Registered Nurse Staffing Research Articles

Assessing the Job Satisfaction of Registered Nurses Using Sentiment Analysis and Clustering Analysis.

Job satisfaction is a critical component of the professional work environment and is often ascertained through surveys that include structured or open-ended questions. Using data from 24,543 respondents to California Board of Registered Nursing biennial surveys, this study examines the job satisfaction of registered nurses (RNs) by applying clustering analysis to structured job satisfaction items and sentiment analysis to free-text comments. The clustering analysis identified three job satisfaction groups (low, medium, and high satisfaction). Sentiment analysis scores were significantly associated with the job satisfaction groups in both bivariate and multivariate analyses. Differences between the job satisfaction clusters were mostly driven by satisfaction with workload, adequacy of the clerical support services, adequacy of the number of RN staff, and skills of RN colleagues. In addition, there was dispersion in satisfaction related to involvement in management and policy decisions, recognition for a job well done, and opportunities for professional development.

Medical care in Australian residential aged care: Perspectives of residents, family, nurses and general practitioners.

The importance of residential aged care facility (RACF)'s medical care is growing, driven by world-wide demographic trends in ageing populations. Despite this, there is a paucity of research into this care delivery from the perspective of those most involved. This study aimed to identify the enablers of and barriers to satisfactory RACF medical care by focusing on the general practitioner (GP) visit in the experience of residents, their family, registered nurses (RNs) and GPs. A multi-site case study was conducted at four purposively chosen RACFs in rural and regional New South Wales, Australia. Data derived from semi-structured interviews with 35 randomly selected aforementioned stakeholders and conducted in 2017 were evaluated using thematic, specifically framework analysis. The study's first key finding was related to the care team and to care recipients. It was evident that the quality of the RN-GP interprofessional collaboration was important for satisfactory care delivery. However, the care team was observed to additionally include RACF care staff and family members. Families were also in need of care. The study's second key finding was related to continuity of care. The interpersonal continuity of care provided by the existing GP continuing a new resident's care was beneficial. Informational continuity of care was found to be important but often disrupted by patient's information being initially unavailable, then fragmented and stored in different places. Medication management systems when accessed were poorly organised, time consuming and complex. This research suggests two useful new paradigms for residential aged care. The first is a re-envisaging of the resident care team to include the RN, GP, family and care staff, and those needing care to include residents and family. Secondly, care teams informed by interpersonal and informational continuity of care, and satisfactory resident care appears inextricably and positively linked.

Nursing Home Vulnerabilities amid COVID-19 Pandemic: A Study of Midwestern States

Background: The COVID-19 pandemic disproportionately affected the older adult population, especially those in nursing homes (NHs). However, there is also evidence that some NHs fared better than others. Objectives: This study examines a set of nursing home related factors to understand whether these factors are associated with the number of COVID-19 cases. Design: We combined three datasets from the Centers for Medicare & Medicaid Services (CMS) – the Star Rating Dataset, the Provider Information Dataset, and the COVID-19 Nursing Home Dataset. Setting and Participants: 4390 NHs that responded to the CMS survey. Methods: Data used is from the period of Jan 1–Dec 27, 2020 for all 12 Midwestern states. The measures used were self-reported information on ratings, staff shortages, PPE shortage, number of beds, Registered Nurse (RN), Licensed Practical Nurses (LPN), Certified Nursing Assistants (CNA) hours per resident, star rating and ownership. Results: Of the 4390 NHs in 12 Midwestern states, high performing NHs were less likely to have more than 30 COVID-19 cases versus low-performing facilities for two of the CMS domains (health inspections, 520 NHs [27.6%] vs 1363 NHs [72.4%]; and staffing 773 NHs [41.1%] vs 1110 NHs [58.9%]). There was also a statistically significant association COVID-19 cases and star rating, NH ownership, NH size, RN, LPN, and CNA staffing in NHs (all p ≤ 0.01). NH ownership status persisted as a predictor of COVID 19 cases when controlled for NH size. Conclusions: Our study highlights two interesting findings. A) a statistically significant association between NH ownership structure and COVID-19 cases among residents - for-profit NHs had higher number of COVID-19 cases B) a statistically significant negative association between RN and CNA staffing and COVID-19 cases (i.e., more staffing hours of RNs and CNA correlated with a smaller number of COVID-19 cases) and a statistically significant positive association between LPN staffing and COVID-19 cases. We discuss ensuing policy implications for NHs.

Effects of Nurse Staffing, Work Environment, Education on Adverse Events in Nursing Homes

This study examined the effect of registered nurse (RN) staffing level, work environment, and education on adverse events experienced by residents in nursing homes. A cross-sectional study was conducted with 216 RNs working in nursing homes who were selected using random stratified sampling by location and bed size. Self-reported questionnaires regarding staffing level, work environment, education level, adverse events, and nurse characteristics were administered. Data from the National Health Insurance Service were used to describe nursing home characteristics. Both multiple and multinomial logistic regressions were used to control for the characteristics of nurses and nursing homes, and investigate the effects of nursing staffing level (number of older adults assigned to a nurse), work environment (Practice Environment Scale of the Nursing Working Index), and level of nursing education on the adverse events experienced by residents. An increase of one resident per RN was significantly associated with a higher incidence of pressure ulcers (OR= 1.019, 95% CI=1.004-1.035). Poor work environment increased the incidence of adverse events such as pressure ulcers (OR= 3.732, 95% CI=1.155-12.056) and sepsis (OR=3.871, 95%CI=1.086-13.800). Compared to RNs with a baccalaureate or higher, RNs with diplomas reported increased incidence rates of pressure ulcers (OR=2.772, 95%CI= 1.173-6.549). RN staffing, work environment, and education level affect the incidence of pressure ulcers, and the work environment affects the incidence of sepsis among residents in nursing homes. Policy-wise, improving the level of nurse staffing, nursing work environment, and nursing education will improve health outcomes of residents.

Nurse Staffing and Nursing Home Deficiency of Care for Inappropriate Psychotropics Use in Residents With Dementia

Psychotropics use to manage behavioral and psychological symptoms of dementia (BPSD) in nursing homes (NHs) has been the focus of policy attention due to their adverse effects. We hypothesized that NHs with lower nursing staffing would have greater reliance on psychotropics use to control BPSD. A NH deficiency of care can be cited for inappropriate psychotropics use (F-tag 758). The association between the occurrence of F-758 tags and nurse staffing in residents with dementia was examined using the 2017-18 Certification and Survey Provider Enhanced Reporting data (n=14,548 NHs). Staffing measures included nursing hours per resident day (HPRD) and registered nurse (RN) skill-mix. Generalized linear mixed models that included covariates (NH location, bed size, ownership, proportion of residents with dementia/depression/psychiatric disorders and with Medicare/Medicaid) estimated the magnitude of the associations. There were 1,872 NHs with F-758 tags indicating inappropriate psychotropics use for NH residents with dementia. NHs with greater RN and certified nurse assistant (CNA) HPRD had significantly lower odds of F-758 tags (OR=0.59 54, 95% CI=0.47 44-0.73 66; OR=0.87, 95% CI=0.77-0.99, respectively) and similar findings were found in NHs with greater RN skill-mix (OR=0.14 10, 95% CI=0.05 04-0.37 25). There were no significant associations between the occurrence of F-758 tags and licensed practice nurse and unlicensed nurse aide HPRD. This study found that RN and CNA staffing had inverse associations with inappropriate psychotropic use citations among residents with dementia. NHs with higher RN staffing ratios may be better able to implement alternatives to pharmacological approaches for BPSD. It is suggested that NHs be equipped with adequate nurse staffing levels to reduce unnecessary psychotropics use.

Nurse Staffing and Coronavirus Infections in California Nursing Homes.

In the United States, 1.4 million nursing home residents have been severely impacted by the COVID-19 pandemic with at least 25,923 resident and 449 staff deaths reported from the virus by June 1, 2020. The majority of residents have chronic illnesses and conditions and are vulnerable to infections and many share rooms and have congregate meals. There was evidence of inadequate registered nurse (RN) staffing levels and infection control procedures in many nursing homes prior to the outbreak of the virus. The aim of this study was to examine the relationship of nurse staffing in California nursing homes and compare homes with and without COVID-19 residents. Study data were from both the California and Los Angeles Departments of Public Health and as well as news organizations on nursing homes reporting COVID-19 infections between March and May 4, 2020. Results indicate that nursing homes with total RN staffing levels under the recommended minimum standard (0.75 hours per resident day) had a two times greater probability of having COVID-19 resident infections. Nursing homes with lower Medicare five-star ratings on total nurse and RN staffing levels (adjusted for acuity), higher total health deficiencies, and more beds had a higher probability of having COVID-19 residents. Nursing homes with low RN and total staffing levels appear to leave residents vulnerable to COVID-19 infections. Establishing minimum staffing standards at the federal and state levels could prevent this in the future.

Association between registered nurse staffing levels and in-hospital mortality in craniotomy patients using Korean National Health Insurance data

BackgroundThe level of registered nurse (RN) staffing is a fundamental factor influencing patient safety. Craniotomy patients need intensive care after surgery, the majority of which is provided by RNs.MethodsThis study was conducted to investigate the relationship of the RN staffing level of general wards and intensive care units (ICUs) with in-hospital mortality after craniotomy using Korean National Health Insurance claim data. The RN staffing level was categorized based on the bed-to-RN ratio.ResultsThe in-hospital mortality rate of craniotomy patients was elevated at hospitals with a high bed-to-RN ratio in general wards, ICUs, and hospitals overall. It was determined that in-hospital mortality of craniotomy patients could be decreased by more than 50% by reducing the bed-to-RN ratio from 4.5 or more to less than 3.5 in general wards, from 1.25 or more to less than 0.88 in ICUs, and from 2.5 or more to less than 1.67 in hospitals overall.ConclusionsSince the RN staffing level is related to the in-hospital mortality rate of craniotomy patients, a sufficient staffing level of RNs should be ensured to reduce the mortality of craniotomy patients.

Effects of registered nurse staffing on quality of care and resident outcomes in nursing homes

Few studies focus on Registered Nurse (RN) staffing and resident health outcomes in Korean nursing homes. This study aimed to investigate the effects of RN staffing on quality of care and resident outcomes in South Korean nursing homes. The study was a secondary data analysis of 5679 participants from the National Health Insurance Service. A mixed-effect linear model and multinomial logistic regression model assessed resident outcomes and quality of care, respectively. The number of RNs significantly affected patient mortality. The overall evaluation rating for quality of care in nursing homes increased as the number of RNs increased. Level of RN staffing in nursing homes influenced health management and quality of care for residents. A variety of efforts are needed to strengthen the workforce of RNs in nursing homes, including enacting a law for safe RN staffing and converting the evaluation of nursing home quality into health outcomes.

Driving Nurse Satisfaction Through Shared Governance

Within a Magnet®-designated academic medical center, registered nurse (RN) satisfaction survey results demonstrated opportunities to further enhance decision-making. The aim of this initiative was to improve RN satisfaction through the implementation and standardization of shared governance resources. Led by clinical nurses supporting the shared governance council, innovative tools were implemented and disseminated through a multimodal communication approach across the department of nursing. Significant improvements in RN satisfaction were noted as a result of the targeted interventions. This initiative highlighted the need for standardized resources to grow and support shared governance throughout the organization.

Staffing Trends in Magnet and Non-Magnet Hospitals After State Legislation.

Evidence suggests that Magnet and non-Magnet hospitals differ with respect to quality of care. Our study examined registered nurse (RN) staffing over time in Magnet and non-Magnet hospitals using unit-level, publicly available data in New Jersey. A secondary analysis of longitudinal RN staffing data was conducted using mandated, publicly reported data of 64 hospitals representing 12 nursing specialties across 8 years (2008-2015). Staffing ratios were trended over time to compare RN staffing changes in Magnet and non-Magnet hospitals. Staffing was comparable in Magnet and non-Magnet hospitals for 9 of 12 specialties. On average, from 2008 until 2015, RN staffing slightly increased, with a greater percent increase in Magnet hospitals (6.9%) than in non-Magnet hospitals (4.7%). Over 8 years in New Jersey, RN staffing improved in Magnet and non-Magnet hospitals. Although there was a slight increase for Magnet hospitals, there was no meaningful difference in staffing for all 12 specialties.

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.

Registered Nurse Staffing, Workload, and Nursing Care Left Undone, and Their Relationships to Patient Safety in Hemodialysis Units

Patient safety is an important foundation of high-quality care. Yet little is known regarding the effects of nursing indicators on patient safety in dialysis units. The purpose of this study was to examine interrelationships among registered nurse (RN) staffing, workload, nursing care left undone, and patient safety outcomes in hemodialysis settings. The sample consisted of 104 staff nurses who worked in hemodialysis facilities and completed a mailed survey. Low RN staffing, high RN workloads, and RN nursing care left undone were significantly associated with unsafe patient shift change periods and low safety ratings. Care left undone was an indirect pathway through which low RN staffing and high workloads impacted safety. Patient safety in hemodialysis units can be enhanced by ensuring adequate RN staffing and reasonable RN workloads, as well as redesigning responsibilities so RNs can complete necessary care activities.

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.

STAFFING AND CARE QUALITY OF NURSING HOMES IN KOREA

Staffing has been regarded as the most important factor for the quality of care service in nursing homes. Korea introduced Long-Term Care Insurance (LTCI) in 2008. The payment system of LTCI has incentivized LTC facilities based on the staffing level of LTC facilities. This study aims to investigate whether staffing is associated with quality of care. The effect of staffing on care quality was assessed using ordered logit analysis. Staffing data in 2015 were retrieved from claim data in the National Health Insurance Service. The publicly reported care service quality grade in 2015 was used as a proxy for care quality. Staffing of registered nurses (RN) and social workers were strongly associated with the care quality. As the number of RNs per residents additionally increased, the LTC facilities were more likely to receive better grades (OR=16851.54, p<0.000). The effect of social workers’ staffing was significant for the care service quality, even though the effect size of smaller than that of RNs (OR=345.87, p<0.000). However, staffing in other professions such as nurse assistants (NA) and personal care workers (PCW) was insignificantly associated with care quality. The effect of staffing on service quality might not be profession-neutral. RN staffing affects most in care quality in Korea. Still, the possibility remains that PCWs or NAs could serve for indirect care services such as cooking or cleaning because of short staffing in indirect care services. This finding could be considered when designing financial incentives for nursing homes in Korea as well as other countries.

Hospital staffing patterns and safety culture perceptions: The mediating role of perceived teamwork and perceived handoffs.

As hospitals are under increasing pressure to improve quality and safety, safety culture has become a focal issue for high-risk organizations, including hospitals. Prior research has examined how structural characteristics directly impact safety culture. However, and based on Donabedian's structure-process-outcome quality model, there is a need to understand the processes that intermediate the relationship between structural characteristics and safety culture perceptions. The processes by which registered nurse (RN) and hospitalist staffing may affect safety culture perceptions were examined in this study. Specifically, this study investigates the processes of perceived teamwork across units and perceived handoffs. Data sources for this research included Hospital Survey on Patient Safety Culture from the Agency for Healthcare Research and Quality, the American Hospital Association's Annual Survey Data, the American Hospital Association Information Technology supplement, and the Area Health Resource File. Two separate mediation models for each process were used. Propensity weights were assigned to each hospital in the sample ( N = 207) to adjust for potential nonresponse bias of hospitals that did not assess employee's safety culture perceptions. Results suggest that RN staffing influences safety culture perceptions, but hospitalist staffing does not. In addition, RN staffing has an indirect effect on safety culture perceptions through better processes. Our study sheds light on how staffing affects safety culture perceptions. Specifically, our findings suggest that positive perceptions of teamwork across units and handoffs are integral in the relationship between RN staffing and safety culture perceptions. Hospital managers should, therefore, invest resources in staff recruitment and retention. In addition, a targeted focus on perceived teamwork and handoffs may allow hospital managers to improve safety culture perceptions.

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...

National trends and variation in nurse staffing on inpatient psychiatric units.

The purpose of this study was to examine national trends and variation in nurse staffing on inpatient psychiatric units in US general hospitals from 2005-2017. The National Database of Nursing Quality Indicators® provided data on nurse staffing from 1,143 psychiatric units in 610 US hospitals. A weighted linear mixed model was fitted for each of two staffing measures: Registered nurse (RN) hours per patient day (HPPD) and non-RN HPPD. Monthly staffing levels were modeled as a function of study year, unit type, and hospital bed size, teaching status, government ownership, for-profit status, metropolitan location, and US census division. Very gradual upward trends in staffing were observed. Compared with adult units, child/adolescent units had lower RN staffing and higher non-RN staffing. Levels of both types of staffing were lower in for-profit facilities. The Pacific census division had higher RN staffing than every other census division by an estimated margin of 0.52-1.54 HPPD, and census divisions with the lowest levels of RN staffing had the highest levels of non-RN staffing. Despite concerns expressed over the past 15 years about patient violence, staffing levels, and use of seclusion and restraint on psychiatric units, average staffing levels have apparently increased only modestly since 2005, and increases in RN staffing on psychiatric units have not kept pace with increases in general care units. Marked regional differences in staffing merit further investigation.

Association of registered nurse and nursing support staffing with inpatient hospital mortality

BackgroundThe association of nursing staffing with patient outcomes has primarily been studied by comparing high to low staffed hospitals, raising concern other factors may account for observed differences. We examine...

Hospital nurse staffing and staff–patient interactions: an observational study

BackgroundExisting evidence indicates that reducing nurse staffing and/or skill mix adversely affects care quality. Nursing shortages may lead managers to dilute nursing team skill mix, substituting assistant personnel for registered...

The effect of registered nurses on nursing home residents’ outcomes, controlling for organizational and health care market factors

Despite cumulative and integrative evidence of registered nurse (RN) staffing on nursing home residents’ outcomes worldwide, few studies integrate the effects of residents’ case mix, healthcare markets, and nurse staffing on psychotropic-medication use and weight loss in Korea. This article examined the relationship between nurse staffing and residents’ quality-of-care outcomes, controlling for long-term healthcare market characteristics in Korea. Using a multilevel cross-sectional design, a disproportionate stratified random sampling was used. Of 87 nursing homes contacted, 60 agreed to participate. Weighted linear regression was used to test the hypotheses. RN hours per resident day (HPRD) had a statistically significant positive impact on reducing the number of residents with psychotropic medication (ß = − .331, p = .008). Greater RN HPRD positively marginally related to fewer residents with cognitive impairment (ß = − 0.201, p = .139). Higher turnover of RN staff related to decreased proportions of residents with weight loss (ß = − .331 p = .008). Policymakers should cautiously consider requiring mandatory nurse staffing in nursing homes in Korea, where it is still acceptable to have certified nurse aids as substitutes for RNs.