Nurse Staffing and Patient Outcomes in Belgian Acute Hospitals: Cross-sectional Analysis of Administrative Data

Overview

Journal Int J Nurs Stud

Specialty Nursing

Date 2008 Jul 29

PMID 18656875

Citations 19

Authors

Koen Van den Heede

Walter Sermeus

Luwis Diya

Sean P Clarke

Emmanuel Lesaffre

Arthur Vleugels

Linda H Aiken

Affiliations

Soon will be listed here.

Abstract

Background: Studies have linked nurse staffing levels (number and skill mix) to several nurse-sensitive patient outcomes. However, evidence from European countries has been limited.

Objectives: This study examines the association between nurse staffing levels (i.e. acuity-adjusted Nursing Hours per Patient Day, the proportion of registered nurses with a Bachelor's degree) and 10 different patient outcomes potentially sensitive to nursing care. DESIGN-SETTING-PARTICIPANTS: Cross-sectional analyses of linked data from the Belgian Nursing Minimum Dataset (general acute care and intensive care nursing units: n=1403) and Belgian Hospital Discharge Dataset (general, orthopedic and vascular surgery patients: n=260,923) of the year 2003 from all acute hospitals (n=115).

Methods: Logistic regression analyses, estimated by using a Generalized Estimation Equation Model, were used to study the association between nurse staffing and patient outcomes.

Results: The mean acuity-adjusted Nursing Hours per Patient Day in Belgian hospitals was 2.62 (S.D.=0.29). The variability in patient outcome rates between hospitals is considerable. The inter-quartile ranges for the 10 patient outcomes go from 0.35 for Deep Venous Thrombosis to 3.77 for failure-to-rescue. No significant association was found between the acuity-adjusted Nursing Hours per Patient Day, proportion of registered nurses with a Bachelor's degree and the selected patient outcomes.

Conclusion: The absence of associations between hospital-level nurse staffing measures and patient outcomes should not be inferred as implying that nurse staffing does not have an impact on patient outcomes in Belgian hospitals. To better understand the dynamics of the nurse staffing and patient outcomes relationship in acute hospitals, further analyses (i.e. nursing unit level analyses) of these and other outcomes are recommended, in addition to inclusion of other study variables, including data about nursing practice environments in hospitals.

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References

Brennan T, Leape L, Laird N, Hebert L, Localio A, Lawthers A . Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991; 324(6):370-6. DOI: 10.1056/NEJM199102073240604. View

Needleman J, Kurtzman E, Kizer K . Performance measurement of nursing care: state of the science and the current consensus. Med Care Res Rev. 2007; 64(2 Suppl):10S-43S. DOI: 10.1177/1077558707299260. View

Aiken L, Clarke S, Cheung R, Sloane D, Silber J . Educational levels of hospital nurses and surgical patient mortality. JAMA. 2003; 290(12):1617-23. PMC: 3077115. DOI: 10.1001/jama.290.12.1617. View

Estryn-Behar M, Van der Heijden B, Oginska H, Camerino D, Nezet O, Conway P . The impact of social work environment, teamwork characteristics, burnout, and personal factors upon intent to leave among European nurses. Med Care. 2007; 45(10):939-50. DOI: 10.1097/MLR.0b013e31806728d8. View

Tourangeau A, Cranley L, Jeffs L . Impact of nursing on hospital patient mortality: a focused review and related policy implications. Qual Saf Health Care. 2006; 15(1):4-8. PMC: 2563988. DOI: 10.1136/qshc.2005.014514. View

Silber J, Rosenbaum P, Williams S, Ross R, Schwartz J . The relationship between choice of outcome measure and hospital rank in general surgical procedures: implications for quality assessment. Int J Qual Health Care. 1997; 9(3):193-200. DOI: 10.1093/intqhc/9.3.193. View

Elixhauser A, Steiner C, Harris D, Coffey R . Comorbidity measures for use with administrative data. Med Care. 1998; 36(1):8-27. DOI: 10.1097/00005650-199801000-00004. View

Silber J, Williams S, KRAKAUER H, Schwartz J . Hospital and patient characteristics associated with death after surgery. A study of adverse occurrence and failure to rescue. Med Care. 1992; 30(7):615-29. DOI: 10.1097/00005650-199207000-00004. View

Wilson R, Runciman W, Gibberd R, Harrison B, Newby L, Hamilton J . The Quality in Australian Health Care Study. Med J Aust. 1995; 163(9):458-71. DOI: 10.5694/j.1326-5377.1995.tb124691.x. View

10.

Van den Heede K, Sermeus W, Diya L, Lesaffre E, Vleugels A . Adverse outcomes in Belgian acute hospitals: retrospective analysis of the national hospital discharge dataset. Int J Qual Health Care. 2006; 18(3):211-9. DOI: 10.1093/intqhc/mzl003. View

11.

Gunnarsdottir S, Clarke S, Rafferty A, Nutbeam D . Front-line management, staffing and nurse-doctor relationships as predictors of nurse and patient outcomes. a survey of Icelandic hospital nurses. Int J Nurs Stud. 2007; 46(7):920-7. DOI: 10.1016/j.ijnurstu.2006.11.007. View

12.

Hugonnet S, Villaveces A, Pittet D . Nurse staffing level and nosocomial infections: empirical evaluation of the case-crossover and case-time-control designs. Am J Epidemiol. 2007; 165(11):1321-7. DOI: 10.1093/aje/kwm041. View

13.

Lake E . The nursing practice environment: measurement and evidence. Med Care Res Rev. 2007; 64(2 Suppl):104S-22S. DOI: 10.1177/1077558707299253. View

14.

Vincent C, Neale G, Woloshynowych M . Adverse events in British hospitals: preliminary retrospective record review. BMJ. 2001; 322(7285):517-9. PMC: 26554. DOI: 10.1136/bmj.322.7285.517. View

15.

Aiken L, Clarke S, Sloane D, Sochalski J, Silber J . Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002; 288(16):1987-93. DOI: 10.1001/jama.288.16.1987. View

16.

Sermeus W, Delesie L, Van den Heede K, Diya L, Lesaffre E . Measuring the intensity of nursing care: making use of the Belgian Nursing Minimum Data Set. Int J Nurs Stud. 2007; 45(7):1011-21. DOI: 10.1016/j.ijnurstu.2007.05.006. View

17.

Rafferty A, Clarke S, Coles J, Ball J, James P, Mckee M . Outcomes of variation in hospital nurse staffing in English hospitals: cross-sectional analysis of survey data and discharge records. Int J Nurs Stud. 2006; 44(2):175-82. PMC: 2894580. DOI: 10.1016/j.ijnurstu.2006.08.003. View

18.

Van den Heede K, Clarke S, Sermeus W, Vleugels A, Aiken L . International experts' perspectives on the state of the nurse staffing and patient outcomes literature. J Nurs Scholarsh. 2007; 39(4):290-7. DOI: 10.1111/j.1547-5069.2007.00183.x. View

19.

Pine M, Jordan H, Elixhauser A, Fry D, Hoaglin D, Jones B . Enhancement of claims data to improve risk adjustment of hospital mortality. JAMA. 2007; 297(1):71-6. DOI: 10.1001/jama.297.1.71. View

20.

Estabrooks C, Midodzi W, Cummings G, Ricker K, Giovannetti P . The impact of hospital nursing characteristics on 30-day mortality. Nurs Res. 2005; 54(2):74-84. DOI: 10.1097/00006199-200503000-00002. View