 publications

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“…Only four studies were assessed as relatively strong for both external and internal validity , Patrician et al, 2011, Sales et al, 2008, Spetz et al, 2013. Establishing that presumed cause preceded the presumed effect is a basic requirement for inferring that an observed association between variables is a causal one (Antonakis et al, 2010).…”

Section: Review Resultsmentioning

confidence: 99%

“…Generally outcomes over a given period were associated with averaged staffing over the same period. In only six studies was the temporal link between changes in staffing levels and outcomes established, either because one preceded the other or they were measured simultaneously , Donaldson et al, 2005, Needleman et al, 2011, Patrician et al, 2011, Tschannen et al, 2010 .…”

Section: Review Resultsmentioning

confidence: 99%

“…Three of the twelve found that having more nurses was significantly associated with lower rates of falls (Donaldson et al, 2005, Patrician et al, 2011, Potter et al, 2003.…”

Section: Other Outcomesmentioning

confidence: 99%

“…Nine studies explored associations with drug administration errors of which three showed low staffing to be significantly associated with higher rates of errors (Frith et al, 2012, Patrician et al, 2011. One study found that wards with more nursing staff had significantly higher error rates (Blegen and Vaughn, 1998).…”

Section: Other Outcomesmentioning

confidence: 99%

“…A number of these studies found an association between a nursing skill mix that has a higher proportion of RNs and better outcomes including lower mortality / failure to rescue (Blegen et al, 2011, Estabrooks et al, 2005, lower rates of infections (Blegen et al, 2011, Cho et al, 2003, McGillis Hall et al, 2004, falls (Blegen and Vaughn, 1998, Donaldson et al, 2005, Patrician et al, 2011, pressure ulcers (Blegen et al, 2011, Ibe et al, 2008, and higher patient satisfaction (Potter et al, 2003). The overall pattern of results is largely consistent, with the only significant contradictory evidence coming from one of the weaker studies which showed that a higher proportion of registered nurses was associated with a higher nurse reported incidence of pneumonia (Ausserhofer et al, 2013).…”

Section: March 2016mentioning

confidence: 99%

See 4 more Smart Citations

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

228

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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Section: Review Resultsmentioning

confidence: 99%

Section: Review Resultsmentioning

confidence: 99%

“…Three of the twelve found that having more nurses was significantly associated with lower rates of falls (Donaldson et al, 2005, Patrician et al, 2011, Potter et al, 2003.…”

Section: Other Outcomesmentioning

confidence: 99%

Section: Other Outcomesmentioning

confidence: 99%

Section: March 2016mentioning

confidence: 99%

See 3 more Smart Citations

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

228

216

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Quality and safety during the off hours in medicine units: A mixed methods study of front‐line provider perspectives

Gonzalo

Moser

Lehman

et al. 2014

Journal of Hospital Medicine

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BACKGROUND Hospital off‐hours care is associated with poor outcomes. Mutual conceptualization among provider groups may facilitate improvement efforts. Provider‐perceived threats to quality are unreported. OBJECTIVES The objectives of this study were to identify perceived off‐hours quality and safety issues, assess the most significant, and evaluate differences between nurses, and attending and housestaff physicians, and providers with day and night experience. DESIGN Prospective, sequential, exploratory mixed‐methods study. MEASURES Open‐ended descriptions of adverse events/near misses occurring overnight (n = 190) were analyzed using thematic analysis. From these results, a survey was developed to assess perceptions of quality/frequency of each issue (7‐point scale, 7 = the highest rating) and highest‐quality overnight period (7–10 pm, 10 pm−1 am, 1–4 am, 4–7 am). RESULTS Primary issues related to mismanagement, delivery processes, and communication/coordination. Of 214 surveys, 160 responses (75%) were received. Least‐optimal issues related to “communication” (2.93) and “timeliness/safety” (3.89) of emergency department transfers; most‐optimal issues related to timely lab reporting (4.70). On the 7‐point scale, comparisons among nurses, and attending and housestaff physicians revealed differences in quality of “communication between physicians” (4.29 vs 6.00 vs 5.14) and “communication between consultants–primary providers” (3.46 vs 5.75 vs 4.35, P < 0.001). Comparisons between day–night providers revealed lower ratings from day providers in 12/24 items (P < 0.05), including “communication during emergency department transfers” (4.81 vs 3.86). All groups ranked 4 to 7am lowest in quality. CONCLUSIONS Nurses, and attending and housestaff physicians lack a shared mental model of off‐hours care. Several issues, including emergency department transfers and timeliness of consults, were identified by all providers as problematic, meriting further investigation and intervention. Journal of Hospital Medicine 2014;9:756–763. © 2014 Society of Hospital Medicine

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Shift work disorder, mental health and burnout among nurses: A cross‐sectional study

et al. 2022

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The Association of Shift-Level Nurse Staffing With Adverse Patient Events

Abstract: Consideration must be given to nurse staffing and experience levels on every shift.

Cited by 77 publications

References 13 publications

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

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

Quality and safety during the off hours in medicine units: A mixed methods study of front‐line provider perspectives

Shift work disorder, mental health and burnout among nurses: A cross‐sectional study

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