Demanding safe staffing levels to ensure quality nursing care


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Leaked NICE guidelines reveal need for more staff
Accident and Emergency departments may be too short-staffed to cope with demand "almost half of the time", says suppressed guidelines from the National Institute for Health and Care Excellence (NICE).

Manifesto for safe staffing
Patients are sicker than ever before. The Safe Staffing Alliance believes that meeting those patients' needs through compassionate care can only be achieved by adequate nurse staffing levels. Given the compelling evidence of a link between registered nurse (RN) numbers and quality of care, ensuring there are sufficient nurses, in all areas of service provision, is a priority.

Our response to the NICE safe nurse staffing guidelines
The Safe Staffing Alliance (SSA) welcomes the National Institute of Clinical Excellence (NICE) draft guideline on 'Safe staffing for nursing in adult inpatient wards in acute hospitals'.

We have created two Safe Staffing Alliance 'Never More Than 8' posters available for you to download.

Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction
Context The worsening hospital nurse shortage and recent California legislation mandating minimum hospital patient-tonurse ratios demand an understanding of how nurse staffing levels affect patient outcomes and nurse retention in hospital practice. Objective To determine the association between the patient-to-nurse ratio and patient mortality, failure-to-rescue (deaths following complications) among surgical patients, and factors related to nurse retention. Design, Setting, and Participants Cross-sectional analyses of linked data from 10 184 staff nurses surveyed, 232 342 general, orthopedic, and vascular surgery patients discharged from the hospital between April 1, 1998, and November 30, 1999, and administrative data from 168 nonfederal adult general hospitals in Pennsylvania. Main Outcome Measures Risk-adjusted patient mortality and failure-to-rescue within 30 days of admission, and nursereported job dissatisfaction and job-related burnout.

Nurse Staffing and Inpatient Hospital Mortality
Cross-sectional studies of hospital-level administrative data have shown an association between lower levels of staffing of registered nurses (RNs) and increased patient mortality. However, such studies have been criticized because they have not shown a direct link between the level of staffing and individual patient experiences and have not included sufficient statistical controls.

Establishing the relationship between nurse staffing and hospital mortality using a clustered discrete-time logistic model
Studies based on aggregated hospital outcome data have established that there is a relationship between nurse staffing and adverse events. However, this result could not be confirmed in Belgium where 96 per cent of the variability of nurse staffing levels over nursing units (belonging to different hospitals) is explained by within-hospital variability. To better appreciate the possible impact of nurse staffing levels on adverse events, we propose a multilevel approach reflecting the complex nature of the data. In particular we suggest a clustered discrete-time logistic model that captures the risks associated with a given unit in the patient's trajectory through the hospital. The model also allows for nurse staffing levels to affect the current and subsequent nursing unit (carry-over effect). In the model 'time' is represented by the sequential number of the nursing unit that the patient is passing through. The model incorporates hospital and nursing unit random effects to express that patients treated in the same hospital and taken care of by nurses of the same unit share a common environment. In this study we used Belgian national administrative databases for the year 2003 to assess the relationship between nurse staffing levels and nurse education variables with in-hospital mortality. The analysis was restricted to elective cardiac surgery patients. Lower nursing unit staffing levels in the general nursing units were associated with high in-hospital mortality in units past the traditional cardiac surgery nursing units.

Nurse staffing and patient outcomes in Belgian acute hospitals: Cross-sectional analysis of administrative data
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.

Relationships Between Nurse Staffing and Patient Out comes
Nursing studies have shown that nursing care delivery changes affect staff and organizational out comes, but the effects on cli ent out comes have not been studied sufficiently. The pur pose of this study was thus to examine the effect of nurse staff ing variables - daily ave age hours of care, ratio of RNs to average patient census, work load, and skill mix- on patient out comes as mea sured by five adverse occurrences. The adverse patient occur rences included unit rates of patient falls, pressure ulcers, respiratory and urinary tract infections, and patient/family com plaints. Variables were mea sured retrospectively using consistently available data from each month of fiscal year 2000 from 21 medical-surgical nursing care units in a 1394-bed medical center in Taiwan. Data were analyzed by descriptive and multivariate inferential statistics while controlling for patient acuity level. Results showed that work load of nurses is the most powerful predictor of nosocomial infections and hours of care best predicted the five adverse patient out come indices. Lower adverse out come rates were more consistently related to a higher proportion of N3 level of RNs. Patients could fare better when N3s play a significant role in the staffing mix. The findings provide further empirical support for the context of implications that patient out comes are correlated to organizational structure. It obviously illustrates the relationships between nurse staff ing and the quality of nursing practice.

Nurse Staffing Levels Make a Difference on Patient Outcomes: A Multisite Study in Chinese Hospitals
Purpose : The purpose of this study is to examine the relationship between nurse staffing and patient outcomes in hospitals in mainland China. Methods : The study was conducted in 181 hospitals across all of the eight economic zones in mainland China using a four-stage sampling design. Two instruments, the China Nurse Survey and the patient satisfactionmeasurement from the Hospital Consumer Assessment of Healthcare Providers and Systems, were employed in data collection. In this article, 7,802 nurse surveys and 5,430 patient surveys from 600 medical and surgical units were analyzed.

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Evidence Safe level How often Patients

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