Paper
Thursday, July 22, 2004
The Effect of Work Environment and Nurse Characteristics on Patient Outcomes
Linda O'Brien-Pallas, RN, PhD1, Donna Thomson, BScN, MScN2, Linda McGillis Hall, RN, PhD1, Sping Wang, PhD3, Xiaoqiang Li, PhD4, and Raquel M Meyer, RN, PhD, Student5. (1) Faculty of Nursing, University of Toronto, Toronto, ON, Canada, (2) St. Peter's Hospital, University of Toronto, Hamilton, ON, Canada, (3) Nursing Effectiveness, Utilization and Outcomes Research Unit, University of Toronto, Toronto, ON, Canada, (4) Nursing Effectiveness, Utilization & Outcomes Research Unit, University of Toronto, Toronto, ON, Canada, (5) NRU, University of Toronto, Toronto, ON, Canada
Objective: To describe how inputs and throughputs in the PCDM influence patient medical consequences and changes in patient knowledge, behavior and status and SF-12 health status at discharge. Population, Setting, Sample: A total of 1230 patients on 24 nursing units in 6 Canadian hospitals were included. Data were collected February through August 2002 for a total of 8113 patient days. Patients were entered into the study upon admission to the unit and were followed until hospital discharge. Design: Cross sectional and longitudinal designs were used. Multilevel logistic regression modeling was used to understand the influence of patient and nurse individual level variables and unit level variables on patient outcomes. Concepts and Variables Studied: As outlined in Abstract 1. Results: Improved patient SF-12 physical health scores at discharge were 45% less likely when P/U exceeded 80%, 11 % less likely for every extra nursing diagnosis and 7% less likely for each extra hour of overtime. Improved patient behavior scores at discharge were 176% more likely when nurses were satisfied and 53% less likely when job insecurity prevailed. Improvements in patient knowledge about their condition were 74% more likely for every 10% increase in RN worked hours on the unit and 24% more likely for every 10% increase in full-time nurses on the unit. Every 10% increase in the proportion of nurses on the unit with frequent shift changes reduced the odds of improved knowledge by 44%. Patients who suffered medical consequences were 319% more likely to be referred to home care. Conclusion: Managers can change staffing practices to alter the work environment. Implications: To improve patient outcomes, managers should address nurse satisfaction, create job security, increase the proportion of RN hours, hire full-time staff, and maintain P/U within a range of 85% ± 5%.
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