Issues in AdministrationPostoperative complications: Does intensive care unit staff nursing make a difference?*
Section snippets
Methods
This study represents a secondary analysis of hospital discharge data that were linked to a survey of organizational characteristics of ICUs. The target population of patients who had undergone abdominal aortic surgery was chosen because this surgery is a relatively common procedure performed in a variety of acute-care hospitals and typically requires care in an ICU after surgery.
Hospital sample
As summarized in Table II, 38 hospitals (83%) responded to the survey.Characteristics Number (%) Hospital Bed size <240 14 (37) 241-400 17 (45) >400 7 (18) Hospital abdominal aortic surgery volume (mean cases/year) >36 6 (16) <36 32 (84) Surgeon abdominal aortic surgery volume (mean cases/year) >8 14 (37) <8 24 (63) ICU Staffed beds <10 11 (31) 10-15 13 (36) 16-20 9 (25) >20 3 (8)
Discussion
This study assessed the association between ICU staffing nurse and the likelihood of cardiac, respiratory, and other complications in patients who had had abdominal aortic surgery. The intensity of nurse staffing was significantly associated with all 3 groups of complications. This study extends other recent studies examining nurse staffing and complications11, 12, 13, 14 because it measured staffing at the unit level, included only RNs who were providing direct care, and included multiple
Limitations
Although the sample of 38 ICUs was limited to 1 state, there is no indication that ICUs in this state differ from those in other states with regards to organizational characteristics.5 Although the response rate for the survey was 83%, the nurse manager may or may not have been involved in survey completion, and responses may represent perceptions or experiences over time. Specifically, the responses to items regarding nurse staffing were likely to represent the experiences of the ICU nurse
Implications for practice and research
This study contributes to the growing evidence supporting the relationship between structural aspects of nursing care units and patient outcomes. Specifically, this study and others demonstrate that a lower proportion of RNs has consistently been associated with the development of respiratory complications.11, 12, 13, 14, 15 Nurse managers and administrators may be able to use this evidence to advocate for increased non-RN support, such as the use of respiratory therapists to moderate the risk
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Reprint requests: Deborah Dang, MS, RN, 600 N Wolfe St, Baltimore, MD 21287-1007.