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Beauvais B, Pradhan R, Ramamonjiarivelo Z, Mileski M, Shanmugam R. When Agency Fails: An Analysis of the Association Between Hospital Agency Staffing and Quality Outcomes. Risk Manag Healthc Policy 2024; 17:1361-1372. [PMID: 38803621 PMCID: PMC11129761 DOI: 10.2147/rmhp.s459840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Staffing is critical to hospital quality, but recent years have seen hospitals grappling with severe shortages, forcing them to rely on contract or agency staff for urgent patient care needs. This shift in staffing mix has raised questions about its impact on quality. Consequently, this study investigated whether the increased use of agency staff has affected healthcare quality in hospitals. Given the limited recent research on this topic, practitioners remain uncertain about the effectiveness of their staffing strategies and their potential impact on quality. Methods Drawing from agency theory, data were obtained from Definitive Healthcare which consolidates information from numerous public access databases pertaining to hospitals such as the American Hospital Association Annual Survey (hospital profile) and the Hospital Value-Based Purchasing Program (quality data). We conducted a cross-sectional study using a multivariable linear regression model (2021-2022) with appropriate organizational and market- level control variables. Quality was measured across eight variables while the independent variable of interest was agency labor cost ratio operationalized as the percentage of net patient revenue consumed by agency labor expense. Results Our results suggested that the employment of agency staff was significantly and negatively associated with six of eight quality measures tested, including the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) star rating, Hospital Compare rating, the hospital Total Performance Score (TPS), and three of the four sub-domains that comprise the TPS: clinical domain score, person and community engagement domain score, and the efficiency and cost reduction score. Discussion Our results indicated that the increased use of agency labor may have a significant negative influence on quality outcomes at the hospital level. Our findings support the premise that interventions that promote full-time staffing may be more supportive of the quality of care delivered as well as patients' perceptions of care.
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Affiliation(s)
- Bradley Beauvais
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Rohit Pradhan
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Zo Ramamonjiarivelo
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Michael Mileski
- School of Health Administration, Texas State University, San Marcos, TX, USA
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Saiki M, Nishimiya G, Gotoh T, Hirota K, Sakai I. Experiences and attitudes of task-shifting and task-sharing of physicians, nurses, and nursing assistants in hospitals: a qualitative systematic review protocol. JBI Evid Synth 2024; 22:856-863. [PMID: 37997847 DOI: 10.11124/jbies-23-00140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
OBJECTIVE The objective of this review is to explore the experiences and attitudes of physicians, nurses, and nursing assistants regarding task-shifting and task-sharing in hospitals. INTRODUCTION Despite multiple health care professionals performing overlapping tasks, the need for effective task-shifting and task-sharing remains a concern. Understanding task-shifting and task-sharing experiences, as well as the attitudes of health care providers in hospitals, is essential for providing safe and patient-appropriate care with limited human resources. INCLUSION CRITERIA Qualitative studies that examine the experiences and attitudes of physicians, nurses, and nursing assistants in hospitals regarding task-shifting and task-sharing will be included. The review will include physicians, advanced practice nurses who are nurse practitioners or clinical nurse specialists, registered nurses, and nursing assistants. Midwives, pharmacists, occupational therapists, physical therapists, and students will be excluded. METHODS PubMed, MEDLINE, CINAHL, PsycINFO, Cochrane Database, and Web of Science will be searched as part of a 3-step search strategy. We will search for unpublished research and gray literature using Google Scholar and ProQuest Dissertations and Theses. Studies published in English or Japanese from the time each database was established to the present will be considered for inclusion. The methodological quality of all studies will be evaluated by screening against the inclusion criteria and by at least 2 critical evaluations using the standardized JBI checklist. Synthesized results will be pooled by meta-aggregation and published as a ConQual Summary of Findings. REVIEW REGISTRATION PROSPERO CRD42023409612.
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Affiliation(s)
- Masatoshi Saiki
- Department of Advanced Clinical Nursing, Frontier Clinical Nursing, Graduate School of Nursing, Chiba university, Chiba, Japan
| | - Gaku Nishimiya
- Nursing Department, Chiba University Hospital, Chiba, Japan
| | - Tomomi Gotoh
- Graduate School of Nursing, Chiba University, Chiba, Japan
| | | | - Ikuko Sakai
- Department of Advanced Clinical Nursing, Frontier Clinical Nursing, Graduate School of Nursing, Chiba university, Chiba, Japan
- The Chiba University Centre for Evidence Based Practice: A JBI Centre for Excellence, Chiba University, Chiba, Japan
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Bachnick S, Unbeck M, Ahmadi Shad M, Falta K, Grossmann N, Holle D, Bartakova J, Musy SN, Hellberg S, Dillner P, Atoof F, Khorasanizadeh M, Kelly-Pettersson P, Simon M. TAILR (Nursing-Sensitive Events and Their Association With Individual Nurse Staffing Levels) Project: Protocol for an International Longitudinal Multicenter Study. JMIR Res Protoc 2024; 13:e56262. [PMID: 38648083 PMCID: PMC11074892 DOI: 10.2196/56262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Nursing-sensitive events (NSEs) are common, accounting for up to 77% of adverse events in hospitalized patients (eg, fall-related harm, pressure ulcers, and health care-associated infections). NSEs lead to adverse patient outcomes and impose an economic burden on hospitals due to increased medical costs through a prolonged hospital stay and additional medical procedures. To reduce NSEs and ensure high-quality nursing care, appropriate nurse staffing levels are needed. Although the link between nurse staffing and NSEs has been described in many studies, appropriate nurse staffing levels are lacking. Existing studies describe constant staffing exposure at the unit or hospital level without assessing patient-level exposure to nurse staffing during the hospital stay. Few studies have assessed nurse staffing and patient outcomes using a single-center longitudinal design, with limited generalizability. There is a need for multicenter longitudinal studies with improved potential for generalizing the association between individual nurse staffing levels and NSEs. OBJECTIVE This study aimed (1) to determine the prevalence, preventability, type, and severity of NSEs; (2) to describe individual patient-level nurse staffing exposure across hospitals; (3) to assess the effect of nurse staffing on NSEs in patients; and (4) to identify thresholds of safe nurse staffing levels and test them against NSEs in hospitalized patients. METHODS This international multicenter study uses a longitudinal and observational research design; it involves 4 countries (Switzerland, Sweden, Germany, and Iran), with participation from 14 hospitals and 61 medical, surgery, and mixed units. The 16-week observation period will collect NSEs using systematic retrospective record reviews. A total of 3680 patient admissions will be reviewed, with 60 randomly selected admissions per unit. To be included, patients must have been hospitalized for at least 48 hours. Nurse staffing data (ie, the number of nurses and their education level) will be collected daily for each shift to assess the association between NSEs and individual nurse staffing levels. Additionally, hospital data (ie, type, teaching status, and ownership) and unit data (ie, service line and number of beds) will be collected. RESULTS As of January 2024, the verification process for the plausibility and comprehensibility of patients' and nurse staffing data is underway across all 4 countries. Data analyses are planned to be completed by spring 2024, with the first results expected to be published in late 2024. CONCLUSIONS This study will provide comprehensive information on NSEs, including their prevalence, preventability, type, and severity, across countries. Moreover, it seeks to enhance understanding of NSE mechanisms and the potential impact of nurse staffing on these events. We will evaluate within- and between-hospital variability to identify productive strategies to ensure safe nurse staffing levels, thereby reducing NSEs in hospitalized patients. The TAILR (Nursing-Sensitive Events and Their Association With Individual Nurse Staffing Levels) study will focus on the optimization of scarce staffing resources. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56262.
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Affiliation(s)
- Stefanie Bachnick
- Department of Nursing Science, University of Applied Sciences, Bochum, Germany
| | - Maria Unbeck
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Maryam Ahmadi Shad
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Katja Falta
- Department of Nursing Science, University of Applied Sciences, Bochum, Germany
| | - Nicole Grossmann
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Daniela Holle
- Department of Nursing Science, University of Applied Sciences, Bochum, Germany
| | - Jana Bartakova
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
- Health Economics Facility, Department of Public Health, University of Basel, Basel, Switzerland
| | - Sarah N Musy
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Sarah Hellberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Danderyd University Hospital, Stockholm, Sweden
| | - Pernilla Dillner
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Fatemeh Atoof
- Social Determinants of Health Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Paula Kelly-Pettersson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Danderyd University Hospital, Stockholm, Sweden
| | - Michael Simon
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
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Edfeldt K, Nyholm L, Jangland E, Gunnarsson AK, Fröjd C, Hauffman A. Missed nursing care in surgical care- a hazard to patient safety: a quantitative study within the inCHARGE programme. BMC Nurs 2024; 23:233. [PMID: 38584285 PMCID: PMC10999080 DOI: 10.1186/s12912-024-01877-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 03/17/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Missed nursing care occurs globally, and the consequences are severe for the patients when fundamental care needs are not fulfilled, nor delivered in a person-centred way. This study aimed to investigate the occurrence and cause of missed nursing care, and the relationship between registered nurses' and nursing assistants' perceptions of missed nursing care, in a surgical care context. METHODS A quantitative study was performed using the MISSCARE survey, measuring missed nursing care and associated reasons, in three surgical wards with registered nurses and nursing assistants as the participants (n = 118), during May-November in 2022. The MISSCARE survey also covers background data such as job satisfaction and intention to leave. The survey was distributed paper-based and the response rate was 88%. RESULTS Aspects of nursing care rated to be missed the most were 'attending interdisciplinary care conferences', 'turning patient every 2 h', 'ambulation 3 times per day or as ordered', and 'mouth care'. Differences between registered nurse and nursing assistant ratings were detected for eight out of 24 items, where registered nurses rated more missed nursing care. The uppermost reasons for missed nursing care were 'inadequate number of staff' and 'unexpected rise in patient volume and/or acuity on the unit'. Registered nurses and nursing assistants rated differently regarding six of 17 items. Almost every fourth staff member (24.6%, n = 29) had the intention to leave within a year in the present department. CONCLUSIONS The occurrence of missed nursing care is frequent in the surgical context, and in combination with a high number of staff members intending to leave their employment, poses a hazard to patient safety. Registered nurses, holding higher educational levels, reported more missed care compared with the nursing assistants. The main reason for missed nursing care was an inadequate number of staff. These findings support a warranted investment in nursing within the organisation. The results can be used to form strategies and interventions, to reduce nurse attrition and optimise competence utilisation, and to achieve safe person-centered fundamental care.
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Affiliation(s)
- Katarina Edfeldt
- Dept of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden.
| | - Lena Nyholm
- Dept of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Eva Jangland
- Dept of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Anna-Karin Gunnarsson
- Dept of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Camilla Fröjd
- Dept of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Anna Hauffman
- Dept of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
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Hodgson NR, Kwun R, Gorbatkin C, Davies J, Fisher J. Emergency department responses to nursing shortages. Int J Emerg Med 2024; 17:51. [PMID: 38580916 PMCID: PMC10996074 DOI: 10.1186/s12245-024-00628-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 03/28/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic exacerbated the nursing shortage, which is predicted to continue to worsen with significant numbers of nurses planning to retire within the next 5 years. There remains a lack of published information regarding recommended interventions for emergency departments (EDs) facing a sudden nursing shortage. METHODS We queried emergency department leaders from the American College of Emergency Physicians to examine the impact of nursing shortages on EDs and to gather real-world interventions employed to mitigate the effects of the shortage. RESULTS Most respondents (98.5%) reported nursing shortages, with 83.3% describing prolonged shortages lasting more than 12 months, with negative impacts such as misses/near-misses (93.9%) and increasing left without being seen rates (90.9%). ED leaders reported a range of interventions, including operational flow changes, utilizing alternative staff to fill nurse roles, recruitment of new nurses, and retention strategies for existing nurses. They employed temporary and permanent pay increases as well as efforts to improve the ED work environment and techniques to hire new nurses from atypical pipelines. CONCLUSION We report a patchwork of solutions ED leaders utilized which may have variable efficacy among different EDs; personalization is essential when selecting interventions during a sudden nursing shortage.
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Affiliation(s)
- Nicole R Hodgson
- Department of Emergency Medicine, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA.
| | - Richard Kwun
- Department of Emergency Medicine, Swedish Medical Center, Issaquah, WA, USA
| | - Chad Gorbatkin
- Department of Emergency Medicine, Madigan Army Medical Center, JBLM, Lakewood, WA, USA
| | - Jeanie Davies
- American College of Emergency Physicians, Irving, TX, USA
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Algunmeeyn A, Mrayyan MT, Suliman WA, Abunab HY, Al-Rjoub S. Effective clinical nursing leadership in hospitals: barriers from the perspectives of nurse managers. BMJ LEADER 2024; 8:20-24. [PMID: 37248037 DOI: 10.1136/leader-2022-000681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 04/25/2023] [Indexed: 05/31/2023]
Abstract
AIM The purpose of this study was to identify barriers to effective clinical nursing leadership in Jordanian hospitals from the perspectives of nurse managers (NMs). BACKGROUND Clinical leadership is about expertise in specialised fields and involving professionals in clinical care. Even though leadership terminology has been used in nursing and healthcare business literature, clinical leadership is still misunderstood, including its barriers. METHOD This study adopted a qualitative narrative approach and recruited a purposive sample of 19 NMs and two associate executive directors of nursing from two hospitals. Data were collected through two focus group discussions and in-depth interviews and were analysed using content analysis. The study was guided by the 'Consolidated Criteria for Reporting Qualitative Research'. RESULT Four themes emerged regarding barriers to effective clinical nursing leadership: (1) power differential, (2) inconsistent connectedness with physicians, (3) lack of early socialisation experiences and (4) clinical practice reform is a mutual responsibility. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE Barriers are detrimental to effective clinical leadership; they are associated with interdisciplinary and professional socialisation factors. Managers and academicians at all levels should immediately consider these barriers as a priority. Innovative clinical leaders should identify barriers to effective clinical leadership at the early stages. Thus, innovative clinical leadership programmes are warranted.
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Affiliation(s)
- Abdullah Algunmeeyn
- Faculty of Nursing, Advanced Nursing Department, Isra University, Amman, Jordan
| | - Majd T Mrayyan
- Department of Community and Mental Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | - Wafika A Suliman
- Faculty of Nursing, Advanced Nursing Department, Isra University, Amman, Jordan
| | - Hamzeh Y Abunab
- Faculty of Nursing, Basic Nursing Department, Isra University, Amman, Jordan
| | - Saleem Al-Rjoub
- Faculty of Nursing, Department of Community and Mental Health Nursing, Hashemite University, Amman, Jordan
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Yang C, Kuebeler MK, Jiang R, Knox MK, Wong JJ, Mehta PD, Dorsey LE, Petersen LA. Beyond Hospital-Level Aggregated Data: A Methodology to Adapt Clinical Data From the Electronic Health Record for Nursing Unit-Level Research. Med Care 2024; 62:189-195. [PMID: 38180051 DOI: 10.1097/mlr.0000000000001972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND Studies of nurse staffing frequently use data aggregated at the hospital level that do not provide the appropriate context to inform unit-level decisions, such as nurse staffing. OBJECTIVES Describe a method to link patient data collected during the provision of routine care and recorded in the electronic health record (EHR) to the nursing units where care occurred in a national dataset. RESEARCH DESIGN We identified all Veterans Health Administration acute care hospitalizations in the calendar year 2019 nationwide. We linked patient-level EHR and bar code medication administration data to nursing units using a crosswalk. We divided hospitalizations into segments based on the patient's time-stamped location (ward stays). We calculated the number of ward stays and medication administrations linked to a nursing unit and the unit-level and facility-level mean patient risk scores. RESULTS We extracted data on 1117 nursing units, 3782 EHR patient locations associated with 1,137,391 ward stays, and 67,772 bar code medication administration locations associated with 147,686,996 medication administrations across 125 Veterans Health Administration facilities. We linked 89.46% of ward stays and 93.10% of medication administrations to a nursing unit. The average (standard deviation) unit-level patient severity across all facilities is 4.71 (1.52), versus 4.53 (0.88) at the facility level. CONCLUSIONS Identification of units is indispensable for using EHR data to understand unit-level phenomena in nursing research and can provide the context-specific information needed by managers making frontline decisions about staffing.
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Affiliation(s)
- Christine Yang
- Michael E. DeBakey VA Medical Center, Houston, TX
- Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX
- Department of Psychology, Baylor College of Medicine, Houston, TX
| | - Mark K Kuebeler
- Michael E. DeBakey VA Medical Center, Houston, TX
- Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX
- Department of Psychology, Baylor College of Medicine, Houston, TX
| | - Rebecca Jiang
- Michael E. DeBakey VA Medical Center, Houston, TX
- Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX
- Department of Psychology, Baylor College of Medicine, Houston, TX
| | - Melissa K Knox
- Michael E. DeBakey VA Medical Center, Houston, TX
- Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX
- Department of Psychology, Baylor College of Medicine, Houston, TX
| | - Janine J Wong
- Department of Psychology, Baylor College of Medicine, Houston, TX
| | - Paras D Mehta
- Department of Medicine, University of Houston, Houston, TX
| | | | - Laura A Petersen
- Michael E. DeBakey VA Medical Center, Houston, TX
- Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX
- Department of Psychology, Baylor College of Medicine, Houston, TX
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Pignatiello S, Donofrio H, Horn J, Moore A, Mau KA, Distelhorst K. THRIVE: A Theory-Based Program to Support Hospital Nursing Assistants. J Nurs Adm 2024; 54:142-147. [PMID: 38349893 DOI: 10.1097/nna.0000000000001398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Nursing assistants are vital healthcare team members who often experience personal challenges to professional success. The Transformational Healthcare Readiness through Innovative Vocational Education (THRIVE) program is designed to combat these challenges through coaching and curriculum that is steeped in adult learning and social theories. The program's goal is to increase retention and success of newly hired nursing assistants through personal and professional support. Components of THRIVE can be adapted in a variety of healthcare settings.
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Affiliation(s)
- Shannon Pignatiello
- Author Affiliations: Nursing Education Manager (Pignatiello), Nursing Education Program Manager (Horn), Caregiver Support Specialist (Donofrio), Administrative Program Coordinator (Moore), and Senior Director of Nursing Education (Dr Mau), Nurse Scientist I (Dr Distelhorst), Nursing Institute, Cleveland Clinic, Ohio
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Tait D, Davis D, Roche MA, Paterson C. Nurse/midwife-to-patient ratios: A scoping review. Contemp Nurse 2024:1-13. [PMID: 38408182 DOI: 10.1080/10376178.2024.2318361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/08/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND A significant body of work has linked high nurse or midwife workload to negative patient outcomes. Anecdotal reports suggest that mandated ratio models enhance patient care and improve nurse job satisfaction. However, there is limited focused research. OBJECTIVE To identify key outcomes, implementation processes, and research needs regarding nurse/midwife-to-patient ratios in the Australian healthcare context. DESIGN Scoping review. METHODS Data sources were CINAHL, Open Dissertations, Medline, and Scopus. 289 articles screened, and 53 full text documents independently assessed against criteria by two reviewers and conflicts resolved by a third reviewer, using Covidence™. Three studies were included in this review. RESULTS Studies focused on nurse (job satisfaction, burnout), patient (mortality, readmission, length of stay) and system (costs) outcomes with limited information on implementation processes and no midwifery research. CONCLUSIONS Ratios provide benefits for patients, nurses, and hospitals although there is limited research in Australia. Implementation was poorly reported..
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Affiliation(s)
- Darcy Tait
- Australian Catholic University, School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Watson, Australian Capital Territory, Australia
| | - Deborah Davis
- University of Canberra, School of Nursing, Midwifery and Public Health, Faculty of Health & ACT Government Health Directorate, Bruce, Australian Capital Territory, Australia
| | - Michael A Roche
- University of Canberra, School of Nursing, Midwifery and Public Health, Faculty of Health & ACT Government Health Directorate, Bruce, Australian Capital Territory, Australia
- University of Technology Sydney, School of Nursing and Midwifery, Faculty of Health, Ultimo, New South Wales, Australia
| | - Catherine Paterson
- University of Canberra, School of Nursing, Midwifery and Public Health, Faculty of Health & ACT Government Health Directorate, Bruce, Australian Capital Territory, Australia
- Robert Gordon University, School of Nursing, Midwifery & Paramedic Practice, Garthdee, UK
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Malinowska-Lipień I, Put D, Maluchnik M, Gabryś T, Kózka M, Gajda K, Gniadek A, Brzostek T, Squires A. Influence of the work environment of nurses on the 30-day mortality of patients hospitalized in Polish hospitals. cross-sectional studies. BMC Nurs 2024; 23:117. [PMID: 38360713 PMCID: PMC10870652 DOI: 10.1186/s12912-024-01762-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND An optimal work environment for nurses is characterized primarily by appropriate staffing, good team relations, and support from the management staff. These factors are consistently associated with a positive assessment of patient safety by a hospital's employees and a reduction in hospital mortality rates. AIM To understand the relationships between the work environment as perceived by nurses on the 30-day mortality of patients treated in Polish hospitals. BACKGROUND An optimal work environment for nurses is characterized primarily by appropriate staffing, good team relations, and support from the management staff. These factors are consistently associated with a positive assessment of patient safety by a hospital's employees and a reduction in hospital mortality rates. MATERIAL AND METHODS The analysis used discharge data from 108,284 patients hospitalized in internal medicine and surgery departments in 21 hospitals (with 24/7 operations) in Poland. Administrative data included coded data to estimate 30-day mortality. A Nurses' satisfaction questionnaire, including the PES-NWI scale and the SAQ questionnaire, was used to assess the work environment of nurses (n = 1,929). Correlations between variables were assessed using the Pearson coefficient. The analysis used a Poisson regression model, which belongs to the class of generalized linear models. RESULTS A lower 30-day mortality rate amongst patients was found among those treated in hospitals where the personnel feel that they may question the decisions or actions of their superiors regarding the care provided (r = - 0.50); nurses are informed about changes introduced on the basis of reports about negligence and mistakes (r = - 0.50); the ward nurse is a good manager (r = - 0.41); nurses receive timely information from the head of the department that may have an impact on their work (r = - 0.41). CONCLUSIONS Factors related to care during hospital stay such as the organization of care at the ward level, analysis of care errors, the number of staff providing direct patient care, informing nurses about mistakes without punishment, and the possibility of nurses challenging the decisions or actions of superiors, which concerns care providing, affect the 30-day mortality of patients after the end of hospitalization in Polish hospitals.
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Affiliation(s)
- Iwona Malinowska-Lipień
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University- Medical College, Kopernika Str. 25, 31-501, Krakow, Poland.
| | - Dariusz Put
- Department of Computational Systems, Krakow University of Economics, Krakow, Poland
| | - Michał Maluchnik
- Department of Adult Neurology, Medical University of Gdansk and University Clinical Center, Gdansk, Poland
- Ministry of Health, Warsaw, Poland
| | - Teresa Gabryś
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University- Medical College, Kopernika Str. 25, 31-501, Krakow, Poland
| | - Maria Kózka
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University- Medical College, Kopernika Str. 25, 31-501, Krakow, Poland
| | - Krzysztof Gajda
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University- Medical College, Krakow, Poland
| | - Agnieszka Gniadek
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University- Medical College, Kopernika Str. 25, 31-501, Krakow, Poland
| | - Tomasz Brzostek
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University- Medical College, Kopernika Str. 25, 31-501, Krakow, Poland
| | - Allison Squires
- Rory Meyers College of Nursing, New York University, New York, USA
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Kim S, Kim GO, Lee S, Kwon YU. Effects of intensive care unit quality assessment on changes in medical staff in medical institutions and in-hospital mortality. HUMAN RESOURCES FOR HEALTH 2024; 22:12. [PMID: 38308311 PMCID: PMC10835892 DOI: 10.1186/s12960-024-00893-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/16/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Quality assessments are being introduced in many countries to improve the quality of care and maintain acceptable quality levels. In South Korea, various quality assessments are being conducted to improve the quality of care, but there is insufficient evidence on intensive care units (ICUs). This study aims to evaluate the impact of ICU quality assessments on the structural indicators in medical institutions and the resulting in-hospital mortality of patients. METHODS This study used data collected in the 2nd and 3rd ICU quality assessments in 2017 and 2019. A total of 72,879 patients admitted to ICUs were included during this period, with 265 institutions that received both assessments. As for structural indicators, changes in medical personnel and equipment were assessed, and in-hospital deaths were evaluated as patient outcomes. To evaluate the association between medical staff and in-hospital mortality, a generalized estimating equation model was performed considering both hospital and patient variables. RESULTS Compared to the second quality evaluation, the number of intensivist physicians and experienced nurses increased in the third quality evaluation; however, there was still a gap in the workforce depending on the type of medical institution. Among all ICU patients admitted during the evaluation period, 12.0% of patients died in the hospital. In-hospital mortality decreased at the 3rd assessment, and hospitals employing intensivist physicians were associated with reduced in-hospital deaths. In addition, an increase in the number of experienced nurses was associated with a decrease in in-hospital mortality, while an increase in the nurse-to-bed ratio increased mortality. CONCLUSIONS ICU quality assessments improved overall structural indicators, but the gap between medical institutions has not improved and interventions are required to bridge this gap. In addition, it is important to maintain skilled medical personnel to bring about better results for patients, and various efforts should be considered. This requires continuous monitoring and further research on long-term effects.
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Affiliation(s)
- Seungju Kim
- Department of Health System, College of Nursing, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea.
- Research Institute for Hospice/Palliative Care, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Gui Ok Kim
- Department of Quality Assessment, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Syalrom Lee
- Department of Quality Assessment, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Yong Uk Kwon
- Healthcare Review and Assessment CommitteeHealth Insurance Review and Assessment Service, Wonju, Republic of Korea
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Peutere L, Pentti J, Ropponen A, Kivimäki M, Härmä M, Krutova O, Ervasti J, Koskinen A, Virtanen M. Association of nurse understaffing and limited nursing work experience with in-hospital mortality among patients: A longitudinal register-based study. Int J Nurs Stud 2024; 150:104628. [PMID: 37992652 DOI: 10.1016/j.ijnurstu.2023.104628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Although nurse understaffing and limited nursing work experience may affect hospital patients' risk of mortality, relatively little longitudinal patient-level evidence on these associations is available. Hospital administrative data could provide important information about the level of staffing, nurses' work experience and patient mortality over time. OBJECTIVE To examine whether daily exposure to nurse understaffing and limited nursing work experience is associated with patient mortality, using patient-level data with different exposure time windows and accounting for several patient-related characteristics. METHODS This longitudinal register-based study combined administrative data on patients (clinical database Auria) and employees (Titania® shift-scheduling) from one hospital district in Finland in 2013-2019, covering a total of 254,446 hospital stays in 40 units. We quantified nurse understaffing as the number of days with low nursing hours in relation to target hours (<90 % of the annual unit median), and limited work experience as the number of days with a low proportion of nurses with >3 years of in-hospital experience, and those aged over 25 (<90 % of the annual unit median). We used two survival model designs to analyze the associations between nurse understaffing and limited nursing work experience and the in-hospital mortality of the patients: we considered these exposures during the first days in hospital and as a cumulative proportion of days with suboptimal staffing during the first 30 days. RESULTS In total, 1.5 % (N = 3937) of the hospital stays ended in death. A 20 % increase in the proportion of days with nurse understaffing was associated with an increased, 1.05-fold mortality risk at the patient level (95 % confidence interval, 1.01-1.10). The cumulative proportion of days with limited nursing work experience, or the combination of nurse understaffing and limited work experience were not associated with increased risk of death among all patients. However, both indicators of limited nursing work experience were associated with an increased mortality risk among patients with comorbidities (HR 1.05, 95 % CI 1.02-1.08 and HR 1.05, 95 % CI 1.00-1.10, respectively). CONCLUSIONS Nurse understaffing was associated with a slight, but a potentially critical increase in patient in-hospital mortality. Limited nursing work experience was associated with increased in-hospital mortality in a subgroup of patients with comorbidities. Increased use of administrative data on planned and realized working hours could be a routine tool for reducing avoidable in-hospital mortality.
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Affiliation(s)
- Laura Peutere
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland; Finnish Institute of Occupational Health, Helsinki, Finland.
| | - Jaana Pentti
- Department of Public Health, University of Turku, Turku, Finland
| | - Annina Ropponen
- Finnish Institute of Occupational Health, Helsinki, Finland; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, Helsinki, Finland; Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Mikko Härmä
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Oxana Krutova
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jenni Ervasti
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Aki Koskinen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Yu X, Li M, Du M, Wang Y, Liu Y, Wang H. Exploring factors that affect nurse staffing: a descriptive qualitative study from nurse managers' perspective. BMC Nurs 2024; 23:80. [PMID: 38291385 PMCID: PMC10829222 DOI: 10.1186/s12912-024-01766-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/25/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND The appropriate nurse staffing reflects the situation of nursing management of human resources. Nurse managers have a pivotal role in determining a competent and sufficient number of nurses. It is important to understand the factors influencing nurse staffing to promote appropriate staffing levels. The study aimed to explore the factors affecting nurse staffing from the perspective of nursing managers. METHODS Purposive sampling was adopted to recruit 14 nurse managers from secondary and tertiary hospitals located in the central region of China, and semi-structured interviews via telephone were conducted from April to May 2022. Interview transcripts were analyzed and collated using thematic analysis. RESULTS This research identified four themes and ten subthemes influencing nurse staffing. Extracted themes include: government level (inadequacy of mandatory policies, budgetary constraints), hospital level (hospital characteristics, the control of nurse labor costs, inadequate support on nursing), patient level (patient characteristics, increasing care needs), and nurse level (nurse shortage, skill-mix, individual high-level needs). CONCLUSION The findings indicate that it is crucial for decision-makers or policymakers to legislate for safe nurse staffing and establish effective supervision and funding incentives. Tailored interventions are also needed to improve the organizational context, address the nurse workforce and balance the structure of nurse staff.
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Affiliation(s)
- Xiaoyan Yu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Miqi Li
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Meichen Du
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Ying Wang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Yu Liu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Hui Wang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, 430030, China.
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Chang YH, Hsu CH, Tseng YC, Hsiung CA. Country-Level Factors Associated With Nurse Salaries: Empirical Evidence From Organisation for Economic Co-operation and Development Countries and Taiwan. J Nurs Res 2023; 31:e303. [PMID: 37988058 DOI: 10.1097/jnr.0000000000000585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Salary impacts nurse retention rates and thus is a factor affecting the nursing shortage both in Taiwan and around the world. Nurses in Taiwan earn a low salary compared with other health professionals and may be undervalued compared with their international counterparts. PURPOSE This study was designed to analyze the factors associated with nurse salary (NS) in Organisation for Economic Co-operation and Development (OECD) countries and to compare NS in Taiwan with those in OECD member states. METHODS Data were extracted from the OECD statistics database and official statistics for Taiwan. For the 28 OECD member countries considered in this study and Taiwan, 21 indicators characterizing healthcare systems, including demographics, socioeconomic status, health behaviors and risks, healthcare resources, health financing, healthcare utilization, health outcomes, and economic inequality, were examined for the period of 2009-2018. A random-effects model (REM) and a fixed-effects model (FEM) were used to investigate the associations between these indicators and annual NS levels. The expected annual NS for Taiwan was estimated and compared with the actual NS for Taiwan using the REM. RESULTS In the REM, higher NS in OECD countries was shown to be positively associated with gross domestic product per capita (0.49, 95% confidence interval [CI] [0.41, 0.56]), proportion of population aged 65 years and over (2.72, 95% CI [2.17, 3.26]), crude birth rate (1.02, 95% CI [0.56, 1.49]), number of computerized tomography scanners per million population (0.26, 95% CI [0.17, 0.35]), alcohol consumption per person (0.94, 95% CI [0.26, 1.61]), and prevalence of obesity (0.64, 95% CI [0.40, 0.89]) and to be in inversely associated with infant mortality rate (-3.13, 95% CI [-3.94, -2.32]), bed density (-0.99, 95% CI [-1.72, -0.25]), number of hospital discharges (-0.08, 95% CI [-0.11, -0.05]), household out-of-pocket expenditure as a percentage of health expenditure (-0.34, 95% CI [-0.56, -0.11]), and the Gini coefficient (-0.25, 95% CI [-0.50, -0.01]). The FEM results were similar to those of the REM. The predicted annual NS for Taiwan based on the REM rose from 29,390 U.S. dollars (corrected for purchasing power parity; 95% CI [22,532, 36,247]) in 2009 to 49,891 U.S. dollars (95% CI [42,344, 57,438]) in 2018. The actual annual NS in Taiwan in 2018 was approximately 12% lower than the model-predicted value. CONCLUSIONS/IMPLICATIONS FOR PRACTICE Taiwan has a lower NS compared with its OECD counterparts. These findings may help policymakers, healthcare managers, and nurse organizations develop effective strategies to improve the remuneration system for nurses in Taiwan.
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Affiliation(s)
| | - Chia Hui Hsu
- MS, Research Assistant, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Yu-Chun Tseng
- MS, Research Assistant, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Chao A Hsiung
- PhD, Honorary Investigator, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
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Kagonya VA, Onyango OO, Maina M, Gathara D, English M, Imam A. Characterising support and care assistants in formal hospital settings: a scoping review. HUMAN RESOURCES FOR HEALTH 2023; 21:90. [PMID: 38012737 PMCID: PMC10680191 DOI: 10.1186/s12960-023-00877-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/16/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND A 15 million health workforce shortage is still experienced globally leading to a sub-optimal healthcare worker-to-population ratio in most countries. The use of low-skilled care assistants has been suggested as a cost-saving human resource for health strategy that can significantly reduce the risks of rationed, delayed, or missed care. However, the characterisation, role assignment, regulation, and clinical governance mechanisms for unlicensed assistive workforce remain unclear or inconsistent. The purpose of this study was to map and collate evidence of how care assistants are labelled, utilised, regulated, and managed in formal hospital settings as well as their impact on patient care. METHODS We conducted a scoping review of literature from PUBMED, CINAHL, PsychINFO, EMBASE, Web of Science, Scopus, and Google Scholar. Searches and eligibility screening were conducted using the Participants-Context-Concepts framework. Thematic content analysis guided the synthesis of the findings. RESULTS 73 records from a total of 15 countries were included in the final full-text review and synthesis. A majority (78%) of these sources were from high-income countries. Many titles are used to describe care assistants, and these vary within and across countries. On ascribed roles, care assistants perform direct patient care, housekeeping, clerical and documentation, portering, patient flow management, ordering of laboratory tests, emergency response and first aid duties. Additional extended roles that require higher competency levels exist in the United States, Australia, and Canada. There is a mixture of both positive and negative sentiments on their impact on patient care or nurses' perception and experiences. Clinical and organisational governance mechanisms vary substantially across the 15 countries. Licensure, regulatory mechanisms, and task-shifting policies are largely absent or not reported in these countries. CONCLUSIONS The nomenclature used to describe care assistants and the tasks they perform vary substantially within countries and across healthcare systems. There is, therefore, a need to review and update the international and national classification of occupations for clarity and more meaningful nomenclature for care assistants. In addition, the association between care assistants and care outcomes or nurses' experience remains unclear. Furthermore, there is a dearth of empirical evidence on this topic from low- and middle-income countries.
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Affiliation(s)
- Vincent A Kagonya
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
| | - Onesmus O Onyango
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Michuki Maina
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - David Gathara
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mike English
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, Health Systems Collaborative, University of Oxford, Oxford, United Kingdom
| | - Abdulazeez Imam
- Nuffield Department of Medicine, Health Systems Collaborative, University of Oxford, Oxford, United Kingdom
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Nonehkaran EA, Mozaffari N, Iranpour S, Soola AH. Identifying the predictors of turnover intention based on nurse managers' toxic leadership behaviors among nurses in Iran: a cross-sectional correlational study. BMC Health Serv Res 2023; 23:1201. [PMID: 37924057 PMCID: PMC10623806 DOI: 10.1186/s12913-023-10046-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/19/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Unfavorable leadership practices are a growing concern in the field of healthcare and nursing that have adverse consequences on nurses' career outcomes. One of the undesirable leadership styles is the toxic leadership style. Considering the importance of nursing managers' leadership style and its impact on nurses' performance and the scarcity of studies in this field, the present study was conducted to determine toxic leadership behaviors in nursing managers and their relationship with the turnover intention among nurses. METHODS A multicenter cross-sectional correlational study. This study involved 551 nurses from 5 educational-medical centers in Ardabil province, north-western Iran. Three self-report scales, including The demographic and occupational information form, the Toxic Leadership Behaviors of Nurse Managers Scale (ToxBH-NM), and the turnover intention questionnaire were adopted for assessment purposes in this study. Data were analyzed using SPSS (Version 22) software using descriptive statistics, Pearson correlation coefficient test, t-test, ANOVA test, and multiple linear regression analysis. RESULTS Overall, 551 nurses participated in this research. There was a significantly positive relationship between Turnover intention and Toxic leadership behavior Subscales (r = 0.475, p < 0.001). Furthermore, multiple linear regression analysis showed Toxic leadership behavior Subscales (Intemperate behavior, Narcissistic behavior, Self-promoting behavior, and Humiliating behavior), Hospital, unit, Age, and Marital status predict Turnover intention when other variables are controlled. CONCLUSION A leader who directly and indirectly adopts toxic behavior toward their employees destructively affects both individuals and organizations. Nurses who work for a manager exhibiting toxic leadership behaviors demonstrated higher turnover intention.
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Affiliation(s)
- Elham Ahangari Nonehkaran
- Department of Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Naser Mozaffari
- Department of Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Sohrab Iranpour
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Aghil Habibi Soola
- Department of Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran.
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Wallenburg I, Friebel R, Winblad U, Maynou Pujolras L, Bal R. 'Nurses are seen as general cargo, not the smart TVs you ship carefully': the politics of nurse staffing in England, Spain, Sweden, and the Netherlands. HEALTH ECONOMICS, POLICY, AND LAW 2023; 18:411-425. [PMID: 37702051 DOI: 10.1017/s1744133123000178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Nurse workforce shortages put healthcare systems under pressure, moving the nursing profession into the core of healthcare policymaking. In this paper, we shift the focus from workforce policy to workforce politics and highlight the political role of nurses in healthcare systems in England, Spain, Sweden, and the Netherlands. Using a comparative discursive institutionalist approach, we study how nurses are organised and represented in these four countries. We show how nurse politics plays out at the levels of representation, working conditions, career building, and by breaking with the public healthcare system. Although there are differences between the countries - with nurses in England and Spain under more pressure than in the Netherlands and Sweden - nurses are often not represented in policy discourses; not just because of institutional ignorance but also because of fragmentation of the profession itself. This institutional ignorance and lack of collective representation, we argue, requires attention to foster the role and position of nurses in contemporary healthcare systems.
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Affiliation(s)
- Iris Wallenburg
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Rocco Friebel
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Laia Maynou Pujolras
- Department of Econometrics, Statistics and Applied Economics (Public Policies), Universitat de Barcelona, Barcelona, Spain
- London School of Economics and Political Science, London, UK
- Center for Research in Health and Economics, Universitat Pompeu Fabra, Barcelona, Spain
| | - Roland Bal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
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Visintini C, Palese A. What Nursing-Sensitive Outcomes Have Been Investigated to Date among Patients with Solid and Hematological Malignancies? A Scoping Review. NURSING REPORTS 2023; 13:1101-1125. [PMID: 37606464 PMCID: PMC10443292 DOI: 10.3390/nursrep13030096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/23/2023] Open
Abstract
Nursing-sensitive outcomes are those outcomes attributable to nursing care. To date three main reviews have summarized the evidence available regarding the nursing outcomes in onco-haematological care. Updating the existing reviews was the main intent of this study; specifically, the aim was to map the state of the art of the science in the field of oncology nursing-sensitive outcomes and to summarise outcomes and metrics documented as being influenced by nursing care. A scoping review was conducted in 2021. The MEDLINE, Cumulative Index to Nursing and Allied Health, Web of Science, and Scopus databases were examined. Qualitative and quantitative primary and secondary studies concerning patients with solid/haematological malignancies, cared for in any setting, published in English, and from any time were all included. Both inductive and deductive approaches were used to analyse the data extracted from the studies. Sixty studies have been included, mostly primary (n = 57, 95.0%) with a quasi- or experimental approach (n = 26, 55.3%), conducted among Europe (n = 27, 45.0%), in hospitals and clinical wards (n = 29, 48.3%), and including from 8 to 4615 patients. In the inductive analysis, there emerged 151 outcomes grouped into 38 categories, with the top category being 'Satisfaction and perception of nursing care received' (n = 32, 21.2%). Outcome measurement systems included mainly self-report questionnaires (n = 89, 66.9%). In the deductive analysis, according to the Oncology Nursing Society 2004 classification, the 'Symptom control and management' domain was the most investigated (n = 44, 29.1%); however, the majority (n = 50, 33.1%) of nursing-sensitive outcomes that emerged were not includible in the available framework. Continuing to map nursing outcomes may be useful for clinicians, managers, educators, and researchers in establishing the endpoints of their practice. The ample number of instruments and metrics that emerged suggests the need for more development of homogeneous assessment systems allowing comparison across health issues, settings, and countries.
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Affiliation(s)
- Chiara Visintini
- Division of Hematology and Stem Cell Transplantation, Clinical University Hospital of Udine, 33100 Udine, Italy;
| | - Alvisa Palese
- Department of Medical Sciences, University of Udine, 33100 Udine, Italy
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Shin SH, Baek OJ, Lee EH. Effects of Nursing Work Environment, Need Satisfaction, and Depression on Turnover Intention in Korea. Healthcare (Basel) 2023; 11:1698. [PMID: 37372816 DOI: 10.3390/healthcare11121698] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
This study examined the effects of the nursing work environment, need satisfaction, and depression on turnover intention in South Korean nurses through a mediating model. This study was a descriptive cross-sectional research study and was conducted through an online questionnaire. A total of 248 nurses were recruited for this study. Data were collected in August 2022. Participants were invited to complete self-reported questionnaires that measure nursing work environment, need satisfaction, depression, turnover intention, and demographic information. The data obtained were analyzed using the dual mediation model applying the PROCESS macro (Model 6). This study analyzed the direct effects of the nursing work environment on need satisfaction, depression, and turnover intention. The nursing work environment also had indirect effects on their turnover intention via need satisfaction and depression. The mediating effect of need satisfaction, which affects the turnover intention by increasing the satisfaction of the nursing work environment, was found to be the greatest. It has been shown that the more positive a nurse's experience of the nursing work environment, the higher the nurse's need satisfaction. According to the study results, the increase in nurses' need satisfaction greatly contributes to the decrease in depression and turnover intention. Therefore, active efforts should be made to improve the nursing work environment to fulfill basic needs.
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Affiliation(s)
- Sun-Hwa Shin
- Nursing Department, College of Nursing, Sahmyook University, Seoul 01795, Republic of Korea
| | - On-Jeon Baek
- Nursing Department, College of Nursing, Sahmyook University, Seoul 01795, Republic of Korea
| | - Eun-Hye Lee
- Nursing Department, College of Nursing, Sahmyook University, Seoul 01795, Republic of Korea
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Patient Outcomes and Hospital Nurses’ Workload: A Cross-Sectional Observational Study in Slovenian Hospitals Using the RN4CAST Survey. Zdr Varst 2023. [DOI: 10.2478/sjph-2023-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
ABSTRACT
Introduction
Higher nursing workload increases the odds of patient deaths, as the work environment has a significant effect on patient outcomes. The aim of the study was to explore the relation between patient outcomes and nurses’ working conditions in hospitals.
Methods
Administrative data on discharges of surgical patients for the year 2019 in eight general hospitals and two university medical centres in Slovenia were collected to determine in-hospital mortality within 30 days of admission. The RN4CAST survey questionnaire was used to gather data from nurses in these hospitals, with 1,010 nurses participating. Data was collected at the beginning of 2020. The number of nurses per shift and the nurse-to-patient ratio per shift were calculated. Univariate, bivariate and multivariate statistical methods were used to analyse the data.
Results
The 30-day in-hospital mortality for surgical patients was 1.00% in the hospitals sampled and ranged from 0.27% to 1.62%. The odds ratio for staffing suggests that each increase of one patient per RN is associated with a 6% increase in the likelihood of a patient dying within 30 days of admission. The mean patient-to-RN ratio was 15.56 (SD=2.50) and varied from 10.29 to 19.39. Four of the 13 tasks checked were not performed on patients during the last shift.
Conclusion
The results are not encouraging, with an extremely critical shortage of RNs and thus a high RN workload. The number of patients per RN is the highest in Europe and also higher than in some non-European countries, and represents an extreme risk to the quality of nursing and healthcare as a whole. The recommendation for acute non-emergency internal medicine and surgery departments is four patients per RN per shift.
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Kaplan EF, Strobel RJ, Young AM, Wisniewski AM, Ahmad RM, Mehaffey JH, Hawkins RB, Yarboro LT, Quader M, Teman NR. Cardiac Surgery Outcomes During the COVID-19 Pandemic Worsened Across All Socioeconomic Statuses. Ann Thorac Surg 2023; 115:1511-1518. [PMID: 36696937 PMCID: PMC9867828 DOI: 10.1016/j.athoracsur.2022.12.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/05/2022] [Accepted: 12/18/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Increasing socioeconomic distress has been associated with worse cardiac surgery outcomes. The extent to which the pandemic affected cardiac surgical access and outcomes remains unknown. We sought to examine the relationship between the COVID-19 pandemic and outcomes after cardiac surgery by socioeconomic status. METHODS All patients undergoing a Society of Thoracic Surgeons (STS) index operation in a regional collaborative, the Virginia Cardiac Services Quality Initiative (2011-2022), were analyzed. Patients were stratified by timing of surgery before vs during the COVID-19 pandemic (March 13, 2020). Hierarchic logistic regression assessed the relationship between the pandemic and operative mortality, major morbidity, and cost, adjusting for the Distressed Communities Index (DCI), STS predicted risk of mortality, intraoperative characteristics, and hospital random effect. RESULTS A total of 37,769 patients across 17 centers were included. Of these, 7269 patients (19.7%) underwent surgery during the pandemic. On average, patients during the pandemic were less socioeconomically distressed (DCI 37.4 vs DCI 41.9; P < .001) and had a lower STS predicted risk of mortality (2.16% vs 2.53%, P < .001). After risk adjustment, the pandemic was significantly associated with increased mortality (odds ratio 1.398; 95% CI, 1.179-1.657; P < .001), cost (+$4823, P < .001), and STS failure to rescue (odds ratio 1.37; 95% CI, 1.10-1.70; P = .005). The negative impact of the pandemic on mortality and cost was similar regardless of DCI. CONCLUSIONS Across all socioeconomic statuses, the pandemic is associated with higher cost and greater risk-adjusted mortality, perhaps related to a resource-constrained health care system. More patients during the pandemic were from less distressed communities, raising concern for access to care in distressed communities.
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Affiliation(s)
- Emily F Kaplan
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Raymond J Strobel
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Andrew M Young
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Alex M Wisniewski
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Raza M Ahmad
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - J Hunter Mehaffey
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Robert B Hawkins
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Leora T Yarboro
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Mohammad Quader
- Division of Cardiothoracic Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Nicholas R Teman
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia.
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Rubbo B, Saville C, Dall'Ora C, Turner L, Jones J, Ball J, Culliford D, Griffiths P. Staffing levels and hospital mortality in England: a national panel study using routinely collected data. BMJ Open 2023; 13:e066702. [PMID: 37197808 DOI: 10.1136/bmjopen-2022-066702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVES Examine the association between multiple clinical staff levels and case-mix adjusted patient mortality in English hospitals. Most studies investigating the association between hospital staffing levels and mortality have focused on single professional groups, in particular nursing. However, single staff group studies might overestimate effects or neglect important contributions to patient safety from other staff groups. DESIGN Retrospective observational study of routinely available data. SETTING AND PARTICIPANTS 138 National Health Service hospital trusts that provided general acute adult services in England between 2015 and 2019. OUTCOME MEASURE Standardised mortality rates were derived from the Summary Hospital level Mortality Indicator data set, with observed deaths as outcome in our models and expected deaths as offset. Staffing levels were calculated as the ratio of occupied beds per staff group. We developed negative binomial random-effects models with trust as random effects. RESULTS Hospitals with lower levels of medical and allied healthcare professional (AHP) staff (e.g, occupational therapy, physiotherapy, radiography, speech and language therapy) had significantly higher mortality rates (rate ratio: 1.04, 95% CI 1.02 to 1.06, and 1.04, 95% CI 1.02 to 1.06, respectively), while those with lower support staff had lower mortality rates (0.85, 95% CI 0.79 to 0.91 for nurse support, and 1.00, 95% CI 0.99 to 1.00 for AHP support). Estimates of the association between staffing levels and mortality were stronger between-hospitals than within-hospitals, which were not statistically significant in a within-between random effects model. CONCLUSIONS In additional to medicine and nursing, AHP staffing levels may influence hospital mortality rates. Considering multiple staff groups simultaneously when examining the association between hospital mortality and clinical staffing levels is crucial. TRIAL REGISTRATION NUMBER NCT04374812.
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Affiliation(s)
- Bruna Rubbo
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Christina Saville
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
- National Institute for Health Research Applied Research Collaboration (Wessex), University Hospital Southampton, Southampton, UK
| | - Chiara Dall'Ora
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
- National Institute for Health Research Applied Research Collaboration (Wessex), University Hospital Southampton, Southampton, UK
| | - Lesley Turner
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Jeremy Jones
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Jane Ball
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - David Culliford
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
- National Institute for Health Research Applied Research Collaboration (Wessex), University Hospital Southampton, Southampton, UK
| | - Peter Griffiths
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
- National Institute for Health Research Applied Research Collaboration (Wessex), University Hospital Southampton, Southampton, UK
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Brune S, Killam L, Camargo-Plazas P. Caring Knowledge as a Strategy to Mitigate Violence against Nurses: A Discussion Paper. Issues Ment Health Nurs 2023; 44:437-452. [PMID: 37167098 DOI: 10.1080/01612840.2023.2205502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Violence against nurses is a disturbing trend in healthcare that has reached epidemic proportions globally. These violent incidents can result in physical and psychological injury, exacerbating already elevated levels of stress and burnout among nurses, further contributing to absenteeism, turnover, and intent to leave the profession. To ensure the physical and mental well-being of nurses and patients, attention to the development of strategies to reduce violence against nurses must be a priority. Caring knowledge-rooted in the philosophy of care-is a potential strategy for mitigating violence against nurses in healthcare settings. We present what caring knowledge is, analyze its barriers to implementation at the health system and education levels and explore potential solutions to navigate those barriers. We conclude how the application of models of caring knowledge to the nurse-patient relationship has the potential to generate improved patient safety and increased satisfaction for both nurses and patients.
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Affiliation(s)
- Sara Brune
- School of Nursing, Queen's University, Kingston, Ontario, Canada
- Nursing (BSN) Program, University of the Fraser Valley, Chilliwack, British Columbia, Canada
| | - Laura Killam
- School of Nursing, Queen's University, Kingston, Ontario, Canada
- School of Health Sciences and Emergency Services, Cambrian College, Sudbury, Ontario, Canada
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Peutere L, Terho K, Pentti J, Ropponen A, Kivimäki M, Härmä M, Krutova O, Ervasti J, Koskinen A, Virtanen M. Nurse Staffing Level, Length of Work Experience, and Risk of Health Care-Associated Infections Among Hospital Patients: A Prospective Record Linkage Study. Med Care 2023; 61:279-287. [PMID: 36939226 PMCID: PMC10079297 DOI: 10.1097/mlr.0000000000001843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND Nurse understaffing may have several adverse consequences for patients in hospitals, such as health care-associated infections (HAIs), but there is little longitudinal evidence available on staffing levels and HAIs with consideration of incubation times to confirm this. Using daily longitudinal data, we analyzed temporal associations between nurse understaffing and limited work experience, and the risk of HAIs. METHODS The study was based on administrative data of 40 units and 261,067 inpatient periods for a hospital district in Finland in 2013-2019. Survival analyses with moving time windows were used to examine the association of nurse understaffing and limited work experience with the risk of an HAI 2 days after exposure, adjusting for individual risk factors. We reported hazard ratios (HRs) with 95% CIs. RESULTS Neither nurse understaffing nor limited work experience were associated with the overall risk of HAIs. The results were inconsistent across staffing measures and types of HAIs, and many of the associations were weak. Regarding specific HAI types, 1-day exposure to low proportion of nurses with >3 years of in-hospital experience and low proportion of nurses more than 25 years old were associated with increased risk of bloodstream infections (HR=1.30; 95% CI: 1.04-1.62 and HR=1.40; 95% CI: 1.07-1.83). Two-day exposure to low nursing hours relative to target hours was associated with an increased risk of surgical-site infections (HR=2.64, 95% CI: 1.66-4.20). CONCLUSIONS Data from time-varying analyses suggest that nursing staff shortages and limited work experience do not always increase the risk of HAI among patients.
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Affiliation(s)
- Laura Peutere
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu
- Finnish Institute of Occupational Health, Helsinki
| | - Kirsi Terho
- Department of Hospital Hygiene and Infection Control, Turku University Hospital Turku
| | - Jaana Pentti
- Department of Public Health, University of Turku, Turku Finland
| | - Annina Ropponen
- Finnish Institute of Occupational Health, Helsinki
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, Helsinki
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Mikko Härmä
- Finnish Institute of Occupational Health, Helsinki
| | | | | | - Aki Koskinen
- Finnish Institute of Occupational Health, Helsinki
| | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Dall'Ora C, Rubbo B, Saville C, Turner L, Ball J, Ball C, Griffiths P. The association between multi-disciplinary staffing levels and mortality in acute hospitals: a systematic review. HUMAN RESOURCES FOR HEALTH 2023; 21:30. [PMID: 37081525 PMCID: PMC10116759 DOI: 10.1186/s12960-023-00817-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 04/11/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Health systems worldwide are faced with the challenge of adequately staffing their hospital services. Much of the current research and subsequent policy has been focusing on nurse staffing and minimum ratios to ensure quality and safety of patient care. Nonetheless, nurses are not the only profession who interact with patients, and, therefore, not the only professional group who has the potential to influence the outcomes of patients while in hospital. We aimed to synthesise the evidence on the relationship between multi-disciplinary staffing levels in hospital including nursing, medical and allied health professionals and the risk of death. METHODS Systematic review. We searched Embase, Medline, CINAHL, and the Cochrane Library for quantitative or mixed methods studies with a quantitative component exploring the association between multi-disciplinary hospital staffing levels and mortality. RESULTS We included 12 studies. Hospitals with more physicians and registered nurses had lower mortality rates. Higher levels of nursing assistants were associated with higher patient mortality. Only two studies included other health professionals, providing scant evidence about their effect. CONCLUSIONS Pathways for allied health professionals such as physiotherapists, occupational therapists, dietitians, pharmacists, to impact safety and other patient outcomes are plausible and should be explored in future studies.
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Affiliation(s)
- Chiara Dall'Ora
- School of Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK.
- NIHR Applied Research Collaboration Wessex, University of Southampton, Southampton, UK.
| | - Bruna Rubbo
- School of Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Christina Saville
- School of Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Lesley Turner
- School of Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Jane Ball
- School of Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
- NIHR Applied Research Collaboration Wessex, University of Southampton, Southampton, UK
| | - Cheska Ball
- NIHR Applied Research Collaboration Wessex, University of Southampton, Southampton, UK
- Dorset County Hospital NHS Foundation Trust, Dorchester, UK
| | - Peter Griffiths
- School of Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
- NIHR Applied Research Collaboration Wessex, University of Southampton, Southampton, UK
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Lee JL, Kim Y. Research Topic Trends on Turnover Intention among Korean Registered Nurses: An Analysis Using Topic Modeling. Healthcare (Basel) 2023; 11:healthcare11081139. [PMID: 37107972 PMCID: PMC10138232 DOI: 10.3390/healthcare11081139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
This study aimed to explore research topic trends on turnover intention among Korean hospital nurses by analyzing the keywords and topics of related articles. Methods: This text-mining study collected, processed, and analyzed text data from 390 nursing articles published between 1 January 2010 and 30 June 2021 that were collected via search engines. The collected unstructured text data were preprocessed, and the NetMiner program was used to perform keyword analysis and topic modeling. Results: The word with the highest degree centrality was "job satisfaction", the word with the highest betweenness centrality was "job satisfaction", and the word with the highest closeness centrality and frequency was "job stress". The top 10 keywords in both the frequency analysis and the 3 centrality analyses included "job stress", "burnout", "organizational commitment", "emotional labor", "job", and "job embeddedness". The 676 preprocessed key words were categorized into five topics: "job", "burnout", "workplace bullying", "job stress", and "emotional labor". Since many individual-level factors have already been thoroughly investigated, future research should concentrate on enabling successful organizational interventions that extend beyond the microsystem.
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Affiliation(s)
- Jung Lim Lee
- Department of Nursing, Daejeon University, Daejeon-si 34520, Republic of Korea
| | - Youngji Kim
- Department of Nursing, College of Nursing and Health, Kongju National University, Kongju-si 32588, Republic of Korea
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Determining the Role of Employee Engagement in Nurse Retention along with the Mediation of Organizational Culture. Healthcare (Basel) 2023; 11:healthcare11050760. [PMID: 36900765 PMCID: PMC10001374 DOI: 10.3390/healthcare11050760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/26/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
In today's unpredictable environment, the rapid emergence of the COVID-19 pandemic has shaken the world and its healthcare infrastructure immensely. As nurses are the building blocks of the healthcare personnel labor market, organizations should develop tactics that aid in their retention. With a solid theoretical foundation in self-determination theory, this study aims to understand the role of employee engagement in keeping nurses in 51 hospitals in the Northern Indian region, along with the mediation of organizational culture through smart PLS. In a complementary mediation relationship with organizational culture, nurse retention is positively correlated with employee engagement.
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Morita K, Matsui H, Ono S, Fushimi K, Yasunaga H. Association between better night-shift nurse staffing and surgical outcomes: A retrospective cohort study using a nationwide inpatient database in Japan. J Nurs Scholarsh 2023; 55:494-505. [PMID: 36345776 DOI: 10.1111/jnu.12845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/14/2022] [Accepted: 10/24/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Although many studies have investigated the relationship between patient outcomes and the level of nurse staffing, little is known about the association between increased night-shift nurse staffing and patient outcomes. In the Japanese universal health insurance system, a new scheme of additional financial incentives for acute care hospitals was launched in 2012 to increase the number of nurses during the night shift in general wards. The objective of this study was to investigate whether an additional financial incentive to increase night-shift nurse staffing in general wards was associated with better patient outcomes. DESIGN Adoption of the above-mentioned scheme of additional financial incentives was used as a natural experiment, and the difference-in-differences method was conducted to evaluate the effect of the scheme. The study was performed using a nationwide inpatient database and hospital information in Japan. METHODS To conduct a difference-in-differences analysis, first, hospitals with and without increased night-shift nurse staffing were matched using propensity score matching. A patient-level difference-in-differences analysis was then conducted. The intervention group comprised the hospitals that adopted the new scheme of additional financial incentives. The outcome measures were in-hospital mortality, failure to rescue, and length of hospital stay. RESULTS Subjects were 403,971 adult patients who underwent planned major surgeries in Japanese acute care hospitals from April 2012 to March 2018. The adjusted difference-in-differences estimates were not significant for in-hospital mortality (odds ratio: 0.83; 95% confidence interval: 0.68 to 1.01; p = 0.07) or failure to rescue (odds ratio: 0.92; 95% confidence interval: 0.73 to 1.14; p = 0.44). The adjusted difference-in-differences estimate for length of hospital stay was significant (percent change: -3.2%; 95% confidence interval: -6.1 to -0.3%; p = 0.029), indicating that the adoption of the scheme was associated with a decreased length of hospital stay. CONCLUSIONS Increased night-shift nurse staffing was not associated with a decrease in in-hospital mortality or failure to rescue, but it was associated with a reduction in the length of hospital stay. It may be necessary to consider changes in policy content to make the policy more effective. The findings of this study are potentially useful for medical policymakers considering nurse staffing to decrease the length of stay, which may decrease costs. CLINICAL RELEVANCE This study showed that increased night-shift nurse staffing was not associated with a decrease in in-hospital mortality or failure to rescue, but it was associated with a reduction in the length of hospital stay. The examination of the effectiveness of increasing nurse staffing during a specific shift in acute care hospitals is potentially useful for health policymakers worldwide in their considerations of future nurse staffing policies.
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Affiliation(s)
- Kojiro Morita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sachiko Ono
- Department of Eat-loss Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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A 4‐Bed Close-Observation Pod model of multidisciplinary care in hospital: A mixed methods study4-Bed Close Observation Pod Study. Collegian 2023. [DOI: 10.1016/j.colegn.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Unplanned hospital admissions due to secondary health conditions after spinal cord injury: a population-based description of determinants of length of stay. Spinal Cord 2023; 61:290-295. [PMID: 36782017 DOI: 10.1038/s41393-023-00880-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 01/27/2023] [Accepted: 02/01/2023] [Indexed: 02/15/2023]
Abstract
STUDY DESIGN Population-based prospective study. OBJECTIVES To provide a population-based description of length of stay (LOS) and person-related risk factors following unplanned hospital admission due to a secondary health condition (SHC) in persons with spinal cord injury (SCI). SETTING Specialized SCI hospital and rehabilitation center in Switzerland. METHODS Descriptive analysis of LOS using routine clinical data of persons with SCI, who were acutely hospitalized between 01.01.2017-30.06.2018. Multivariable regression analysis was used to derive marginal predictions of LOS by acute SHCs and person characteristics. RESULTS The study included 183 persons, 83% were male, and the median age was 57 years (interquartile range, IQR, 49-67 years). SCI cause was traumatic in 160 (88.4%) cases, 92 (50.3%) were persons with tetraplegia, 147 (80.3%) were classified as motor complete lesions (American Spinal Injury Association Impairment Scale (AIS) A or B) and median time since injury (TSI) was 24 (IQR 13-34) years. Median LOS was 19 (IQR 9-39) days, varying from 74 (IQR 39-92) days for pressure ulcers, 13 (IQR 8-24) days for urinary tract infections (UTI), to 27 (IQR 18-47) days for fractures. LOS was prolonged in persons with multiple co-morbidities or those developing complications during hospitalization. Sex, SCI etiology and lesion level were not associated with LOS. CONCLUSIONS This population-based description identified substantial variation in LOS between acute SHCs and clinical complications as the main, potentially modifiable, person-related risk factors for extended hospital stay.
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Van den Heede K, Balcaen K, Bouckaert N, Bruyneel L, Cornelis J, Sermeus W, Van de Voorde C. Improving hospital nurse staffing during the pandemic: Implementation of the 2019 Fund for Health Care Staff in Belgium. Health Policy 2023; 128:69-74. [PMID: 36462953 PMCID: PMC9701585 DOI: 10.1016/j.healthpol.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 10/08/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
Chronic hospital nurse understaffing is a pre-existing condition of the COVID-19 pandemic. With nurses on the frontline against the pandemic, safe nurse staffing in hospitals is high on the political agenda of the responsible ministers of Health. This paper presents a recent Belgian policy reform to improve nurse staffing levels. Although the reform was initiated before the pandemic, its roll-out took place from 2020 onwards. Through a substantial increase of the hospital budget, policy makers envisaged to improve patient-to-nurse ratios. Yet, this ambition was considerably toned down during the implementation. Due to a shortage of nurses in the labour market, hospital associations successfully lobbied to allocate part of the budget to hire non-nursing staff. Moreover, other healthcare settings claimed their share of the pie. Elements of international best-practice examples such as ward managers supernumerary to the team and increasing the transparency on staffing decisions were adopted. Other measures, such as mandated patient-to-nurse ratios, nurse staffing committees, or the monitoring or public reporting of ratios, were not retained. Additional measures were taken to safeguard that bedside staffing levels would improve, such as the requirement to demonstrate a net increase in staff to obtain additional budget, staffing plan's approval by local work councils and recommendation to base staff allocation on patient acuity measures. This policy process makes clear that the engagement of budgets is only a first step towards safe staffing levels, which needs to be embedded in a comprehensive policy plan. Future evaluation of bedside nurse staffing levels and nurse wellbeing is needed to conclude about the effectiveness of these measures and the intended and unintended effects they provoked.
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Affiliation(s)
- Koen Van den Heede
- Belgian Healthcare Knowledge Centre (KCE), Kruidtuinlaan 55, 1000 Brussels, Belgium,Leuven Institute for Healthcare Policy ... Katholieke Universiteit Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium,Corresponding author at: KCE Belgian Health Care Knowledge Centre: Federaal Kenniscentrum voor de Gezondheidszorg, Kruidtuinlaan 55 doorbuilding 9th… 1000 Brussels, Belgium
| | - Koen Balcaen
- University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Nicolas Bouckaert
- Belgian Healthcare Knowledge Centre (KCE), Kruidtuinlaan 55, 1000 Brussels, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy ... Katholieke Universiteit Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium
| | - Justien Cornelis
- Belgian Healthcare Knowledge Centre (KCE), Kruidtuinlaan 55, 1000 Brussels, Belgium
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy ... Katholieke Universiteit Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium
| | - Carine Van de Voorde
- Belgian Healthcare Knowledge Centre (KCE), Kruidtuinlaan 55, 1000 Brussels, Belgium
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Nurse Performance Metrics: A Scoping Review. J Nurs Adm 2023; 53:110-115. [PMID: 36693001 DOI: 10.1097/nna.0000000000001251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The purposes of this scoping review are: 1) to identify instances in the literature that describe measuring individual nurse performance and 2) characterize those metrics. BACKGROUND The impact of nurses on patient outcomes has been demonstrated at the unit or hospital level, with nurses measured in aggregate. There is an opportunity to evaluate individual nurse performance by creating metrics that capture it. METHODS A scoping review based on the framework published by the Joanna Briggs Institute was performed. RESULTS Researchers identified 12 articles. Three themes were trended: the emerging nature of these metrics in the literature, variability in their applications, and performance implications. CONCLUSIONS Individual nurse performance metrics is an emerging body of research with variability in the types of metrics developed. There is an opportunity for future researchers to work with nurse leaders and staff nurses to optimize these metrics and to use them to support nursing practice and patient care.
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Nursing Assistant Staffing Model: Implementation and Outcome Evaluation in Taiwan Hospitals. THE JOURNAL OF NURSING RESEARCH : JNR 2023; 31:e254. [PMID: 36626236 DOI: 10.1097/jnr.0000000000000540] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND A key policy of the Taiwan healthcare system is promoting the hiring of nursing assistants (NAs) to reduce the workload of nurses. However, few studies in the literature have compared the relative effectiveness of different nurse staffing policies, and no studies have addressed the impact of the NA staffing (NAS) model. PURPOSE This study explored the current status of the NAS model as implemented in Taiwan hospitals and to investigate the methods used to evaluate the outcomes of NAS model implementation. METHODS A cross-sectional online survey was performed in hospitals nationwide from June 1 to December 31, 2018. There were 153 government-accredited hospitals being invited to participate in the survey. RESULTS Of the 139 hospitals that completed the online survey, 26% (36 hospitals) had implemented the NAS model. Many of the hospitals had hired full-time, certified NAs. Most of the tasks assigned to NAs were in the nonprofessional/general and technical work categories. In addition, medical wards were the most frequently assigned workplace, especially on day shifts. Few of the surveyed hospitals had evaluated the effectiveness of the NAS model. Improvement after implementation of the NAS model (based on the 35 outcome indicators) was found to vary significantly. The most commonly used outcome indicator was patient satisfaction. All the stakeholders, including patients, family caregivers, nurses, and nurse supervisors, supported implementation of the NAS model. However, some of the participants expressed concerns regarding the difficulties involved with model implementation. CONCLUSIONS/IMPLICATIONS FOR PRACTICE Although the NAS model may be beneficial, further empirical research is necessary to confirm the contributions of NAs. Additional evidence regarding the benefits of the NAS model for hospital performance and patient outcomes may be expected to motivate more hospital administrators to adopt this model.
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Nilsson L, Lindblad M, Johansson N, Säfström L, Schildmeijer K, Ekstedt M, Unbeck M. Exploring nursing-sensitive events in home healthcare: A national multicenter cohort study using a trigger tool. Int J Nurs Stud 2023; 138:104434. [PMID: 36630873 DOI: 10.1016/j.ijnurstu.2022.104434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/10/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND The provision of home healthcare is increasing in response to the growing aging population with the need for chronic disease management in their homes. Safety work differs from hospital care. The incidence of adverse events in home healthcare is sparsely studied but is estimated to occur in-one third of patients, and most are deemed preventable. Although nursing care is crucial for risk assessment and preventive work in the home environment, the role of registered nurses in the prevention of no-harm incidents and adverse events has not received sufficient scientific attention. OBJECTIVES To explore nursing-sensitive events in patients receiving home healthcare. DESIGN, SETTING AND PARTICIPANTS A Swedish national multicenter study based on a structured record review of 600 randomly chosen healthcare records from 10 organizations in different regions of the country. METHODS Ten trained teams, each including physician(s) and registered nurses, undertook a review based on the Global Trigger Tool method. The review covered a maximum of 90 days from admission to home healthcare. First, each record was screened for the presence of 38 predefined triggers. In the second step, every potential event was assessed according to preventability, types of events, severity, time of occurrence, consequences of the event, and potential contributing causes. RESULTS In total, 699 events were identified in the study. Of these, 495 (74.0%) were classified as nursing-sensitive (227 no-harm incidents and 268 adverse events) and affected 267 (44.5%) patients, with a mean of 1.9 events per patient. The majority (n = 367, 73.1%) were considered preventable. The most prominent types of nursing-sensitive event were falls (n = 138, 27.9%), pressure ulcers (n = 62, 12.5%), healthcare-associated infections (n = 58, 11.7%) and medication management (n = 50, 10.1%). Concerning severity, 45.9% were classified as no-harm incidents and another 36.6% resulted in temporary harm that required extra healthcare resources: 226 hospital days, 66 physician visits in outpatient care, and 99 in home healthcare. All severity types occurred from day 1, except death, which included only one patient. The most frequent contributing factors were deficiencies in nursing care, treatment & diagnosis, with the subgroups nursing care, observation, treatment & follow-up, followed by deficiencies in the organization. CONCLUSIONS Nursing-sensitive events in home healthcare are common, often preventable, and occur from the start of the care period. This study contributes to increased knowledge of patient safety shortcomings and points to the important role that registered nurses play in patient safety work.
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Affiliation(s)
- Lena Nilsson
- Department of Anaesthesiology and Intensive Care, Department of Medical and Health Sciences, Faculty of Medicine and Health Science, Linköping University, Linköping, Sweden.
| | - Marléne Lindblad
- Department of Health Sciences, Swedish Red Cross University, Stockholm, Sweden
| | - Nathalie Johansson
- School of Health and Welfare, Dalarna University, Falun, Sweden; Örsundsbro Health Center, Region Uppsala, Sweden
| | - Lisa Säfström
- School of Health and Welfare, Dalarna University, Falun, Sweden; Heby Home Health Care, Heby, Sweden
| | | | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Unbeck
- School of Health and Welfare, Dalarna University, Falun, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Stock G, McDermott C. The effects of physicians on operational and financial performance in United States hospitals: staffing, human capital and knowledge spillovers. INTERNATIONAL JOURNAL OF OPERATIONS & PRODUCTION MANAGEMENT 2023. [DOI: 10.1108/ijopm-07-2022-0457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PurposeThe authors examine how physician staffing, human capital and knowledge spillovers are related to multiple dimensions of hospital operational and financial performance at the organizational level.Design/methodology/approachThe authors use a data set assembled from multiple sources for more than 1,300 US hospitals and employ hierarchical linear regression to test this study’s hypotheses. The authors use multiple quality, efficiency and financial measures of performance for these hospitals.FindingsThe authors find that higher levels of staffing, skills and knowledge spillovers associated with physicians were positively associated with multiple dimensions of hospital performance. The authors find linear and nonlinear relationships between experience and performance, with the relationships primarily negative, and nonlinear relationships between spillovers and quality performance.Practical implicationsHospital managers should consider increasing physician staffing levels if possible. In addition, the overall Final MIPS Score from the Centers for Medicare and Medicaid Services might be included as a factor in determining which physicians practice in a hospital. Finally, if possible, encouraging physicians to practice at multiple hospitals will likely be beneficial to hospital performance.Originality/valueThis study’s findings are original in that they explore how physician-specific staffing and human capital, which have received comparatively little attention in the literature, are related to several different dimensions of hospital-level operational and financial performance. To the best of the authors’ knowledge, this paper is also the first to examine the relationship between the construct of physician knowledge spillovers and hospital-level operational and financial performance.
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Ruano-Ferrer F, Gutiérrez- Giner MI. Safety perception in the operating environment: The nurses' perspective versus that of the surgeons. Heliyon 2023; 9:e12676. [PMID: 36685413 PMCID: PMC9849966 DOI: 10.1016/j.heliyon.2022.e12676] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 01/06/2023] Open
Abstract
Background Adverse effects due to surgery occur in 25% of patients, and the patient safety perception seems to differ between nurses and surgeons in the operating room (OR). This difference can be attributed to lack of communication. However, our hospital has not conducted any studies on patient safety climate (PSC) in the OR. Aims To determine if the perception of PSC of nurses and surgeons in the OR diverges and understand whether these differences could be explained by communication gap. Methods A total of 42 perioperative nurses and 44 surgeons in the OR of a tertiary hospital answered the Spanish version of the US Hospital Survey on PSC. This was an observational, cross-sectional study with descriptive statistics and a non-parametric test. Results Nurses had a worse perception of the dimensions of overall safety, leader expectations, teamwork within units, feedback, staffing, and hospital management (p < .05). Although no differences were found concerning organizational learning/continuous improvement, communication openness, nonpunitive responses, and teamwork across hospital unit dimensions, the findings suggest that the nurses' perception was worse than that of the surgeons. Conclusions In general, OR nurses have worse PSC than surgeons, mainly in the areas where communication it's important. Our study has provided the data that will enable the hospital management team to make decisions to improve the PSC in the operating room area. We recommend a more active presence of nurses in directive teams.
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Affiliation(s)
- Fátima Ruano-Ferrer
- Hospital Universitario Materno-Infantil (HUMIC). Universidad de Las Palmas de Gran Canaria, Avenida Marítima del Sur, S/n, 35016, Las Palmas de Gran Canaria, Las Palmas, Spain,Corresponding author.
| | - María Isabel Gutiérrez- Giner
- Complejo Hospitalario Universitario Insular-Materno Infantil, Universidad de Las Palmas de Gran Canaria, Avenida Marítima del Sur, S/n, 35016, Las Palmas de Gran Canaria, Las Palmas, Spain
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Sharma N, Moffa G, Schwendimann R, Endrich O, Ausserhofer D, Simon M. The effect of time-varying capacity utilization on 14-day in-hospital mortality: a retrospective longitudinal study in Swiss general hospitals. BMC Health Serv Res 2022; 22:1551. [PMID: 36536376 PMCID: PMC9764719 DOI: 10.1186/s12913-022-08950-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND High bed-occupancy (capacity utilization) rates are commonly thought to increase in-hospital mortality; however, little evidence supports a causal relationship between the two. This observational study aimed to assess three time-varying covariates-capacity utilization, patient turnover and clinical complexity level- and to estimate causal effect of time-varying high capacity utilization on 14 day in-hospital mortality. METHODS This retrospective population-based analysis was based on routine administrative data (n = 1,152,506 inpatient cases) of 102 Swiss general hospitals. Considering the longitudinal nature of the problem from available literature and expert knowledge, we represented the underlying data generating mechanism as a directed acyclic graph. To adjust for patient turnover and patient clinical complexity levels as time-varying confounders, we fitted a marginal structure model (MSM) that used inverse probability of treatment weights (IPTWs) for high and low capacity utilization. We also adjusted for patient age and sex, weekdays-vs-weekend, comorbidity weight, and hospital type. RESULTS For each participating hospital, our analyses evaluated the ≥85th percentile as a threshold for high capacity utilization for the higher risk of mortality. The mean bed-occupancy threshold was 83.1% (SD 8.6) across hospitals and ranged from 42.1 to 95.9% between hospitals. For each additional day of exposure to high capacity utilization, our MSM incorporating IPTWs showed a 2% increase in the odds of 14-day in-hospital mortality (OR 1.02, 95% CI: 1.01 to 1.03). CONCLUSIONS Exposure to high capacity utilization increases the mortality risk of inpatients. Accurate monitoring of capacity utilization and flexible human resource planning are key strategies for hospitals to lower the exposure to high capacity utilization.
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Affiliation(s)
- Narayan Sharma
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Giusi Moffa
- grid.6612.30000 0004 1937 0642Department of Mathematics and Computer Science, University of Basel, Basel, Switzerland
| | - René Schwendimann
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland ,grid.410567.1Patient Safety Office, University Hospital Basel, Basel, Switzerland
| | - Olga Endrich
- grid.411656.10000 0004 0479 0855Directorate of Medicine, Inselspital University Hospital Bern, Bern, Switzerland
| | - Dietmar Ausserhofer
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland ,College of Health Care-Professions Claudiana, Bozen, Italy
| | - Michael Simon
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
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Mavridis C, Aidonidis G, Evangelou M, Kalogeridis A. Mandatory vaccinations, the segregation of citizens, and the promotion of inequality in the modern democracy of Greece and other democratic countries in the era of COVID-19. HISTORY AND PHILOSOPHY OF THE LIFE SCIENCES 2022; 44:72. [PMID: 36477872 PMCID: PMC9734873 DOI: 10.1007/s40656-022-00548-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/04/2022] [Indexed: 05/25/2023]
Abstract
During the COVID-19 pandemic, the Greek authorities enforced a vaccination mandate for healthcare workers (HCWs). At the same time, multiple concerns were raised about the epidemiological profile of Greece in addition to the ethical status of the harsh measures and their impact on employees, organizations, society, and public health. According to the World Health Organization (WHO), considerations regarding the evidence of vaccine safety and effectiveness, necessity, and proportionality should be clearly evaluated by before imposing mandatory vaccination policies. We discuss the issues regarding the mechanics of the transmission and contraction of SARS-CoV-2, the toxicity of COVID-19 vaccines, and the impact of the suspension of HCWs who did not vaccinate versus the potential expected benefits in addition to whether the vaccine mandates were justified considering the overall epidemiological context.
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Affiliation(s)
| | | | | | - Athanasios Kalogeridis
- 2nd Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloníki, Greece
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Griffiths P, Dall'Ora C. Nurse staffing and patient safety in acute hospitals: Cassandra calls again? BMJ Qual Saf 2022; 32:241-243. [PMID: 36597996 DOI: 10.1136/bmjqs-2022-015578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Peter Griffiths
- NIHR Applied Research Collaboration (Wessex), University of Southampton, Southampton, Hampshire, UK
| | - Chiara Dall'Ora
- NIHR Applied Research Collaboration (Wessex), University of Southampton, Southampton, Hampshire, UK
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Senek M, Robertson S, Taylor B, Wood E, King R, Ryan T. Consequences of understaffing on type of missed community care- a cross-sectional study. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100075. [PMID: 38745608 PMCID: PMC11080403 DOI: 10.1016/j.ijnsa.2022.100075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/30/2021] [Accepted: 03/08/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Resource cuts to primary and community care in combination with a decline of those working in community settings is compromising quality of care and patient safety in the UK. It is reported that the negative consequences of understaffing and underfunding have worsened due to the COVID-19 pandemic. OBJECTIVE This is a cross-sectional study that aimed to examine short and long-term District and Community nursing working conditions. The objectives were to assess the prevalence of understaffing and missed care and the relationship between individual and organisational factors and their association with missed care outcome. We further explored the relationship between additional caseload, staffing levels and missed care. METHODS We developed a questionnaire based on the validated MISSCARE survey. Outcome measures were, number of vacancies per team, staffing levels, reported incidence of missed care, type of missed care, length of shift and overtime. RESULTS Only 23% of teams reported having no vacancies. The mean staffing ratio was reported at 60%, including agency/bank staff (0.59±1.5). Prevalence of missed care was relatively high (60%≈). The distribution of types of missed care was spread evenly across all types of nursing care. A backward stepwise regression analysis showed that the Proportion of Permanent staff capacity OR=7.9 (95% CI 0.09-0.65), Active Caseload Size OR= 5.5 (95% CI: 1.0 - 1.003), Number of RNs on the team (OR 4.8 (95% CI:1.003-1.058) and Amount of Overtime worked (OR= 3.9 (95% CI:0.98-1.0) variable are statistically significant predictors of missed care. The analysis showed an increase in additional allocated cases per RN as the permanent staff proportion decreased to 70%, at which point the likelihood of reported Missed Care outcome peaks. CONCLUSION The compromised quality of care related to human resources and organisational aspects of the nursing process. Where RNs worked longer hours to make up for the backlog of cases, the prevalence of missed care was more likely. Longer working hours in the community increased the risk of compromised care and sub-optimal patient care. The aspects of the nursing process identified as 'missed' related to The World Health Organisation's three main pillars of community nursing (health promotion, patient education and screening). As such, significant components of the two first pillars are, according to these data, being undermined.
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Affiliation(s)
- Michaela Senek
- The University of Sheffield, Health Sciences School, 387 Glossop Road, Sheffield S10 2HQ, United Kingdom
| | - Steven Robertson
- The University of Sheffield, Health Sciences School, 387 Glossop Road, Sheffield S10 2HQ, United Kingdom
| | - Bethany Taylor
- The University of Sheffield, Health Sciences School, 387 Glossop Road, Sheffield S10 2HQ, United Kingdom
| | - Emily Wood
- The University of Sheffield, Health Sciences School, 387 Glossop Road, Sheffield S10 2HQ, United Kingdom
| | - Rachel King
- The University of Sheffield, Health Sciences School, 387 Glossop Road, Sheffield S10 2HQ, United Kingdom
| | - Tony Ryan
- The University of Sheffield, Health Sciences School, 387 Glossop Road, Sheffield S10 2HQ, United Kingdom
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Yoon HJ. The Effect of Nurse Staffing on Patient Outcomes in Acute Care Hospitals in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15566. [PMID: 36497641 PMCID: PMC9736847 DOI: 10.3390/ijerph192315566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/19/2022] [Accepted: 11/20/2022] [Indexed: 06/17/2023]
Abstract
Nurse staffing is an important factor influencing patient health outcomes. This study aimed to analyze the effects of nurse staffing on patient health outcomes, such as length of stay, mortality within 30 days of hospitalization, and readmission within 7 days of discharge, in acute care hospitals in Korea. Data from the first quarter of 2018 were collected using public and inpatient sample data from the Health Insurance Review and Assessment Service. The data of 46,196 patients admitted to 536 general wards of acute care hospitals were analyzed. A multilevel logistic analysis was performed for the patients' mortality and early readmission, and a multilevel zero-truncated negative binomial analysis was performed for the length of stay. The average length of stay in acute care hospitals was 6.54 ± 6.03 days, the mortality rate was 1.1%, and the early readmission rate was 7.1%. As the nurse staffing level increased, the length of stay and number of early readmissions were likely to decrease. It can be concluded that interventions to improve nurse staffing are required; for example, a policy that compels medical institutions to comply with Korea's medical law standards should be implemented. Additionally, continuous research and interventions are needed to establish an appropriate nurse staffing level according to patient severity.
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Affiliation(s)
- Hyo-Jeong Yoon
- Department of Nursing, Yeungnam University College, Daegu 42415, Republic of Korea
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Kang J, Lee Y. Health-Related Factors Influencing Nurse Turnover by Clinical Career: A Secondary Data Analysis of Clinical Nurses in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15222. [PMID: 36429939 PMCID: PMC9690249 DOI: 10.3390/ijerph192215222] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
The increase in clinical nurse turnover is an important issue in human resource management worldwide. Factors influencing it include health-related risk factors such as sleep quality and presenteeism, which need further exploration. We examined differences in job survival time of clinical nurses in relation to nurses' sleep quality and presenteeism. Participants were 857 Korean clinical nurses with more than three months' experience providing direct patient care. Data were analyzed using a time-independent Cox proportional hazard regression analysis of factors affecting actual turnover of clinical nurses. Average job survival times of competent, proficient, and expert nurses were 33, 64, and 143 months, respectively. Sleep quality and presentism significantly affected turnover risk. For clinical nurses with less than three years of experience, sleep quality significantly influenced the risk of turnover. For clinical nurses with more than six years of experience, presenteeism significantly affected the risk of turnover. The findings of this study offer a clinical career-based approach to reduce the turnover rate of clinical nurses. A differentiated approach based on work experience is necessary to establish a turnover management strategy for clinical nurses.
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Affiliation(s)
- Jiwon Kang
- Research Institute of Nursing Science, Ajou University, Suwon 16499, Republic of Korea
- School of Nursing, University of Minnesota, Minneapolis, MN 55455, USA
| | - Youngjin Lee
- College of Nursing, Ajou University, Suwon 16499, Republic of Korea
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Abuosi AA, Poku CA, Attafuah PYA, Anaba EA, Abor PA, Setordji A, Nketiah-Amponsah E. Safety culture and adverse event reporting in Ghanaian healthcare facilities: Implications for patient safety. PLoS One 2022; 17:e0275606. [PMID: 36260634 PMCID: PMC9581362 DOI: 10.1371/journal.pone.0275606] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/20/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Recognizing the values and norms significant to healthcare organizations (Safety Culture) are the prerequisites for safety and quality care. Understanding the safety culture is essential for improving undesirable workforce attitudes and behaviours such as lack of adverse event reporting. The study assessed the frequency of adverse event reporting, the patient safety culture determinants of the adverse event reporting, and the implications for Ghanaian healthcare facilities. METHODS The study employed a multi-centre cross-sectional survey on 1651 health professionals in 13 healthcare facilities in Ghana using the Survey on Patient Safety (SOPS) Culture, Hospital Survey questionnaire. Analyses included descriptive, Spearman Rho correlation, one-way ANOVA, and a Binary logistic regression model. RESULTS The majority of health professionals had at least reported adverse events in the past 12 months across all 13 healthcare facilities. Teamwork (Mean: 4.18, SD: 0.566) and response to errors (Mean: 3.40, SD: 0.742) were the satisfactory patient safety culture. The patient safety culture dimensions were statistically significant (χ2 (9, N = 1642) = 69.28, p < .001) in distinguishing between participants who frequently reported adverse events and otherwise. CONCLUSION Promoting an effective patient safety culture is the ultimate way to overcome the challenges of adverse event reporting, and this can effectively be dealt with by developing policies to regulate the incidence and reporting of adverse events. The quality of healthcare and patient safety can also be enhanced when healthcare managers dedicate adequate support and resources to ensure teamwork, effective communication, and blame-free culture.
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Affiliation(s)
- Aaron Asibi Abuosi
- Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Ghana
| | - Collins Atta Poku
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Research, Education, and Administration, School of Nursing and Midwifery, University of Ghana, Legon, Ghana
| | - Priscilla Y. A. Attafuah
- Department of Community Health Nursing, School of Nursing and Midwifery, University of Ghana, Legon, Ghana
| | - Emmanuel Anongeba Anaba
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Ghana
| | - Patience Aseweh Abor
- Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Ghana
| | - Adelaide Setordji
- Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Ghana
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Zeyrek AŞ, Fidan Ö, Köktaş NÇ. The adaptation of the Nurse Turnover Intention Scale into Turkish: A validity and reliability study. Int J Nurs Pract 2022; 29:e13109. [PMID: 36259444 DOI: 10.1111/ijn.13109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 10/24/2022]
Abstract
AIM The aim of this study was to adapt the Nurse Turnover Intention Scale to Turkish and test its validity and reliability. METHODS This methodological study was conducted with 200 nurses. The Personal Information Form and the Nurse Turnover Intention Scale were used for data collection between November and December 2021. Language and content validity, explanatory and confirmatory factor analysis, criterion validity, Cronbach's alpha coefficient, item-total score correlation and test-retest reliability methods were used for the validity and reliability analysis of the scale. RESULTS Exploratory factor analysis showed that the Nurse Turnover Intention Scale had a single factor. Its single factor structure was confirmed using confirmatory factor analysis. Cronbach's alpha coefficient of the scale was 0.902, and factor loading was between 0.60 and 0.78. Statistical analyses indicated that each item in the Turkish version of the scale had a high internal consistency. The test-retest correlation value was found as p < 0.05. CONCLUSION The Nurse Turnover Intention Scale has been confirmed to be a suitable, valid and reliable measurement tool for Turkish society. Nurse turnover intention is the most powerful predictor of actual turnover within the nursing profession. This scale will help to easily attain valid and reliable outcomes.
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Affiliation(s)
- Arife Şanlıalp Zeyrek
- Department of Nursing, Faculty of Health Sciences, Pamukkale University, Denizli, Turkey
| | - Özlem Fidan
- Department of Nursing, Faculty of Health Sciences, Pamukkale University, Denizli, Turkey
| | - Nesrin Çunkuş Köktaş
- Department of Nursing, Faculty of Health Sciences, Pamukkale University, Denizli, Turkey
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Imam A, Obiesie S, Aluvaala J, Maina JM, Gathara D, English M. Identifying gaps in global evidence for nurse staffing and patient care outcomes research in low/middle-income countries: an umbrella review. BMJ Open 2022; 12:e064050. [PMID: 36223964 PMCID: PMC9562716 DOI: 10.1136/bmjopen-2022-064050] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To identify nurse staffing and patient care outcome literature in published systematic reviews and map out the evidence gaps for low/middle-income countries (LMICs). METHODS We included quantitative systematic reviews on nurse staffing levels and patient care outcomes in regular ward settings published in English. We excluded qualitative reviews or reviews on nursing skill mix. We searched the Cochrane Register of Systematic Reviews, the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, Medline, Embase and Cumulative Index to Nursing and Allied Health Literature from inception until July 2021. We used the A Measurement Tool to Assess Systematic Reviews -2 (AMSTAR-2) criteria for risk of bias assessment and conducted a narrative synthesis. RESULTS From 843 papers, we included 14 in our final synthesis. There were overlaps in primary studies summarised across reviews, but overall, the reviews summarised 136 unique primary articles. Only 4 out of 14 reviews had data on LMIC publications and only 9 (6.6%) of 136 unique primary articles were conducted in LMICs. Only 8 of 23 patient care outcomes were reported from LMICs. Less research was conducted in contexts with staffing levels that are typical of many LMIC contexts. DISCUSSION Our umbrella review identified very limited data for nurse staffing and patient care outcomes in LMICs. We also identified data from high-income countries might not be good proxies for LMICs as staffing levels where this research was conducted had comparatively better staffing levels than the few LMIC studies. This highlights a critical need for the conduct of nurse staffing research in LMIC contexts. LIMITATIONS We included data on systematic reviews that scored low on our risk of bias assessment because we sought to provide a broad description of the research area. We only considered systematic reviews published in English and did not include any qualitative reviews in our synthesis. PROSPERO REGISTRATION NUMBER CRD42021286908.
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Affiliation(s)
- Abdulazeez Imam
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sopuruchukwu Obiesie
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Jalemba Aluvaala
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | | | - David Gathara
- Wellcome Trust Research Program, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Maternal Adolescent Reproductive and Child Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mike English
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Barrow E, Lear RA, Morbi A, Long S, Darzi A, Mayer E, Archer S. How do hospital inpatients conceptualise patient safety? A qualitative interview study using constructivist grounded theory. BMJ Qual Saf 2022:bmjqs-2022-014695. [PMID: 36198506 DOI: 10.1136/bmjqs-2022-014695] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 09/18/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Efforts to involve patients in patient safety continue to revolve around professionally derived notions of minimising clinical risk, yet evidence suggests that patients hold perspectives on patient safety that are distinct from clinicians and academics. This study aims to understand how hospital inpatients across three different specialties conceptualise patient safety and develop a conceptual model that reflects their perspectives. METHODS A qualitative semi-structured interview study was conducted with 24 inpatients across three clinical specialties (medicine for the elderly, elective surgery and maternity) at a large central London teaching hospital. An abbreviated form of constructivist grounded theory was employed to analyse interview transcripts. Constant comparative analysis and memo-writing using the clustering technique were used to develop a model of how patients conceptualise patient safety. RESULTS While some patients described patient safety using terms consistent with clinical/academic definitions, patients predominantly conceptualised patient safety in the context of what made them 'feel safe'. Patients' feelings of safety arose from a range of care experiences involving specific actors: hospital staff, the patient, their friends/family/carers, and the healthcare organisation. Four types of experiences contributed to how patients conceptualise safety: actions observed by patients; actions received by patients; actions performed by patients themselves; and shared actions involving patients and other actors in their care. CONCLUSIONS Our findings support the need for a patient safety paradigm that is meaningful to all stakeholders, incorporating what matters to patients to feel safe in hospital. Additional work should explore and test how the proposed conceptual model can be practically applied and implemented to incorporate the patient conceptualisation of patient safety into everyday clinical practice.
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Affiliation(s)
- Emily Barrow
- NIHR Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Rachael A Lear
- NIHR Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK
| | - Abigail Morbi
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Susannah Long
- NIHR Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK
| | - Ara Darzi
- NIHR Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Erik Mayer
- NIHR Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK
| | - Stephanie Archer
- NIHR Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK .,Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,Department of Psychology, University of Cambridge, Cambridge, UK
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Imam A, Gathara D, Aluvaala J, Maina M, English M. Evaluating the effects of supplementing ward nurses on quality of newborn care in Kenyan neonatal units: protocol for a prospective workforce intervention study. BMC Health Serv Res 2022; 22:1230. [PMID: 36195863 PMCID: PMC9530438 DOI: 10.1186/s12913-022-08597-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Data from High Income Countries have now linked low nurse staff to patient ratios to poor quality patient care. Adequately staffing hospitals is however still a challenge in resource-constrained Low-middle income countries (LMICs) and poor staff-to-patient ratios are largely taken as a norm. This in part relates to limited evidence on the relationship between staffing and quality of patient care in these settings and also an absence of research on benefits that might occur from improving hospital staff numbers in LMICs. This study will determine the effect on the quality of patient care of prospectively adding extra nursing staff to newborn units in a resource constrained LMIC setting and describe the relationship between staffing and quality of care. METHODS This prospective workforce intervention study will involve a multi-method approach. We will conduct a before and after study in newborn units of 4 intervention hospitals and a single time-point comparison in 4 non-intervention hospitals to determine if there is a change in the level of missed nursing care, a process measure of the quality of patient care. We will also determine the effect of our intervention on routinely collected quality indicators using interrupted time series analysis. Using three nurse staffing metrics (Total nursing hours, nursing hours per patient day and nursing hours per patient per shift), we will describe the relationship between staffing and the quality of patient care. DISCUSSION There is an urgent need for the implementation of staffing policies in resource constrained LMICs that are guided by relevant contextual data. To the best of our knowledge, this is the first study to evaluate the prospective addition of nursing staff in resource-constrained care settings. Our findings are likely to provide the much-needed evidence for better staffing in these settings. TRIAL REGISTRATION This study was retrospectively registered in the Pan African Clinical Trial Registry ( https://pactr.samrc.ac.za/Default.aspx?Logout=True ) database on the 10th of June 2022 with a unique identification number-PACTR202206477083141.
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Affiliation(s)
- Abdulazeez Imam
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
- Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - David Gathara
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Jalemba Aluvaala
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Paediatrics, University of Nairobi, Nairobi, Kenya
| | - Michuki Maina
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Mike English
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Dall'Ora C, Saville C, Rubbo B, Turner L, Jones J, Griffiths P. Nurse staffing levels and patient outcomes: A systematic review of longitudinal studies. Int J Nurs Stud 2022; 134:104311. [DOI: 10.1016/j.ijnurstu.2022.104311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/04/2022] [Accepted: 06/09/2022] [Indexed: 02/08/2023]
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Nhongo D, Holt A, Flenady T, Rebar A, Bail K. Nurse staffing and adverse events in residential aged care: Retrospective multi-site analysis. Collegian 2022. [DOI: 10.1016/j.colegn.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Khanna AK, Labeau SO, McCartney K, Blot SI, Deschepper M. International variation in length of stay in intensive care units and the impact of patient-to-nurse ratios. Intensive Crit Care Nurs 2022; 72:103265. [PMID: 35672212 DOI: 10.1016/j.iccn.2022.103265] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/25/2022] [Accepted: 05/16/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To assess variation in ICU length of stay between countries with varying patient-to-nurse ratios; to compare ICU length of stay of individual countries against an international benchmark. DESIGN Secondary analysis of the DecubICUs trial (performed on 15 May 2018). SETTING The study cohort included 12,794 adult ICU patients (57 countries). Only countries with minimally twenty patients discharged (or deceased) within 30 days of ICU admission were included. MAIN OUTCOME MEASURE Multivariate Cox regression was used to evaluate ICU length of stay, censored at 30 days, across countries and for patient-to-nurse ratio, adjusted for sex, age, admission type and Simplified Acute Physiology Score II. The resulting hazard ratios for countries, indicating longer or shorter length of stay than average, were plotted on a forest plot. Results by country were benchmarked against the overall length of stay using Kaplan-Meier curves. RESULTS Patients had a median ICU length of stay of 11 days (interquartile range, 4-27). Hazard ratio by country ranged from minimally 0.42 (95% confidence interval 0.35-0.51) for Greece, to maximaly1.94 (1.28-2.93) for Lithuania. The hazard ratio for patient-to-nurse was 0.96 (0.94-0.98), indicating that higher patient-to-nurse ratio results in longer length of stay. CONCLUSIONS Despite adjustment for case-mix, we observed significant heterogeneity of ICU length of stay in-between countries, and a significantly longer length of stay when patient-to-nurse ratio increases. Future studies determining underlying characteristics of individual ICUs and broader organisation of healthcare infrastructure within countries may further explain the observed heterogeneity in ICU length of stay.
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Affiliation(s)
- Ashish K Khanna
- Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157, USA; Outcomes Research Consortium, Cleveland 44195, OH, USA.
| | - Sonia O Labeau
- School of Healthcare, Nurse Education Programme, HOGENT University of Applied Sciences and Arts, Keramiekstraat 80, 9000 Ghent, Belgium; Department of Internal Medicine & Pediatrics, Faculty of Medicine and Health Science, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Kathryn McCartney
- Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157, USA
| | - Stijn I Blot
- School of Healthcare, Nurse Education Programme, HOGENT University of Applied Sciences and Arts, Keramiekstraat 80, 9000 Ghent, Belgium; Department of Internal Medicine & Pediatrics, Faculty of Medicine and Health Science, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium. https://twitter.com/@StijnBLOT
| | - Mieke Deschepper
- Strategic Policy Cell, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium. https://twitter.com/@MiekeDeschepper
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