Nurse Staffing and Patient Outcomes During a Natural Disaster

Abstract

Background Hurricane Sandy was the most destructive natural disaster ever to hit the eastern seaboard of the United States. It disrupted the healthcare system, the sustainability of staff, and the quality of patient care. Purpose The purpose of this study was to examine the association between nurse staffing and patient outcomes in New Jersey hospitals during Hurricane Sandy and to determine whether nurse mobility through the Nurse Licensure Compact could have improved patient outcomes. Methods This study was a cross-sectional analysis of secondary data from multiple sources. Multivariate regression models were used to examine the association between nurse staffing and patient outcomes. Workforce projection models were used to determine whether unemployed nurses in Pennsylvania would be able to meet the need for nurses in New Jersey. Results Nineteen out of 21 counties in New Jersey had a shortage of nurses. Low nurse staffing was associated with poor patient outcomes in New Jersey hospitals during Hurricane Sandy. An increase in the number of nursing hours per patient day could have reduced the average patient length of stay (coefficient = -0.05, p < .01) and lowered the probability of in-hospital mortality (OR = 0.90, p = .03) and two non-mortality adverse events: pressure ulcers (OR = 0.91, p < .01) and restraint use (OR = 0.94, p = .03). The estimated nursing shortages could have been addressed by the large number of unemployed nurses available in seven state borderline counties of Pennsylvania; however, there was no legal mechanism in place to allow for cross-border practice. Conclusion This study suggests that the Nurse Licensure Compact should be implemented nationwide to facilitate mobility of nurses and to increase the surge capacity of hospitals and healthcare systems. Hurricane Sandy was the most destructive natural disaster ever to hit the eastern seaboard of the United States. It disrupted the healthcare system, the sustainability of staff, and the quality of patient care. The purpose of this study was to examine the association between nurse staffing and patient outcomes in New Jersey hospitals during Hurricane Sandy and to determine whether nurse mobility through the Nurse Licensure Compact could have improved patient outcomes. This study was a cross-sectional analysis of secondary data from multiple sources. Multivariate regression models were used to examine the association between nurse staffing and patient outcomes. Workforce projection models were used to determine whether unemployed nurses in Pennsylvania would be able to meet the need for nurses in New Jersey. Nineteen out of 21 counties in New Jersey had a shortage of nurses. Low nurse staffing was associated with poor patient outcomes in New Jersey hospitals during Hurricane Sandy. An increase in the number of nursing hours per patient day could have reduced the average patient length of stay (coefficient = -0.05, p < .01) and lowered the probability of in-hospital mortality (OR = 0.90, p = .03) and two non-mortality adverse events: pressure ulcers (OR = 0.91, p < .01) and restraint use (OR = 0.94, p = .03). The estimated nursing shortages could have been addressed by the large number of unemployed nurses available in seven state borderline counties of Pennsylvania; however, there was no legal mechanism in place to allow for cross-border practice. This study suggests that the Nurse Licensure Compact should be implemented nationwide to facilitate mobility of nurses and to increase the surge capacity of hospitals and healthcare systems.