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To determine the impact of the addition of nursing support workers to nursing units (wards) on patient mortality and morbidity.
Methods:
Retrospective analysis of longitudinal morbidity and mortality data. Administrative data were collected for all patients admitted to a hospital in Western Australia for more than 24 hours over a 4-year period. 256,302 records in total. Data included records from 2 years before the introduction of AINs (2006-2007, 125,762 records) and 2 years after the introduction of AINs (2009-2010, 130,540 records). Data were further divided into nursing wards with and without AINs for the latter period. Nurse Sensitive Outcomes (NSOs) were identified in the data following established international methods, using algorithms with inclusion and exclusion criteria based on ICD-10 codes (Needleman et al., 2011; Duffield, Diers, et al., 2011; Roche, Duffield, Aisbett, Diers, & Stasa, 2012; Twigg et al., 2011). Two analyses were undertaken for each NSO: a pre/post analysis of the introduction of AINs and a post-only analysis of AIN/non-AIN wards. Logistic regression models were developed with adjustments for a range of factors including age, gender, length of stay, Charlson comorbidity index, DRG cost weight, skillmix and ward transfers. Ethics approval was obtained from two universities and three hospitals.
Results:
Comparison of NSOs pre- and post-introduction of AINs found that the observed frequency of most NSOs was higher than the expected frequency across all wards. On wards where AINs had been added to staffing, higher that expected rates of urinary tract infections, falls and mortality were observed, with statistically significant differences relative to pre-introduction. In the post-only analysis, patients who spent longer periods on wards with low skillmix and on AIN wards were significantly more likely to experience an NSO.
Conclusion:
When nursing support workers are added to the staffing complement on a ward, the impact on patient care should be monitored. Low skillmix has been identified in the literature as being associated with poorer patient outcomes, and the addition of less skilled workers such as AINs will potentially compound this effect. Therefore, careful consideration needs to be given to the environment into which AINs are introduced, particularly if they are introduced into wards that already have low skillmix.