Association of registered nurse and nursing support staffing with inpatient hospital mortality

BMJ Quality & Safety
Jack NeedlemanPatricia W Stone

Abstract

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. 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. 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 examin...Continue Reading

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Citations

Sep 11, 2019·BMJ Quality & Safety·Linda H Aiken, Douglas M Sloane
Nov 17, 2019·Journal of Nursing Management·Neal KawMuhammad M Mamdani
Jan 23, 2020·American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses·Cindy L Munro, Aluko A Hope
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Feb 13, 2021·BMJ Quality & Safety·Perla J Marang-van de Mheen, Charles Vincent
Nov 13, 2020·The Journal of Nursing Administration·Dillon J DzikowiczMary G Carey
Nov 4, 2020·International Journal of Environmental Research and Public Health·Ana María Porcel-GálvezElena Fernández-García
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Aug 26, 2020·Journal of the American Medical Directors Association·Lena Marmstål HammarAnne-Marie Boström
Mar 28, 2021·Journal of Nursing Management·Thamiris Ricci de AraújoAna Maria Laus
Jan 11, 2020·BMJ Quality & Safety·Jack Needleman, Patricia W Stone
Jun 3, 2021·International Journal of Environmental Research and Public Health·Young-Taek ParkKwang Gi Kim
May 18, 2021·Journal of Nursing Management·Lorena Acea-LópezErica Briones-Vozmediano
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Sep 10, 2021·BMJ Quality & Safety·Christopher GrondinAshwin Gupta
Jan 6, 2021·Health Care Management Review·Samuel C ThompsonEric W Ford

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