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Peer-Reviewed

Nurse-Staffing Levels and the Quality of Care in Hospitals

Jack Needleman, Ph.D., Peter Buerhaus, Ph.D., R.N., Soeren Mattke, M.D., M.P.H., Maureen Stewart, B.A., and Katya Zelevinsky
N Engl J Med 2002; 346:1715-1722May 30, 2002DOI: 10.1056/NEJMsa012247

Hospitals, wrote Lewis Thomas in The Youngest Science, are “held together, glued together, enabled to function . . . by the nurses.”1 More than 1.3 million registered nurses work in hospitals in the United States. As hospitals have responded to financial pressure from Medicare, managed care, and other private payers, registered nurses have become increasingly dissatisfied with the working conditions in hospitals. They report that they are spending less time taking care of increasingly ill patients and believe that the safety and quality of inpatient care are deteriorating.2-7 Although the number of hours of care per patient-day provided by registered nurses rose through the mid-1990s,8-12 some question whether the staffing of nurses has increased rapidly enough to keep pace with the increasing severity of illness among hospitalized patients and thus to ensure safe and high-quality care.13

Research on the relation between the level of staffing by nurses in hospitals and patients’ outcomes has been inconclusive. Whereas some studies have reported an association between higher levels of staffing by nurses and lower mortality,14-20 as well as lower rates of other adverse outcomes,21-30 others have found no such relations.30-39 Previous studies have assessed only a limited number of outcomes that are sensitive to the extent or quality of nursing care, such as falls by patients and errors in medication. Many studies have used small samples of hospitals, controlled only to a limited extent for the patient’s initial risk for the outcomes under study, failed to include nurses’ aides as part of the nursing staff, and used inconsistent measures of staffing levels. We examined the relation between the levels of staffing by nurses in hospitals and the rates of adverse outcomes among patients, using administrative data from a large multi-state sample of hospitals.

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Peer-Reviewed

Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction

Context The worsening hospital nurse shortage and recent California legislation mandating minimum hospital patient-to-nurse ratios demand an understanding of how nurse staffing levels affect patient outcomes and nurse retention in hospital practice.

Objective To determine the association between the patient-to-nurse ratio and patient mortality, failure-to-rescue (deaths following complications) among surgical patients, and factors related to nurse retention.

Design, Setting, and Participants Cross-sectional analyses of linked data from 10 184 staff nurses surveyed, 232 342 general, orthopedic, and vascular surgery patients discharged from the hospital between April 1, 1998, and November 30, 1999, and administrative data from 168 nonfederal adult general hospitals in Pennsylvania.

Main Outcome Measures Risk-adjusted patient mortality and failure-to-rescue within 30 days of admission, and nurse-reported job dissatisfaction and job-related burnout.

Results After adjusting for patient and hospital characteristics (size, teaching status, and technology), each additional patient per nurse was associated with a 7% (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.03-1.12) increase in the likelihood of dying within 30 days of admission and a 7% (OR, 1.07; 95% CI, 1.02-1.11) increase in the odds of failure-to-rescue. After adjusting for nurse and hospital characteristics, each additional patient per nurse was associated with a 23% (OR, 1.23; 95% CI, 1.13-1.34) increase in the odds of burnout and a 15% (OR, 1.15; 95% CI, 1.07-1.25) increase in the odds of job dissatisfaction.

Conclusions In hospitals with high patient-to-nurse ratios, surgical patients experience higher risk-adjusted 30-day mortality and failure-to-rescue rates, and nurses are more likely to experience burnout and job dissatisfaction.

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Care Staffing Nursing Discussing Doctor mentor
Peer-Reviewed

Evaluation of a peer mentor program for early career gerontological nursing faculty and its potential for application to other fields in nursing and health sciences

Mentor Highlights
•Non-traditional mentorship is important for developing the academic nursing workforce.
•Peer mentorship can successfully assist in early career academic development.
•Peer mentorship can help early career academics to expand their professional network.
•Peer mentorship can be successfully integrated into professional organization.

Abstract
Background
As the retirement rate of senior nursing faculty increases, the need to implement new models for providing mentorship to early career academics will become key to developing and maintaining an experienced faculty.

Purpose
This evaluation of a peer mentorship program for predoctoral and postdoctoral gerontological nurses examined its efficacy, utility, and potential for improvement.

Methods
A web-based survey was developed, implemented, and completed by 22 mentees and 17 mentors (71% and 61% response rates, respectively) as part of the evaluation.

Discussion
The peer mentorship program was found to be valuable by both mentors (64.7%) and mentees (72.7%) in helping mentees further develop their careers and networks and providing mentors with supported mentorship experience.

Conclusion
The peer mentorship program could serve as a model for other professional organizations, academic institutions, and consortiums to enhance and extend the formal vertical mentorship provided to early academic career individuals.

For full text visit, http://www.nursingoutlook.org/article/S0029-6554(16)30011-2/fulltext

Care Staffing Professionals