Objective: Throughout the late 1990’s a number of new nursing staff mixes and models for providing care were introduced as hospitals restructured and redesigned their care delivery systems. One of the objectives of this study was to evaluate, through the identification, collection and analysis of measurable outcome indicators, the impact of different nursing staff mix models on patient outcomes in inpatient care settings in hospitals in Ontario, Canada.
Methods: A descriptive, repeated measures design was used to determine the association between nurse staffing and patient outcomes.
Sampling: A total of 77 medical, surgical or obstetrical patient care units from within the 19 teaching hospitals, were involved in the study. Patients were eligible to participate if they were admitted to an inpatient study unit with one of the following diagnoses: simple pneumonia, chronic obstructive lung disease, major intestinal and rectal surgical procedures, major non-cancer related gynecological and uterine procedures and vaginal deliveries.
Setting: The sample comprises hospitals, selected patients within those hospitals and nurses providing care to the sampled patients. To control for hospital level factors known to influence patient and system outcomes, such as bed size, teaching status and geographic location (urban, non-urban), data was collected from patients admitted to 19 urban teaching hospitals in Ontario hospitals. Limiting participation to these sites reduced any variation in patient outcome that may be due to hospital level factors.
Names of Variables: The patient outcome variables examined include primary data collection on functional status, pain, and the secondary data collection on outcomes of wound infections and medication errors. Functional status was measured using the Functional Independence Measure (Hamilton et al, 1997), the SF-36 (McHorney et al., 1992; Ware et al, 1993), and the Inventory of Functional Status After Childbirth (Fawcett et al, 1988). Pain was measured using the Brief Pain Inventory (Cleeland, 1991).
Findings: Nursing staff mix was found to be a significant predictor of five of the patient health and quality outcomes – functional independence, pain, social functioning, and satisfaction with obstetrical care. The proportion of regulated staff on the unit was associated with better FIM scores and better social functioning on discharge (t=.8.83; p<.0001 ). In the obstetrical population, the professional mix of nurses had a significant effect on patient satisfaction (t=-3.17; p=.05). On units where there was a lower proportion of of RNs/RPNs there was a higher number of medication errors. Similarly, units where there was a lower proportion of of RNs/RPNs and a less experienced staff, had higher rates of wound infection.
Conclusions: The results of this study suggest that a higher proportion of RNs/RPNs on inpatient medical surgical and obstetrical units in Ontario teaching hospitals is associated with improved health and quality outcomes for patients at time of hospital discharge, and lower rates of medication errors and wound infections.
Implications: The study results provide important information on the influence of organizational change strategies and nursing staff mix model on nurse and patient outcomes. The implications of these findings for nurses and the nursing profession will be discussed and suggestions for policy changes will be presented.
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