The Effect of Variations in Nurse Staffing on Patient Length of Stay in the Acute Care Setting
ABSTRACT This study examines the relationship between nurse staffing and patient length of stay (LOS). Data were collected on nurses employed and patients admitted to one of four study units located in two Midwest hospitals. Three nursing variables (hours per patient day [HPPD], skill mix, and nursing expertise) were collected through survey and administrative forms. The nursing data were then linked with patient-specific characteristics (deviation from expected LOS) to test the relationship at the patient level of analysis. Average HPPD was a positive predictor of deviation from expected LOS, whereas overall expertise was a negative predictor of deviation from expected LOS. Higher staffing levels may result in patients being discharged sooner than expected. Nurse administrators must consider the quantity as well as quality of staff when determining optimal staffing levels. Unit staffing levels must include nurses who have both experiential and theoretical knowledge in order to achieve optimal patient outcomes.
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ABSTRACT: BACKGROUND: The nursing care hour has become an international standard unit of measure in research where nurse staffing is a key variable. Until now, there have been no studies verifying whether nursing care hours obtained from hospital data sources can be collected reliably. OBJECTIVES: To examine the processes used by hospitals to generate nursing care hour data and to evaluate inter-rater reliability and guideline compliance with standards of the National Database of Nursing Quality Indicators(®) (NDNQI(®)) and the National Quality Forum. DESIGN AND SETTING: Two-phase descriptive study of all NDNQI hospitals that submitted data in third quarter of 2007. METHODS: Data for phase I came from an online survey created by the authors to ascertain the processes used by hospitals to collect nursing care hours and their compliance with standardized data collection guidelines. In phase II, inter-rater reliability was measured using intra-class correlations between nursing care hours generated from clock hour files submitted to the study team by participants' payroll/accounting departments and aggregated data submitted previously. RESULTS: Phase I data were obtained from a total of 714 respondents. Nearly half (48%) of all sites use payroll records to obtain nursing care hour data and 70% use one of the standardized methods for converting the bi-weekly hours into months. Unit secretaries were reportedly included in NCH by 17.4% of respondents and only 26.2% of sites could accurately identify the point at which newly hired nurses should be included. The phase II findings (n=11) support the ability of two independent raters to obtain similar results when calculating total nursing care hours according to standard guidelines (ICC=0.76-0.99). CONCLUSIONS: Although barriers exist, this study found support for hospitals' abilities to collect reliable nursing care hour data.International journal of nursing studies 08/2012; 50(7). DOI:10.1016/j.ijnurstu.2012.07.012 · 2.25 Impact Factor
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ABSTRACT: Iran's health-care system has witnessed profound changes in the last decades. Despite its progress, the system has currently faced many challenges in one of the important subsystems, nursing. The present review article aimed to present an overview of the opportunities and challenges of the Iranian nursing system, based on recent literature. A broad search of the English and Persian-language literature was carried out, incorporating both electronic and manual components from 1999 to 2009. The results of the investigations among the searched literature are summarized. The major challenges are nursing shortages, job dissatisfaction, poor social position of nurses, the gap between theory and practice, lack of community-based nursing care, lack of an appropriate student recruiting system, and shortages in the nursing educational curriculums. The authors believe that media, political and public support play a pivotal role in improving the image of nursing in society, increasing motivation among Iranian nurses, and promoting the sociocultural climate and the welfare of nurses, which will result in higher levels of quality of care as well as greater patient satisfaction.Japan Journal of Nursing Science 06/2010; 7(1):9-18. DOI:10.1111/j.1742-7924.2010.00137.x · 0.49 Impact Factor
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ABSTRACT: Recent research has highlighted the impact of nursing care on patient outcomes. The link to staffing has also been documented for selected conditions. To date, efforts to establish nurse-sensitive measures have focused largely on adults. This article describes the project undertaken to select and pilot 2 pediatric indicators of nursing quality care to be included in an ongoing national benchmarking program.Journal of nursing care quality 01/2006; 21(3):210-20; quiz 221-2. DOI:10.1097/00001786-200607000-00004 · 1.09 Impact Factor