Nurse Staffing Levels Research Articles

Level of Resident Care Need and Staffing by Size of Nursing Home under the Public Long-term Care Insurance in South Korea

Purpose: Formal long-term care in nursing homes became a popular means of caring for frail elders in South Korea. This universal long-term care (LTC) insurance for elders was introduced in 2008. The aim of this study was to provide information on the extent of and variations in residents’ care needs and nursing staffing characteristics across nursing homes. Methods: This was a population-based secondary analysis of a large national survey study involving 1,472 older residents in 92 nursing homes in South Korea in 2013. Characteristics of residents and nursing homes were collected by functional assessment and an examination of administrator surveys for nursing home size was done using descriptive analysis. Results: Small and small-medium nursing homes were more likely to provide care to non-Medical-aid beneficiaries and older people with lower care need level. These smaller homes also better met the minimum nursing staffing standard. However, they were less likely to hire registered nurses (RNs), as it is not yet a staffing requirement for nursing homes in Korea. Conclusion: South Korea has a policy agenda to increase nursing staffing level, especially by adding RNs, and decrease variations in staffing levels by nursing home size. Further evidence on care-need level, proper resource allocation, and policies designed to strengthen the LTC workforce is essential to advance the LTC system in Korea.

The association between nurse staffing levels and a failure to respond to patients with deranged physiology: A retrospective observational study in the UK

BackgroundResponding to abnormalities in patients’ vital signs is a fundamental aspect of nursing. However, failure to respond to patient deterioration is common and often leads to adverse patient outcomes. This study aimed to determine the association between Registered Nurse (RN) and Nursing Assistant (NA) staffing levels and the failure to respond promptly to patients’ abnormal physiology. MethodsThis retrospective, observational study used routinely collected patients’ vital signs and administrative data, including nursing staffing, from 32 general wards of an acute hospital in England between April 2012 and March 2015. Mixed-effects binomial regression was used to model the relationship between nurse staffing, measured as ‘Hours per Patient Day’ (HPPD), and a composite primary outcome representing failure to respond for patients with National Early Warning Score (NEWS) values ≥ 6 and ≥ 7. ResultsThere were 189,123 NEWS values ≥ 6 and 114,504 NEWS values ≥ 7, affecting 28,098 patients. For patients with NEWS values ≥ 7, failure to respond was significantly associated with levels of RN HPPD ((IRR 0.98, 95% CI 0.96–0.99, p = 0.0001) but not NA HPPD (((IRR 0.99, 95%CI 0.96–1.01, p = 0.238). For patients with NEWS values ≥ 6, no such relationship existed. ConclusionsRN, but not NA, staffing levels influence the rates of failure to respond for patients with the most abnormal vital signs (NEWS values ≥ 7). These findings offer a possible explanation for the increasingly reported association between low RN staffing and an increased risk of patient death during a hospital admission.

Sustainers: Hospitals with sustained superior performance.

The purpose of this article was to investigate the organizational and market-level variables associated with sustained superior hospital performance on Value-Based Purchasing total performance scores (TPS). TPS for 2014 through 2017 was obtained from the Centers for Medicare & Medicaid Services Hospital Compare website. Market-level data were from the 2017 Area Health Resource File, and hospital-level data were from the 2014 American Hospital Association Annual Survey database. We specified a logistic regression model to identify significant predictors of hospitals with sustained superior performance on TPS, that is, "sustainers." Only 8.4% of hospitals were classified as sustainers. Hospitals located in rural markets with a high Medicare Advantage penetration had a higher likelihood of being classified as sustainers. High RN staffing levels, lower Medicare share of inpatient days, not-for-profit ownership, and small size were all significant organizational predictors of sustained superior performance. Both modifiable characteristics, such as nurse staffing levels, and nonmodifiable characteristics, such as rural markets and small hospital size, are associated with the likelihood of hospitals sustaining superior performance over time. Managers need to carefully examine their staffing levels as they pursue interventions to sustain high TPS overtime. Moreover, factors such as Medicare share of inpatient days and size need to be considered when understanding barriers to sustained performance on Value-Based Purchasing domains.

Appropriate Nurse Staffing Levels for U.S. Nursing Homes.

US nursing homes are required to have sufficient nursing staff with the appropriate competencies to assure resident safety and attain or maintain the highest practicable level of physical, mental, and psychosocial well-being of each resident. Minimum nurse staffing levels have been identified in research studies and recommended by experts. Beyond the minimum levels, nursing homes must take into account the resident acuity to assure they have adequate staffing levels to meet the needs of residents. This paper presents a guide for determining whether a nursing home has adequate and appropriate nurse staffing. We propose five basic steps to: (1) determine the collective resident acuity and care needs, (2) determine the actual nurse staffing levels, (3) identify appropriate nurse staffing levels to meet residents care needs, (4) examine evidence regarding the adequacy of staffing, and (5) identify gaps between the actual staffing and the appropriate nursing staffing levels based on resident acuity. Data sources and specific methodologies are analyzed, compared, and recommended. The goal is to assist nursing home nurses and administrators to ensure adequate nursing home staffing levels that protect resident health, safety, and well-being.

Nurse Staffing and Health Outcomes of Psychiatric Inpatients: A Secondary Analysis of National Health Insurance Claims Data.

The present study investigated the association between nurse staffing and health outcomes among psychiatric inpatients in Korea by assessing National Health Insurance claims data. The dataset included 70,136 patients aged 19 years who were inpatients in psychiatric wards for at least two days in 2016 and treated for mental and behavioral disorders due to use of alcohol; schizophrenia, schizotypal and delusional disorders; and mood disorders across 453 hospitals. Nurse staffing levels were measured in three ways: registered nurse-to-inpatient ratio, registered nurse-to-adjusted inpatient ratio, and nursing staff-to-adjusted inpatient ratio. Patient outcomes included length of stay, readmission within 30 days, psychiatric emergency treatment, use of injected psycholeptics for chemical restraint, and hypnotics use. Relationships between nurse staffing levels and patient outcomes were analyzed considering both patient and system characteristics using multilevel modeling. Multilevel analyses revealed that more inpatients per registered nurse, adjusted inpatients per registered nurse, and adjusted inpatients per nursing staff were associated with longer lengths of stay as well as a higher risk of readmission. More adjusted inpatients per registered nurse and adjusted inpatients per nursing staff were also associated with increased hypnotics use but a lower risk of psychiatric emergency treatment. Nurse staffing levels were not significantly associated with the use of injected psycholeptics for chemical restraint. Lower nurse staffing levels are associated with negative health outcomes of psychiatric inpatients. Policies for improving nurse staffing toward an optimal level should be enacted to facilitate better outcomes for psychiatric inpatients in Korea.

The Effects of Long-term Care Hospitals' Nurse Staffing Level on Patient Outcomes: Differences according to Region

The Effects of Long-term Care Hospitals' Nurse Staffing Level on Patient Outcomes: Differences according to Region

ONS Staffing Position Statement: Ambulatory Treatment Centers.

Appropriate nurse staffing levels contribute to the delivery of safe quality care and optimal patient outcomes. However, developing nurse staffing models, particularly in the ambulatory setting, is an ongoing challenge. Within this position statement, the term ambulatory setting includes infusion centers that provide treatment to patients with cancer, including non-chemotherapy treatment centers (e.g., blood products) and radiation therapy treatment centers. These settings share commonalities, including rapid turnover of patients and the administration of some type of treatment or intervention. Nurse staffing refers to the clinical nurses in the setting and does not include advanced practice nurses or nurses in other roles.

Temporary Staffing and Patient Death in Acute Care Hospitals: A Retrospective Longitudinal Study.

To explore the association between the levels of temporary nurse staffing and patient mortality. Achieving adequate nurse staffing levels plays a vital role in keeping patients safe from harm. The evidence around deploying temporary staffing to maintain safe staffing levels is mixed, with some studies reporting no adverse effects on patient mortality. A retrospective longitudinal observational study using routinely collected data on 138,133 patients admitted to a large hospital in the south of England. Data were collected between April 2012 and April 2015. We used multilevel survival models to explore the association between in-hospital deaths and daily variation in registered nurse (RN) and nursing assistant (NA) temporary staffing, measured as hours per patient per day. Analyses controlled for unit and patient risk. Use of temporary staffing was common, with only 24% (n = 7,529) of the 30,980 unit-days having no temporary RN staff and 13% (n = 3,951) having no temporary NAs. The hazard of death was increased by 12% for every day a patient experienced high levels (1.5 hr or more per day) of RN temporary staffing (adjusted hazard ratio [aHR] 1.12, 95% confidence interval [CI] 1.03-1.21). The hazard of death was increased on days when NA temporary staffing was more than 0.5 hr per patient (aHR 1.06; 95% CI 1.03-1.08). Days with more than 1.5 hr per patient of temporary RNs and days with more than 0.5 hr of temporary NAs were associated with increased hazard of death. Heavy reliance on temporary staff is associated with higher risk for patients dying. There is no evidence of harm associated with modest use of temporary RNs so that required staffing levels can be maintained.

Hospital nursing personnel staffing and patient outcome

The purpose of this review is to comment on the association between hospital nursing personnel staffing and patient outcomes, including the avoidance of errors and complications. A literature search was carried out in the Medline database on publications from the last 10years on nursing personnel staffing. Only overviews and observational studies on the topic were available and no controlled or prospective surveys. Most investigators assumed that there was an inverse relationship between low nursing staff levels of hospital wards and intensive care and adverse outcomes, including higher mortality rates; however, there is no clear significance for this assumption and evidence-based definitive lower limits for nursing staff cannot be given due to alack of randomized trials. The causes for unfavorable results in the case of inadequate nursing personnel staffing include hygiene deficiencies, orders not followed and unfulfilled nursing and monitoring measures. Furthermore, staff overload leads to staff dissatisfaction and burnout, which also has anegative impact on the results. Most studies required amaximum patient to nurse ratio of 2:1 for the intensive care unit and an average ratio of not more than 8:1 for surgical wards. With respect to these requirements, changing personnel needs must be considered depending on the current state of the patients being cared for, which enabled all investigators to require aflexible roster design; approval for fixed statutory lower limits for nursing staff was low. The level of education of the nursing staff also played an essential role as qualified nursing staff cannot be replaced at will by less qualified assistant staff. The level of training and the number of the nursing personnel influence hospital mortality and adverse outcomes; however, there are no evidence-based lower levels for nursing staff for inpatient care and perhaps this cannot be the case due to the changing complexity of the patients admitted, the comorbidities and possible treatment complications. There is aconsiderable need for research.

Nursing workload, nurse staffing methodologies and tools: A systematic scoping review and discussion

BackgroundThe importance of nurse staffing levels in acute hospital wards is widely recognised but evidence for tools to determine staffing requirements although extensive, has been reported to be weak. Building on a review of reviews undertaken in 2014, we set out to give an overview of the major approaches to assessing nurse staffing requirements and identify recent evidence in order to address unanswered questions including the accuracy and effectiveness of tools. MethodsWe undertook a systematic scoping review. Searches of Medline, the Cochrane Library and CINAHL were used to identify recent primary research, which was reviewed in the context of conclusions from existing reviews. ResultsThe published literature is extensive and describes a variety of uses for tools including establishment setting, daily deployment and retrospective review. There are a variety of approaches including professional judgement, simple volume-based methods (such as patient-to-nurse ratios), patient prototype/classification and timed-task approaches. Tools generally attempt to match staffing to a mean average demand or time requirement despite evidence of skewed demand distributions. The largest group of recent studies reported the evaluation of (mainly new) tools and systems, but provides little evidence of impacts on patient care and none on costs. Benefits of staffing levels set using the tools appear to be linked to increased staffing with no evidence of tools providing a more efficient or effective use of a given staff resource. Although there is evidence that staffing assessments made using tools may correlate with other assessments, different systems lead to dramatically different estimates of staffing requirements. While it is evident that there are many sources of variation in demand, the extent to which systems can deliver staffing levels to meet such demand is unclear. The assumption that staffing to meet average need is the optimal response to varying demand is untested and may be incorrect. ConclusionsDespite the importance of the question and the large volume of publication evidence about nurse staffing methods remains highly limited. There is no evidence to support the choice of any particular tool. Future research should focus on learning more about the use of existing tools rather than simply developing new ones. Priority research questions include how best to use tools to identify the required staffing level to meet varying patient need and the costs and consequences of using tools. Tweetable abstractDecades of research on tools to determine nurse staffing requirements is largely uninformative. Little is known about the costs or consequences of widely used tools.

The impact of nurse staffing levels and nurse\u2019s education on patient mortality in medical and surgical wards: an observational multicentre study

BackgroundGrowing evidence indicates that improved nurse staffing in acute hospitals is associated with lower hospital mortality. Current research is limited to studies using hospital level data or without proper adjustment for confounders which makes the translation to practice difficult.MethodIn this observational study we analysed retrospectively the control group of a stepped wedge randomised controlled trial concerning 14 medical and 14 surgical wards in seven Belgian hospitals. All patients admitted to these wards during the control period were included in this study. Pregnant patients or children below 17 years of age were excluded. In all patients, we collected age, crude ward mortality, unexpected death, cardiac arrest with Cardiopulmonary Resuscitation (CPR), and unplanned admission to the Intensive Care Unit (ICU). A composite mortality measure was constructed including unexpected death and death up to 72 h after cardiac arrest with CPR or unplanned ICU admission. Every 4 months we obtained, from 30 consecutive patient admissions across all wards, the Charlson comorbidity index. The amount of nursing hours per patient days (NHPPD) were calculated every day for 15 days, once every 4 months. Data were aggregated to the ward level resulting in 68 estimates across wards and time. Linear mixed models were used since they are most appropriate in case of clustered and repeated measures data.ResultsThe unexpected death rate was 1.80 per 1000 patients. Up to 0.76 per 1000 patients died after CPR and 0.62 per 1000 patients died after unplanned admission to the ICU. The mean composite mortality was 3.18 per 1000 patients. The mean NHPPD and proportion of nurse Bachelor hours were respectively 2.48 and 0.59. We found a negative association between the nursing hours per patient day and the composite mortality rate adjusted for possible confounders (B = − 2.771, p = 0.002). The proportion of nurse Bachelor hours was negatively correlated with the composite mortality rate in the same analysis (B = − 8.845, p = 0.023). Using the regression equation, we calculated theoretically optimal NHPPDs.ConclusionsThis study confirms the association between higher nurse staffing levels and lower patient mortality controlled for relevant confounders.

THE IMPACT OF MEDICARE ADVANTAGE ON SKILLED NURSING FACILITY FINANCIAL PERFORMANCE, STAFFING, AND QUALITY

Since the mid-2000s, skilled nursing facilities (SNFs) face an increasing percentage of post-acute care patients enrolled in Medicare Advantage (MA), yet our understanding the of how this affects SNFs is limited. Managed care may provide better coordination and continuous care that enhances SNF quality, but MA plans can also negotiate lower payments, providing SNFs with fewer financial resources to invest in staffing and quality. We use data from 2011-2015 from Medicare Beneficiary Summary File, Minimum Data Set, Certification and Survey Provider Enhanced Reporting, and Medicare Cost Reports to estimate linear fixed effect panel regressions with instrumental variables. We find that SNFs with greater MA share of post-acute care admissions have worse financial performance, lower nursing staff levels, and worse quality as measured by deficiency scores. Our finding favors the hypothesis that MA creates downward financial pressure and strong MA presence in local markets can potentially to spillover to non-MA residents.

Are hospital nurse staffing practices associated with postoperative cardiac events and death? A systematic review.

IntroductionPostoperative cardiac events are frequent complications of surgery, and their occurrence could be associated with suboptimal nurse staffing practices, but the existing evidence remains scattered. We systematically reviewed studies linking nurse staffing practices to postoperative cardiac events and two related outcomes, all-cause mortality and failure-to-rescue.MethodsA systematic search of the English/French literature was undertaken in the CINAHL, PsychInfo, and Medline databases. Studies were included if they: a) were published between 1996 and 2018; b) used a quantitative design; c) examined the association between at least one of seven staffing practices of interest (i.e., staffing levels, skill mix, work environment characteristics, levels of education and experience of the registered nurses, and overtime or temporary staff use) and postoperative cardiac events, mortality or failure-to-rescue; and d) were conducted among surgical patients. Data extraction, analysis, and synthesis, along with study methodological quality appraisal, were performed by two authors. High methodological heterogeneity precluded a formal meta-analysis.ResultsAmong 3,375 retrieved articles, 44 studies were included (39 cross-sectional, 3 longitudinal, 1 case-control, 1 interrupted time series). Existing evidence shows that higher nurse staffing levels, a higher proportion of registered nurses with an education at the baccalaureate degree level, and more supportive work environments are related to lower rates of both 30-day mortality and failure-to-rescue. Other staffing practices were less often studied and showed inconsistent associations with mortality or failure-to-rescue. Similarly, few studies (n = 10) examined the associations between nurse staffing practices and postoperative cardiac events and showed inconsistent results.ConclusionHigher nurse staffing levels, higher registered nurse education (baccalaureate degree level) and more supportive work environments were cross-sectionally associated with lower 30-day mortality and failure-to-rescue rates among surgical patients, but longitudinal studies are required to corroborate these associations. The existing evidence regarding postoperative cardiac events is limited, which warrants further investigation.

An observational study on the rate of reporting of adverse event on healthcare staff in a mental health setting: An application of Poisson expectation maximisation analysis on nurse staffing data.

Evidence highlights the intrinsic link between nurse staffing and expertise, and outcomes for service users of healthcare, and that workforce retention is linked to the clinical and organisational experiences of employees. However, this understanding is less well established in mental health. This study comprises a retrospective observational study carried out on routinely collected data from a large mental healthcare provider. Two databases comprising nurse staffing levels and adverse events were modelled using latent variable methods to account for the presence of multiple underlying behaviours. The analysis reveals a strong dependence of the rate of adverse events on the location and perceived clinical demand of the wards, and a reduction in adverse events where registered nurses exceed 'clinically required levels'. In the first study of its kind, these findings present significant implications for nursing workforce policy and present an opportunity to not only improve safety but potentially impact nurse retention.

Mothering the Mother: An Educational Program for Nurse-Provided Continuous Labor Support.

Continuous labor support (CLS) is associated with improved outcomes including decreased cesarean birth, increased 5-minute APGAR scores, decreased postpartum depression, and decreased nurse turnover rates. Despite this, CLS is not consistently practiced perhaps due to lack of education regarding the benefits of CLS and nurse staffing levels on birthing units. This article will discuss CLS benefits and implementation of an educational program designed to enhance nursing practice with regard to CLS and an educational program designed to provide five skills to perinatal nurses in order to enhance clinical practice. Pretest and posttests were administered and there was a significant knowledge increase related to nurse-provided CLS (p = .001) after attending the program.

PALTC Steps Up Strategies to Attract Nurses

PALTC Steps Up Strategies to Attract Nurses

Public Reporting of Nurse Staffing in the United States

Extensive evidence supports the association between increased nurse staffing and improved quality of patient care. Public reporting or public disclosure of nurse staffing patterns aims to incentivize hospitals to improve staffing by making comparison data available for consumers as well as nurses and hospital administrators. Currently, eight states in the United States publicly report and disclose information on nurse staffing levels to the public. We review the available public reporting mechanisms by systematically categorizing and comparing states that report nurse staffing. We also discuss the implications for future state and federal policy with regard to publicly reporting or disclosing nurse staffing.

Nurse staffing and hospital-acquired conditions: A systematic review.

To systematically review and synthesise primary studies on the relationship between nurse staffing and hospital-acquired conditions. Research examining the association between nurse staffing and hospital-acquired conditions is varied owing to the use of different definitions and methods. This study was conducted based on a systematic review of related nursing literature. The CINAHL, Cochrane Library, DBpia, EBSCO, PubMed, PsycINFO and RISS databases were searched for either English or Korean language studies published between January 2000 and August 2018 that examined the association between nurse staffing and hospital-acquired conditions. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses check list. Totally, 19 published studies were included in the systematic review. Various measures were used to examine association between nurse staffing and hospital-acquired conditions. The majority of the reviewed studies revealed negative relationships between nurse staffing levels and hospital-acquired conditions. However, a substantial number of relationships were not significant. There is a need for future studies to examine the differences in the relationship between nurse staffing and hospital-acquired conditions and to use precise data collection on registered nurses' hours per patient day and total hours per patient day, as it is difficult to collect data on these measures. The findings of this study suggest that sufficient nurse staffing is a strong indicator of the provision of quality patient care. However, continuous efforts are recommended to find more conclusive relationships between nurse staffing and hospital-acquired conditions and to formulate guidelines regarding nurse staffing strategies. Nurse staffing is an important managerial strategy. Especially, given health policy changes, hospitals need to develop staffing strategies to prevent hospital-acquired conditions.

Determining health visitor staffing levels in Wales

Work is under way on an evidence-based workforce planning tool to determine nurse staffing levels for health visiting services across Wales. David Hancock reports

The association between nurse staffing levels and the timeliness of vital signs monitoring: a retrospective observational study in the UK

ObjectivesOmissions and delays in delivering nursing care are widely reported consequences of staffing shortages, with potentially serious impacts on patients. However, studies so far have relied almost exclusively on nurse...