Dataset Information

Association of Nurse Engagement and Nurse Staffing on Patient Safety.

ABSTRACT: BACKGROUND:Nurse engagement is a modifiable element of the work environment and has shown promise as a potential safety intervention. PURPOSE:Our study examined the relationship between the level of engagement, staffing, and assessments of patient safety among nurses working in hospital settings. METHODS:A secondary analysis of linked cross-sectional data was conducted using survey data of 26 960 nurses across 599 hospitals in 4 states. Logistic regression models were used to examine the association between nurse engagement, staffing, and nurse assessments of patient safety. RESULTS:Thirty-two percent of nurses gave their hospital a poor or failing patient safety grade. In 25% of hospitals, nurses fell in the least or only somewhat engaged categories. A 1-unit increase in engagement lowered the odds of an unfavorable safety grade by 29% (P < .001). Hospitals where nurses reported higher levels of engagement were 19% (P < .001) less likely to report that mistakes were held against them. Nurses in poorly staffed hospitals were 6% more likely to report that important information about patients "fell through the cracks" when transferring patients across units (P < .001). CONCLUSIONS:Interventions to improve nurse engagement and adequate staffing serve as strategies to improve patient safety.

SUBMITTER: Brooks Carthon JM

PROVIDER: S-EPMC6263830 | biostudies-literature | 2019 Jan/Mar

REPOSITORIES: biostudies-literature

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Association of Nurse Engagement and Nurse Staffing on Patient Safety.

Brooks Carthon J Margo JM Hatfield Linda L Plover Colin C Dierkes Andrew A Davis Lawrence L Hedgeland Taylor T Sanders Anne Marie AM Visco Frank F Holland Sara S Ballinghoff Jim J Del Guidice Mary M Aiken Linda H LH

Journal of nursing care quality 20190101 1

<h4>Background</h4>Nurse engagement is a modifiable element of the work environment and has shown promise as a potential safety intervention.<h4>Purpose</h4>Our study examined the relationship between the level of engagement, staffing, and assessments of patient safety among nurses working in hospital settings.<h4>Methods</h4>A secondary analysis of linked cross-sectional data was conducted using survey data of 26 960 nurses across 599 hospitals in 4 states. Logistic regression models were used ...[more]

PMID: 29889724

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Project description:OBJECTIVES:To assess whether Massachusetts legislation directed at ICU nurse staffing was associated with improvements in patient outcomes. DESIGN:Retrospective cohort study; difference-in-difference design to compare outcomes in Massachusetts with outcomes of other states (before and after the March 31, 2016, compliance deadline). SETTING:Administrative claims data collected from medical centers across the United States (Vizient). PATIENTS:Adults between 18 and 99 years old who were admitted to ICUs for greater than or equal to 1 day. INTERVENTIONS:Massachusetts General Law c. 111, § 231, which established 1) maximum patient-to-nurse assignments of 2:1 in the ICU and 2) that this determination should be based on a patient acuity tool and by the staff nurses in the unit. MEASUREMENTS AND MAIN RESULTS:Nurse staffing increased similarly in Massachusetts (n = 11 ICUs, Baseline patient-to-nurse ratio 1.38?±?0.16 to Post-mandate 1.28?±?0.15; p = 0.006) and other states (n = 88 ICUs, Baseline 1.35?±?0.19 to Post-mandate 1.31?±?0.17; p = 0.002; difference-in-difference p = 0.20). Massachusetts ICU nurse staffing regulations were not associated with changes in hospital mortality within Massachusetts (Baseline n = 29,754, standardized mortality ratio 1.20?±?0.04 to Post-mandate n = 30,058, 1.15?±?0.04; p = 0.11) or when compared with changes in hospital mortality in other states (Baseline n = 572,952, 1.15?±?0.01 to Post-mandate n = 567,608, 1.09?±?0.01; difference-in-difference p = 0.69). Complications (Massachusetts: Baseline 0.68% to Post-mandate 0.67%; other states: Baseline 0.72% to Post-mandate 0.72%; difference-in-difference p = 0.92) and do-not-resuscitate orders (Massachusetts: Baseline 13.5% to Post-mandate 15.4%; other states: Baseline 12.3% to Post-mandate 14.5%; difference-in-difference p = 0.07) also remained unchanged relative to secular trends. Results were similar in interrupted time series analysis, as well as in subgroups of community hospitals and workload intensive patients receiving mechanical ventilation. CONCLUSIONS:State regulation of patient-to-nurse staffing with the aid of patient complexity scores in intensive care was not associated with either increased nurse staffing or changes in patient outcomes.

Project description:ObjectiveThe objective of this study was to addresses the basic question of whether alternative legislative approaches are effective in encouraging hospitals to increase nurse staffing.MethodsUsing 16 years of nationally representative hospital-level data from the American Hospital Association (AHA) annual survey, we employed a difference-in-difference design to compare changes in productive hours per patient day for registered nurses (RNs), licensed practical/vocational nurses (LPNs), and nursing assistive personnel (NAP) in the state that mandated staffing ratios, states that legislated staffing committees, and states that legislated public reporting, to changes in states that did not implement any nurse staffing legislation before and after the legislation was implemented. We constructed multivariate linear regression models to assess the effects with hospital and year fixed effects, controlling for hospital-level characteristics and state-level factors.ResultsCompared with states with no legislation, the state that legislated minimum staffing ratios had an 0.996 (P<0.01) increase in RN hours per patient day and 0.224 (P<0.01) increase in NAP hours after the legislation was implemented, but no statistically significant changes in RN or NAP hours were found in states that legislated a staffing committee or public reporting. The staffing committee approach had a negative effect on LPN hours (difference-in-difference=-0.076, P<0.01), while the public reporting approach had a positive effect on LPN hours (difference-in-difference=0.115, P<0.01). There was no statistically significant effect of staffing mandate on LPN hours.ConclusionsWhen we included California in the comparison, our model suggests that neither the staffing committee nor the public reporting approach alone are effective in increasing hospital RN staffing, although the public reporting approach appeared to have a positive effect on LPN staffing. When we excluded California form the model, public reporting also had a positive effect on RN staffing. Future research should examine patient outcomes associated with these policies, as well as potential cost savings for hospitals from reduced nurse turnover rates.

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Association of Nurse Engagement and Nurse Staffing on Patient Safety.

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Association of Nurse Engagement and Nurse Staffing on Patient Safety.

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