Number Of Nursing Staff Research Articles

Mortality and readmission differences associated with after-hours hospital admission: A population-based cohort study in Queensland Australia.

Policy makers and health system managers are seeking evidence on the risks involved for patients associated with after-hours care. This study of approximately 1 million patients who were admitted to the 25 largest public hospitals in Queensland Australia sought to quantify mortality and readmission differences associated with after-hours hospital admission. Logistic regression was used to assess whether there were any differences in mortality and readmissions based on the time inpatients were admitted to hospital (after-hours versus within hours). Patient and staffing data, including the variation in physician and nursing staff numbers and seniority were included as explicit predictors within patient outcome models. After adjusting for case-mix confounding, statistically significant higher mortality was observed for patients admitted on weekends via the hospital's emergency department compared to within hours. This finding of elevated mortality risk after-hours held true in sensitivity analyses which explored broader definitions of after-hours care: an "Extended" definition comprising a weekend extending into Friday night and early Monday morning; and a "Twilight" definition comprising weekends and weeknights.There were no significant differences in 30-day readmissions for emergency or elective patients admitted after-hours. Increased mortality risks for elective patients was found to be an evening/weekend effect rather than a day-of-week effect. Workforce metrics that played a role in observed outcome differences within hours/after-hours were more a time of day rather than day of week effect, i.e. staffing impacts differ more between day and night than the weekday versus weekend. Patients admitted after-hours have significantly higher mortality than patients admitted within hours. This study confirms an association between mortality differences and the time patients were admitted to hospital, and identifies characteristics of patients and staffing that affect those outcomes.

Nursing staff ratio and skill mix in Swedish emergency departments: A national cross-sectional benchmark study.

The aim of this study is to describe ratio and skill mix for nursing staff in Swedish emergency departments over a specific 24-h period. The link between number of patients per nursing staff and missed nursing care is well described within the in-hospital setting, showing association with negative outcomes such as increased mortality. Potential association within the emergency department setting is still unexplored. This is a national descriptive cross-sectional benchmark study. The majority (n= 54; 89%) of Swedish emergency departments participated. The patients-per-registered nurse ratio varied between the shifts, from 0.3 patients to 8.8 patients (mean 3.2). The variation of patients per licenced practical nurse varied, from 1.5 to 23.5 patients (mean 5.0). The average skill mix was constant at around 60% registered nurses and 40% licenced practical nurses. The varying ratios for patient per registered nurse and licenced practical nurse in Swedish emergency departments are noteworthy. Furthermore, the patient flow and nursing staff numbers did not match one another, resulting in higher nursing staff ratios during the evening shift. Findings can be used to improve rosters in relation to crowding, to manage the challenging recruitment and retention situation for nursing staff and to improve patient safety.

Nursing staff numbers creep up, but recruitment fears remain

Nursing staff numbers creep up, but recruitment fears remain

Current situation of allocation of academic medical personnel in ophthalmology departments in Germany

At present minimum nursing staff numbers have been defined and are being implemented. In December 2019 the German Medical Association asked the German professional associations about their general experience with planning of medical personnel in hospital departments. As no structured data were available on this subject, the German Ophthalmological Society (DOG) founded aworking group in March 2020 to answer this request. In the course of several consensus meetings, the working group on personnel planning for physicians in hospitals of the DOG prepared aquestionnaire on previous experiences in personnel planning of eye hospitals, which was sent to the heads of all university eye hospitals and departments of ophthalmology in Germany. The questionnaire consisted of individual items with fixed choices and free answers regarding the procedure and current situation of staffing as well as the range of tasks and organization of the medical service. Out of 104 departments 53 (51%) responded, of which 25 were from university departments (64% response), 23 from departments of other public or non-profit ownership (46%) and 5 from departments with private hospital ownership (33%). Of these 49% stated that there was no transparent basis for calculation of the number of medical positions in their hospital. Of the surveyed departments, outpatient tasks, services and revenues were considered in the calculations in only 47%. There was a statistically significant higher ratio of full-time personnel to the numbers of beds in university departments compared to private and publicly owned non-profit institutions (p < 0.001, t‑test). All departments have to cope with multiple additional tasks in addition to clinical patient care, which are taken into account only to alimited extent in the staffing. Approximately 70% of the departments provide a24 h/7day (24/7) medical on-call service on site, 91% have a24/7 surgery on-call service and 34% have acooperation with emergency services run by the Association of Statutory Health Insurance Physicians. The results show how heterogeneously and nontransparent German departments of ophthalmology are staffed in terms of medical doctors. On average, university departments have higher personnel resources per hospital bed to cope with additional tasks in research and teaching. Outpatient tasks, which contribute significantly to the revenues of an eye department, and multiple other tasks are often not taken into account in the personnel calculation. Atransparent and uniform basis for calculation of the medical staff of the departments is desirable in order to achieve asufficient personnel staffing for apatient and employee-oriented working environment.

Surge capacity of intensive care units in case of acute increase in demand caused by COVID-19 in Australia.

ObjectivesTo assess the capacity of intensive care units (ICUs) in Australia to respond to the expected increase in demand associated with COVID‐19.DesignAnalysis of Australian and New Zealand Intensive Care Society (ANZICS) registry data, supplemented by an ICU surge capability survey and veterinary facilities survey (both March 2020).SettingsAll Australian ICUs and veterinary facilities.Main outcome measuresBaseline numbers of ICU beds, ventilators, dialysis machines, extracorporeal membrane oxygenation machines, intravenous infusion pumps, and staff (senior medical staff, registered nurses); incremental capability to increase capacity (surge) by increasing ICU bed numbers; ventilator‐to‐bed ratios; number of ventilators in veterinary facilities.ResultsThe 191 ICUs in Australia provide 2378 intensive care beds during baseline activity (9.3 ICU beds per 100 000 population). Of the 175 ICUs that responded to the surge survey (with 2228 intensive care beds), a maximal surge would add an additional 4258 intensive care beds (191% increase) and 2631 invasive ventilators (120% increase). This surge would require additional staffing of as many as 4092 senior doctors (245% increase over baseline) and 42 720 registered ICU nurses (269% increase over baseline). An additional 188 ventilators are available in veterinary facilities, including 179 human model ventilators.ConclusionsThe directors of Australian ICUs report that intensive care bed capacity could be near tripled in response to the expected increase in demand caused by COVID‐19. But maximal surge in bed numbers could be hampered by a shortfall in invasive ventilators and would also require a large increase in clinician and nursing staff numbers.

Duchess: We must act now on nursing staff numbers

Duchess: We must act now on nursing staff numbers

Staffing Challenges Today.

Staffing Challenges Today.

Research on the formulas of nursing manpower demands in general pediatric wards based on measurement of working hours

Objective To build the dynamic management system of nursing staff allocation in general pediatric wards based on working hours measurement. Methods 30 general pediatric wards of 25 general or children hospitals of upper first class were selected to measure working hours. Depending on the average nursing hours required for pediatric patients in different care levels by each positions, we achieved the nursing staffing formulas. Results 7 nursing posts under double-shift turn and three-shift turn were collected. The average hour that nursing posts provide for one different nursing grade patient was made out. Taking a ward which had 20 patients as nursing grade one and 20 patients as nursing grade two for example, it would need 8-9 responsible nurses, 2-3 long night shift nurses, 1-2 general affairs nurses, 2 night assistance nurse, 1 day assistance nurse by double-shift turn, meanwhile, it would need 8 responsible nurses, 4 early night shift nurses, 3 late night shift nurses, 1-2 general affairs nurses by three-shift turn. Conclusions Using the formulas based on measurement of working hours to calculate the number of nursing staff could provide a way to help the managers. Key words: Nursing care; Pediatric wards; Measurement of working hours; Nursing staff allocation

Action is overdue on safe staffing guidance, RCN tells government

The RCN is calling for swift action to implement a recommendation on safe staffing by Robert Francis in his report on care failings at Mid Staffs. Howard Catton, the college’s head of policy, said enough time had been spent talking about the report. He was speaking at a conference on implementing the Francis report – seven months on from its publication. The report made 29 recommendations on nursing that included a call for the National Institute for Health and Care Excellence (NICE) to draw up best practice guidelines on minimum staff numbers and skill mix on wards. The government’s initial response to the report, which it titled Patients First and Foremost and published in March, accepted the Francis recommendation on staffing guidance. The full government response to the 290 Francis report recommendations is due within weeks. ‘We need to take action rather than have more words,’ said Mr Catton. ‘We just need to do it: commission NICE to work with a steering group of nurses on the guidelines. It could be done within the next 12 months.’ Mr Catton was addressing the conference last week on the same day as the Commons health committee recommended that every hospital ward publishes its staffing levels daily. In its report the committee recommends that hospitals adopt the practice of displaying staff numbers in every ward, as introduced at Salford Royal NHS Foundation Trust. Hospitals should collect information on staffing for every ward daily and publish it immediately for clinical commissioners, the MPs on the committee say. At the Salford trust a teleconference is held with senior nurses each morning at 8.30am. Chaired by the deputy director of nursing, it sets out to determine concerns about nursing staff numbers across all wards and departments. Jane Ball, deputy director of the national nursing research unit and a member of the Safe Staffing Alliance set up by Nursing Standard, endorsed the committee’s recommendation. ‘It is an important thing to do,’ she said. ‘But it is not the whole story. This is a starting point because it is not enough just to publish the numbers; you then need to do something if the levels are low, so we need to make sure measures are in place to ensure ward managers do not let them fall below a certain level by, for example, making good use of temporary staff.’ For more information on the Safe Staffing Alliance go to www.safestaffing.org.uk

Investigation in HBV infection status of nursing staff and analysis of its influencing factors

Objective To grasp the HBV infection status in nursing staff of our hospital and discuss related factors influencing the HBV- positive rate of nursing staff. Methods Through hospital medical staff management systems,number of nursing staff in our hospital were counted,enzyme-linked immunosorbent assay were used to detect HBV infection status.Risk factors such as injection and puncture,surgical dressing,blood and liquid transfusion,specimen collection were set for logistic regression analysis. Results Among 587 nursing staff,the HBsAg positive rate was 4.77％,single-factor analysis showed that injection and puncture,surgical dressing,blood and liquid transfusion,specimen collection,and hepatitis B vaccination were statistically significant.Logistic regression analysis showed that injection and puncture,blood and liquid transfusion,specimen collection,hepatitis B vaccination were related risk factors. Conclusions Injection and puncture,blood and liquid transfusion,specimen collection and other factors are risk factors influencing HBV infection status of nursing staff.Increase of awareness of occupa-tional safety and regular hepatitis B vaccination can reduce HBV infection rate. Key words: Nursing staff; Hepatitis B virus; Infection; Influencing factors

Nursing staff numbers and their relationship to conflict and containment rates on psychiatric wards—A cross sectional time series Poisson regression study

Background The link between positive outcomes and qualified nurse staffing levels is well established for general hospitals. Evidence on staffing levels and outcomes for mental health nursing is more sparse, contradictory and complicated by the day to day allocation of staff resources to wards with more seriously ill patients. Objective To assess whether rises in staffing numbers precede or follow levels of adverse incidents on the wards of psychiatric hospitals. Design Time series analysis of the relationship between shift to shift changes over a six month period in total conflict incidents (aggression, self-harm, absconding, drug/alcohol use, medication refusal), total containment incidents (pro re nata medication, special observation, manual restraint, show of force, time out, seclusion, coerced intramuscular medication) and nurse staffing levels. Settings 32 acute psychiatric wards in England. Methods At the end of every shift, nurses on the participating wards completed a checklist reporting the numbers of conflict and containment incidents, and the numbers of nursing staff on duty. Results Regular qualified nurse staffing levels in the preceding shifts were positively associated with raised conflict and containment levels. Conflict and containment levels in preceding shifts were not associated with nurse staffing levels. Conclusions Results support the interpretation that raised qualified nurse staffing levels lead to small increases in risks of adverse incidents, whereas adverse incidents do not lead to consequent increases in staff. These results may be explicable in terms of the power held and exerted by psychiatric nurses in relation to patients.

Identification of the development needs for the emergency care nursing workforce

In 2000, the government launched their agenda to modernise the National Health Service to deliver high quality care. Within this agenda, Emergency Care provision was seen as a priority. Primarily national targets were set to reduce waiting times in Accident and Emergency (A&E) departments to no more than 4h from arrival to admission, transfer or discharge. National targets to improve access were further expanded into other facets of Emergency Care which together has resulted in major changes in the provision and delivery of emergency care. These changes have resulted in new ways of working across traditional professional and organisational boundaries resulting in the development of new professional roles; new services such as nurse led minor injury units, walk in centres, nurse practitioners and telephone triage in Out of Hours services. Locally, emergency care was a key priority in Shropshire and Staffordshire Strategic Health Authority. As a result the Workforce Development Directorate commissioned this project to scope the nursing workforce to identify nursing staff numbers; roles and titles; and educational preparation. Variations of new nursing roles and titles: educational preparation for all nursing staff; nursing staff establishments compared to national recommendations in particular Emergency Nurse Practitioners, Registered Children's Nurses and Healthcare Assistants and Out of Hours provision are key themes that have been presented together with recommendations.

Nursing care provision for people with intellectual disabilities in institutions: A Taiwanese perspective

Background Little attention has been paid to the healthcare workforce in determining healthcare management for people with intellectual disability (ID) in institutions in Taiwan. This paper investigated the profile of the healthcare workforce among institutions caring for people with ID, and examined differences, particularly in relation to nursing staff numbers, between the various types of settings providing care.Method Data were provided by 121 institutions caring for people with ID in Taiwan. Structured questionnaires were completed at these institutions, providing a cross‐sectional survey.Results Nurses were the main health professionals employed in institutions. Even so, more than half the institutions (52.1%) did not have a nurse on their staff. The larger the size of the institution, the more likely it was that nursing staff were employed there. With regard to the relationship between institutional operating structure and the employment of nursing personnel, public institutions were more likely to employ nurses than private institutions or privately operated state‐owned institutions (POSOE). However there was no statistically significant difference among the various operating structures in terms of the ratio of nurses to people with ID.Conclusions The results highlight the importance of examining the regulation of an appropriate ratio of nurses: people with ID in institutions.

Survey shows differences in nursing staff numbers

District auditors find some wards where just 60 per cent of nursing staff are RNs