Article Text

Download PDFPDF
Association of registered nurse and nursing support staffing with inpatient hospital mortality
  1. Jack Needleman1,
  2. Jianfang Liu2,
  3. Jinjing Shang2,
  4. Elaine L Larson2,3,
  5. Patricia W Stone4
  1. 1Department of Health Policy and Management, Fielding School of Public Health, UCLA, Los Angeles, California, USA
  2. 2School of Nursing, Columbia University, New York, NY, United States
  3. 3Columbia University Mailman School of Public Health, New York City, New York, USA
  4. 4Center for Health Policy, School of Nursing, Columbia University, New York, NY, United States
  1. Correspondence to Dr Jack Needleman, Department of Health Policy and Management, Fielding School of Public Health, UCLA, Los Angeles, CA 90095, USA; needlema{at}ucla.edu

Abstract

Background The association of nursing staffing with patient outcomes has primarily been studied by comparing high to low staffed hospitals, raising concern other factors may account for observed differences. We examine the association of inpatient mortality with patients’ cumulative exposure to shifts with low registered nurse (RN) staffing, low nursing support staffing and high patient turnover.

Methods Cumulative counts of exposure to shifts with low staffing and high patient turnover were used as time-varying covariates in survival analysis of data from a three-campus US academic medical centre for 2007–2012. Staffing below 75% of annual median unit staffing for each staff category and shift type was characterised as low. High patient turnover per day was defined as admissions, discharges and transfers 1 SD above unit annual daily averages.

Results Models included cumulative counts of patient exposure to shifts with low RN staffing, low nursing support staffing, both concurrently and high patient turnover. The HR for exposure to shifts with low RN staffing only was 1.027 (95% CI 1.002 to 1.053, p<0.001), low nursing support only, 1.030 (95% CI 1.017 to 1.042, p<0.001) and shifts with both low, 1.025 (95% CI 1.008 to 1.043, p=0.035). For a model examining cumulative exposure over the second to fifth days of an admission, the HR for exposure to shifts with low RN staffing only was 1.048 (95% CI 0.998 to 1.100, p=0.061), low nursing support only, 1.032 (95% CI 1.008 to 1.057, p<0.01) and for shifts with both low,1.136 (95% CI 1.089 to 1.185, p<0.001). No relationship was observed for high patient turnover and mortality.

Conclusion Low RN and nursing support staffing were associated with increased mortality. The results should encourage hospital leadership to assure both adequate RN and nursing support staffing.

  • nurses
  • health services research
  • hospital medicine
View Full Text

Statistics from Altmetric.com

Footnotes

  • Contributors All authors participated in the design and conduct of the research, writing and/or editing of the manuscript.

  • Funding The study was supported by National Institute of Nursing Research (NINR R01 NR010822).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • Editorial
    Linda H Aiken Douglas M Sloane