Nurse Specialty Certification, Inpatient Mortality, and Failure to Rescue

University of Texas Health Science Center San Antonio, School of Nursing, Texas, USA.
Journal of Nursing Scholarship (Impact Factor: 1.64). 06/2011; 43(2):188-94. DOI: 10.1111/j.1547-5069.2011.01391.x
Source: PubMed


To determine if hospital proportion of staff nurses with specialty certification is associated with risk-adjusted inpatient 30-day mortality and failure to rescue (deaths in surgical inpatients following a major complication).
Secondary analysis of risk-adjusted adult general, orthopedic, and vascular surgical inpatients discharged during 2005-2006 (n= 1,283,241) from 652 nonfederal hospitals controlling for state, hospital, patient, and nursing characteristics by linking outcomes, administrative, and nurse survey data (n= 28,598).
Nurse data, categorized by education and certification status, were aggregated to the hospital level. Logistic regression models were used to estimate effects of specialty certification and other nursing characteristics on mortality and failure to rescue.
Hospital proportion of baccalaureate and certified baccalaureate staff nurses were associated with mortality and failure to rescue; no effect of specialization was seen in the absence of baccalaureate education. A 10% increase in hospital proportion of baccalaureate and certified baccalaureate staff nurses, respectively, decreased the odds of adjusted inpatient 30-day mortality by 6% and 2%; results for failure to rescue were identical.
Nurse specialty certification is associated with better patient outcomes; effect on mortality and failure to rescue in general surgery patients is contingent upon baccalaureate education. Clinical Relevance: Investment in a baccalaureate-educated workforce and specialty certification has the potential to improve the quality of care.

64 Reads
  • Source
    • "These Magnet hospital nurses also report opportunities to influence decisions about workplace organization and patient care, and they report excellent relationships with physicians and advanced practice nurses (Hess, DesRoches, Donelan, Norman, & Buerhaus, 2011). Nurses in Magnet hospitals are also more likely to baccalaureate prepared and have specialty certification (McHugh et al., 2013) both of which have been linked to the quality of patient care (Aiken, Clarke, Cheung, Sloane, & Silber, 2003; Aiken et al., 2011; Boyle, Gajewski, & Miller, 2012; Kendall-Gallagher, Aiken, Sloane, & Cimiotti, 2011; Kutney-Lee, Sloane, & Aiken, 2013). In this study, our findings suggest that emergency department patients with symptoms of acute coronary syndrome or AMI are more likely to receive the care they need if they were treated in hospitals that are Magnet accredited. "
    [Show abstract] [Hide abstract]
    ABSTRACT: During a stay in the emergency department the treatment that cardiac patients receive can have a significant effect on health outcomes; yet, little is known about the process of care in emergency departments. In this study we examined the effect of nurse resources on the process of care in all New Jersey hospital-based emergency departments. Patient-to-nurse ratio, nurse skill mix, and Magnet accreditation were associated with aspirin on arrival and percutaneous coronary intervention within 90minutes of arrival.
    Applied Nursing Research 07/2014; 28(2). DOI:10.1016/j.apnr.2014.06.002 · 0.73 Impact Factor
  • Source
    • "This reflects the idea of a theory/practice gap: an issue that has long confounded nursing scholars. In the 1990s Walker [6] highlighted the tensions between thinking and doing nursing; and this tension continues, despite increasing numbers of clinical nurses pursuing higher degree education and research [7,8]. These pursuits are often seen internationally as essential criteria for clinical expert positions. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Clinical scholarship has been conceptualised and theorised in the nursing literature for over 30 years but no research has captured nurses’ clinicians’ views on how it differs or is the same as clinical expertise and clinical leadership. The aim of this study was to determine clinical nurses’ understanding of the differences and similarities between the clinical expert, clinical leader and clinical scholar. Methods A descriptive interpretative qualitative approach using semi-structured interviews with 18 practising nurses from Australia, Canada and England. The audio-taped interviews were transcribed and the text coded for emerging themes. The themes were sorted into categories of clinical expert, clinical leader and clinical scholarship as described by the participants. These themes were then compared and contrasted and the essential elements that characterise the nursing roles of the clinical expert, clinical leader and clinical scholar were identified. Results Clinical experts were seen as linking knowledge to practice with some displaying clinical leadership and scholarship. Clinical leadership is seen as a positional construct with a management emphasis. For the clinical scholar they linked theory and practice and encouraged research and dissemination of knowledge. Conclusion There are distinct markers for the roles of clinical expert, clinical leader and clinical scholar. Nurses working in one or more of these roles need to work together to improve patient care. An ‘ideal nurse’ may be a blending of all three constructs. As nursing is a practice discipline its scholarship should be predominantly based on clinical scholarship. Nurses need to be encouraged to go beyond their roles as clinical leaders and experts to use their position to challenge and change through the propagation of knowledge to their community.
    BMC Nursing 04/2013; 12(1):12. DOI:10.1186/1472-6955-12-12
  • [Show abstract] [Hide abstract]
    ABSTRACT: Certification is accepted as a universal affirmation of expertise. Nurse educators validate and demonstrate expertise in nursing education by earning the Certified Nurse Educator credential offered through the National League for Nursing's Academic Nurse Educator Certification Program. Educators can prepare to achieve success in certification by reviewing eligibility requirements, creating an individual preparation plan, and using integrated, evidence-based learning strategies.
    Nurse educator 01/2014; 39(1):45-8. DOI:10.1097/NNE.0000000000000002 · 0.67 Impact Factor
Show more