Dataset Information

A quantitative systematic review of the association between nurse skill mix and nursing-sensitive patient outcomes in the acute care setting.

ABSTRACT:

Aims

To examine the association between nurse skill mix (the proportion of total hours provided by Registered Nurses) and patient outcomes in acute care hospitals.

Design

A quantitative systematic review included studies published in English between January 2000 - September 2018.

Data sources

Cochrane Library, CINAHL Plus with Full Text, MEDLINE, Scopus, Web of Science and Joanna Briggs Institute were searched. Observational and experimental study designs were included. Mix-methods designs were included if the quantitative component met the criteria.

Review methods

The Systematic Review guidelines of the Joanna Briggs Institute and its critical appraisal instrument were used. An inverse association was determined when seventy-five percent or more of studies with significant results found this association.

Results

Sixty-three articles were included. Twelve patient outcomes were inversely associated with nursing skill mix (i.e., higher nursing skill mix was significantly associated with improved patient outcomes). These were length of stay; ulcer, gastritis and upper gastrointestinal bleeds; acute myocardial infarction; restraint use; failure-to-rescue; pneumonia; sepsis; urinary tract infection; mortality/30-day mortality; pressure injury; infections and shock/cardiac arrest/heart failure.

Conclusion

Nursing skill mix affected 12 patient outcomes. However, further investigation using experimental or longitudinal study designs are required to establish causal relationships. Consensus on the definition of skill mix is required to enable more robust evaluation of the impact of changes in skill mix on patient outcomes.

Impact

Skill mix is perhaps more important than the number of nurses in reducing adverse patient outcomes such as mortality and failure to rescue, albeit the optimal staffing profile remains elusive in workforce planning.

SUBMITTER: Twigg DE

PROVIDER: S-EPMC6899638 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Publications

A quantitative systematic review of the association between nurse skill mix and nursing-sensitive patient outcomes in the acute care setting.

Twigg Diane E DE Kutzer Yvonne Y Jacob Elisabeth E Seaman Karla K

Journal of advanced nursing 20191003 12

<h4>Aims</h4>To examine the association between nurse skill mix (the proportion of total hours provided by Registered Nurses) and patient outcomes in acute care hospitals.<h4>Design</h4>A quantitative systematic review included studies published in English between January 2000 - September 2018.<h4>Data sources</h4>Cochrane Library, CINAHL Plus with Full Text, MEDLINE, Scopus, Web of Science and Joanna Briggs Institute were searched. Observational and experimental study designs were included. Mix ...[more]

PMID: 31483509

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Project description:There is a lack of evidence to guide district nurses in using nurse-sensitive patient outcomes as it is unclear how these outcomes are currently used in daily district nursing practice. Therefore, we aimed to explore (1) which nurse-sensitive patient outcomes are measured and how these outcomes are measured, (2) how district nurses use the outcomes to learn from and improve current practice and (3) the barriers and facilitators to using outcomes in current district nursing practice. An exploratory cross-sectional survey study was conducted. The survey was distributed online among nurses working for various district nursing care organisations across the Netherlands. The responses from 132 nurses were analysed, demonstrating that different instruments or questionnaires are available and used in district nursing care as outcome measures. The nurse-sensitive patient outcomes most often measured with validated instruments are pain using the Numeric Rating Scale or Visual Analogue Scale, delirium using the Delirium Observation Scale, weight loss using the Short Nutritional Assessment Questionnaire and caregiver burden using the Caregiver Strain Index or a Dutch equivalent. Falls and client satisfaction with delivered care are most often measured using unvalidated outcome measures. The other nurse-sensitive outcomes are measured in different ways. Outcomes are measured, reported and fed back to the nursing team multiple times and in various ways to learn from and improve current practice. In general, nurses have a positive attitude towards using nurse-sensitive outcomes in practice, but there is a lack of facilitation to support them. Because insight into how nurses can and should be supported is still lacking, exploring their needs in further research is desirable. Additionally, due to the high variation in the utilisation of outcomes in current practice, it is recommended to create more uniformity by developing (inter)national guidelines on using nurse-sensitive patient outcomes in district nursing care.

Project description:ObjectivesTo determine nurse-sensitive outcomes in district nursing care for community-living older people. Nurse-sensitive outcomes are defined as patient outcomes that are relevant based on nurses' scope and domain of practice and that are influenced by nursing inputs and interventions.DesignA Delphi study following the RAND/UCLA Appropriateness Method with two rounds of data collection.SettingDistrict nursing care in the community care setting in the Netherlands.ParticipantsExperts with current or recent clinical experience as district nurses as well as expertise in research, teaching, practice, or policy in the area of district nursing.Main outcome measuresExperts assessed potential nurse-sensitive outcomes for their sensitivity to nursing care by scoring the relevance of each outcome and the ability of the outcome to be influenced by nursing care (influenceability). The relevance and influenceability of each outcome were scored on a nine-point Likert scale. A group median of 7 to 9 indicated that the outcome was assessed as relevant and/or influenceable. To measure agreement among experts, the disagreement index was used, with a score of <1 indicating agreement.ResultsIn Delphi round two, 11 experts assessed 46 outcomes. In total, 26 outcomes (56.5%) were assessed as nurse-sensitive. The nurse-sensitive outcomes with the highest median scores for both relevance and influenceability were the patient's autonomy, the patient's ability to make decisions regarding the provision of care, the patient's satisfaction with delivered district nursing care, the quality of dying and death, and the compliance of the patient with needed care.ConclusionsThis study determined 26 nurse-sensitive outcomes for district nursing care for community-living older people based on the collective opinion of experts in district nursing care. This insight could guide the development of quality indicators for district nursing care. Further research is needed to operationalise the outcomes and to determine which outcomes are relevant for specific subgroups.

Project description:OBJECTIVES:To determine the association of hospital nursing skill mix with patient mortality, patient ratings of their care and indicators of quality of care. DESIGN:Cross-sectional patient discharge data, hospital characteristics and nurse and patient survey data were merged and analysed using generalised estimating equations (GEE) and logistic regression models. SETTING:Adult acute care hospitals in Belgium, England, Finland, Ireland, Spain and Switzerland. PARTICIPANTS:Survey data were collected from 13?077 nurses in 243 hospitals, and 18?828 patients in 182 of the same hospitals in the six countries. Discharge data were obtained for 275?519 surgical patients in 188 of these hospitals. MAIN OUTCOME MEASURES:Patient mortality, patient ratings of care, care quality, patient safety, adverse events and nurse burnout and job dissatisfaction. RESULTS:Richer nurse skill mix (eg, every 10-point increase in the percentage of professional nurses among all nursing personnel) was associated with lower odds of mortality (OR=0.89), lower odds of low hospital ratings from patients (OR=0.90) and lower odds of reports of poor quality (OR=0.89), poor safety grades (OR=0.85) and other poor outcomes (0.80<OR<0.93), after adjusting for patient and hospital factors. Each 10 percentage point reduction in the proportion of professional nurses is associated with an 11% increase in the odds of death. In our hospital sample, there were an average of six caregivers for every 25 patients, four of whom were professional nurses. Substituting one nurse assistant for a professional nurse for every 25 patients is associated with a 21% increase in the odds of dying. CONCLUSIONS:A bedside care workforce with a greater proportion of professional nurses is associated with better outcomes for patients and nurses. Reducing nursing skill mix by adding nursing associates and other categories of assistive nursing personnel without professional nurse qualifications may contribute to preventable deaths, erode quality and safety of hospital care and contribute to hospital nurse shortages.

Dataset Information

A quantitative systematic review of the association between nurse skill mix and nursing-sensitive patient outcomes in the acute care setting.

Aims

Design

Data sources

Review methods

Results

Conclusion

Impact

Publications

A quantitative systematic review of the association between nurse skill mix and nursing-sensitive patient outcomes in the acute care setting.

Similar Datasets

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