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Learning Objective 1: Identify how processes of care predict nursing sensitive outcomes for falls, falls with injury and hospital acquired pressure ulcers.
Learning Objective 2: Analyze implications of including processes of care in analyses of staffing adequacy at the unit level.
The primary research question guiding this study was, “how do unit level characteristics of RN workload and clinical processes of care interact to predict variance in selected nursing sensitive outcomes?” This report is part of a larger study examining the Impact of Medical Surgical Acute Care Microsystem Nurse Characteristics and Practices on Patient Outcome, funded by the Robert Wood Johnson Foundation, Interdisciplinary Nursing Quality Research Initiative (INQRI).
Study Population and Design
We created an empirically derived predictive model examining individual and collective effects of unit level nurse workload, staff nurse characteristics and selected risk assessment and preventive intervention processes of care on variance in nurse sensitive acute care patient outcomes at the microsystem level. The sample included data submitted to an established nursing sensitive benchmarking registry by 219 hospitals with 827 medical surgical units. We modeled event counts per year for Injury Falls/1000 patient days and Hospital Acquired Pressure Ulcer (HAPU) prevalence using the discrete Poisson with zero-inflation (ZIP) regression model suited to data with excess zeroes above what would be expected with a Poisson distribution. Falls/1000 patient days was modeled with an ordinary least squares regression.
Principal Findings
We found that patient outcomes were predicted by combinations of all elements in our model, including: unit/patient characteristics, nursing workload, RN expertise, and clinical processes, and predictors were different for each outcome. Falls and Injury Falls were predicted by patient characteristics and clinical process variables. HAPU prevalence was predicted by a combination of all elements in our model: unit/patient characteristics, nursing workload, RN expertise, and clinical processes. Restraint Use was also predicted by a combination of all elements: unit/patient characteristics, nursing workload, RN expertise, and clinical processes
Conclusions and Implications
Staffing adequacy is multifaceted and complex. The content of nursing actions is powerful predictor of outcomes.