Friday, 21 November 2014

Do nurse staffing levels influence patient outcomes?

Roger Watson, Editor-in-Chief

As much as I would like it to be, the relationship between nurse staffing and patient outcomes is not clear. A recent article from an Australian study by Winton et al. (2014) titled ‘The relationship between nurse staffing and inpatient complications’ and published in JAN cites methodological problems as one reason. Of course, this is a difficult area to investigate. It would be hard envisage clinical trials which compared nursing care with no nursing care  — which I imagine would easily demonstrate the value of nursing per se — and the situation is further complicated by definitions of nursing (RNs versus unqualified assistants) and the various levels of skill mix that can be implemented. It is even further complicated by the myriad outcomes and patient complications that could be selected as comparative measures. Nevertheless, this area merits investigation as arguments about staffing levels and skill mix are common, and those who hold healthcare budgets need to know how to spend their money (often it is our money) wisely. Insufficient nursing care may lead to expensive complications but unnecessary spending on nursing staff may waste valuable resources.

The article by Winton et al. (2014) compared 256,984 hospitalizations with and without complications against staffing levels in a retrospective longitudinal study and found that the pattern was not consistent. Specifically, they said: ‘our results did not support the widely held assumption that improved nurse staffing levels are associated with decreased patient complication rates.’ Clearly, further investigation is required.


Reference

Winton LW, Bremner AP, Geelhoeld E, Finn J (2014) The relationship between nursestaffing and inpatient complications Journal of Advanced Nursing doi: 10.1111/jan.12572

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