Major articleNurse staffing, burnout, and health care–associated infection
Section snippets
Methods
In this study, we analyzed secondary data from a 2006 survey of 7,076 registered nurses working in 161 hospitals in Pennsylvania. We merged 3 data sources: the nurse survey data, the 2006 Pennsylvania Health Care Cost Containment Council (PHC4) report on hospital infections, and the American Hospital Association (AHA) Annual Survey on hospital characteristics. The PHC4 data on health care–associated infections are not identified by administrative patient discharge data codes, but rather
Data analysis
Descriptive information is provided for the hospitals and nurses in our sample. We used ordinary least squares regression models to estimate the effect of nurse staffing on infection rates, before and after controlling for nurse and hospital characteristics. We estimated 3 linear regression models for both types of hospital infections to assess the individual effect of nurse staffing on infection rate, and the extent to which nurse burnout could explain that effect. In our first model, we
Results
Characteristics of the study hospitals and nurses used as controls are summarized in Table 1. Our sample included 161 acute care Pennsylvania hospitals that provided infection data to the PHC4 and nurses who were surveyed and employed in those same hospitals. The average number of beds per hospital was 227, almost half of the hospitals were identified as teaching hospitals, and 40% were high-technology hospitals. On average, nurses cared for 5.7 patients, the average number of patients per
Discussion
In this study, we examined the effect of nurse staffing and burnout on health care–associated urinary tract and surgical site infections. Our findings confirm an association between nurse staffing and health care–associated infection rates, with fewer infections seen in hospitals in which nurses care for fewer patients. The higher rate of infections in hospitals in which nurses care for more patients seems to be related, at least in part, to the high nurse burnout associated with heavier
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Research for this article was conducted at the Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA.
Supported by the National Institute of Nursing Research, National Institutes of Health (grant R01-NR004513).
The authors have no conflicts of interest to disclose.