Changes in proportion of bachelor's nurses associated with improvements in patient outcomes

Understanding of and attitudes towards nursing education reform at medical colleges in Kyrgyzstan: A mixed-method study

AIM

To determine teachers' understanding of and attitudes towards nursing education reform at four medical colleges in Kyrgyzstan.

BACKGROUND

The quality of nursing education at undergraduate and postgraduate levels has a major impact on patient outcomes and the development of nursing as a profession and a science.

INTRODUCTION

Lower middle-income countries have sought to advance their nursing education by adopting the experiences of high-income countries.

METHODS

A mixed-method cross-sectional study design was used. The STROBE combined checklist was followed. A cohort of all faculty members at four colleges were included (N = 150). The questionnaire consisted of 10 groups of questions and statements. Both quantitative and qualitative data were collected.

FINDINGS

A total of 56.4% of respondents were familiar with the European approach to nurse education; 73.3% of respondents with a nursing education reported being familiar with the European approach, compared to 40.7% of respondents with a medical education. Qualitative written comments yielded 57 superscripts of codes, 14 subcategories, 5 categories and 2 themes as drivers and barriers of reform.

DISCUSSION

The survey revealed weak support for the nursing education reform. Respondents do not envisage nurse education being offered at all three levels of higher education (bachelor's, master's, and PhD), and even fewer recognise nurses as leaders of healthcare institutions.

IMPLICATION FOR NURSING

Teachers in nursing programmes should mostly be nurses with academic careers.

IMPLICATION FOR HEALTH POLICY

Nursing is still not recognised as an extremely important health profession that needs to be developed. This misunderstanding and negative attitude towards the role of nurses in the health care system are evident in both the quantitative and qualitative parts of the study.

Associations between nurse-to-patient ratio, nurse educational level, and nurse-sensitive patient outcomes: A 12-month prospective observational study

AIM

To investigate the associations between nurse staffing levels, nurse educational level, and nurse-sensitive patient outcomes among patients in medical and surgical wards.

BACKGROUND

Patient outcomes are affected by a variety of factors, including nurse staffing and registered nurse (RN) educational levels. An examination of the associations between these factors and patient outcomes will help identify the impact that nurses make on patient care, including health and safety.

METHODS

A 12-month prospective observational study was conducted in four major hospitals in Hong Kong. Data on nurse staffing were collected daily, while data on nurse-sensitive patient outcomes were retrieved from patient records and nursing documentation. Multiple regression was used to examine the association between each of the outcomes and the explanatory variables including nurse-to-patient ratio and educational qualifications at the ward level. The STROBE guidelines were followed in this study.

RESULTS

The average monthly nurse-to-patient ratio per ward was 1:9.2 (1:7.4 for day (morning and afternoon) and 1:19.1 for night shifts). The percentage of RNs with a bachelor's or higher degree was 83.6%. A higher nurse-to-patient ratio was significantly associated with a larger number of patients with physical restraints and catheter-associated urinary tract infections. A significant association was also found between a higher percentage of RNs with a bachelor's or higher degree and a smaller number of physical restraints used.

CONCLUSIONS

Nurse staffing and educational levels were associated with key patient outcomes such as physical restraint use and incidence of catheter-associated urinary tract infections.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Current nurse staffing strategies should be refined in light of these findings in order to enhance patient health and safety outcomes.

Changes in Patient Care Experiences and the Nurse Work Environment: A Longitudinal Study of U.S. Hospitals

Addressing patient experience is a priority in the health care system. Hospital Consumer Assessment of Providers and Systems (HCAHPS) survey results incentivize hospitals to elevate patient experience, a factor in patient-centered care. Although hospital nursing resources have been positively associated with better HCAHPS ratings, it is unknown how changes in nursing resources are associated with changes in HCAHPS ratings over time. This two-period longitudinal study ranked the associations between changes in nurse staffing, skill mix, nurse education, and work environment on HCAHPS ratings and found that changes in the work environment had the strongest associations (β = 2.29; p < .001) with improved HCAHPS ratings. Our findings provide hospital administrators with empirical evidence that may help make informed decisions on how to best invest limited resources to improve HCAHPS ratings, including the potential utility of improving the work environment through enhancing Nursing Quality of Care and Nurse Participation in Hospital Affairs.

Hospital nurse staffing variation and Covid-19 deaths: A cross-sectional study

BACKGROUND

During the Covid-19 pandemic, Covid-19 mortality varied depending on the hospital where patients were admitted, but it is unknown what aspects of hospitals were important for mitigating preventable deaths.

OBJECTIVE

To determine whether hospital differences in pre-pandemic and during pandemic nursing resources-average patient-to-registered nurse (RN) staffing ratios, proportion of bachelor-qualified RNs, nurse work environments, Magnet recognition-explain differences in risk-adjusted Covid-19 mortality; and to estimate how many deaths may have been prevented if nurses were better resourced prior to and during the pandemic.

METHODS

This is a cross-sectional study of 87,936 Medicare beneficiaries (65-99 years old) hospitalized with Covid-19 and discharged (or died) between April 1 and December 31, 2020, in 237 general acute care hospitals in New York and Illinois. Measures of hospital nursing resources (i.e. patient-to-RN staffing ratios, proportion of bachelor-qualified RNs, nurse work environments, Magnet recognition) in the pre-pandemic period (December 2019 to February 2020) and during (April to June 2021) were used to predict in-hospital and 30-day mortality using adjusted logistic regression models.

RESULTS

The mean age of patients was 78 years (8.6 SD); 51 % were male (n = 44,998). 23 % of patients admitted to the hospital with Covid-19 died during the hospitalization (n = 20,243); 31.5 % died within 30-days of admission (n = 27,719). Patients admitted with Covid-19 to hospitals with better nursing resources pre-pandemic and during the pandemic were statistically significantly less likely to die. For example, each additional patient in the average nurses' workload pre-pandemic was associated with 20 % higher odds of in-hospital mortality (OR 1.20, 95 % CI [1.12-1.28], p < 0.001) and 15 % higher odds of 30-day mortality (OR 1.15, 95 % CI [1.09-1.21], p < 0.001). Hospitals with greater proportions of BSN-qualified RNs, better quality nurse work environments, and Magnet recognition offered similar protective benefits to patients during the pandemic. If all hospitals in the study had superior nursing resources prior to or during the pandemic, models estimate many thousands of deaths among patients hospitalized with Covid-19 could have been avoided.

CONCLUSIONS

Patients with Covid-19 admitted to hospitals with adequate numbers of RNs caring for patients, a workforce rich in BSN-qualified RNs, and high-quality nurse work environments (both prior to and during the Covid-19 pandemic) were more likely to survive the hospitalization. Bolstering these hospital nursing resources during ordinary times is necessary to ensure better patient outcomes and emergency-preparedness of hospitals for future public health emergencies.

The Impact of Assessment of Nurses' Experiences in Thoracic Surgery in Onco-Hematological Patients

Background: Nowadays, Thoracic Surgery is technologically advanced; therefore, it also focuses its attention on nursing care. The aim of the study is to evaluate the effect of the assessment of a dedicated team of nurses (DTN) in all onco-hematological patients undergoing VATS lobectomy for lung cancer on the outcome of the patient, preventing pressure injuries, reducing perioperative stress, duration of operations, complications, and hospital stay times. Methods: We performed a single-center observational retrospective study, including 31 DTN and 760 onco-hematological patients who underwent thoracic surgery between 30 October 2018 and 30 June 2023 at "Vanvitelli" University of Naples. Results: DTN ensures good nursing care before, during, and after surgery. Operative time was reduced by approximately 20 min, decreasing hospital infections in the DNT period and reducing intraoperative complications such as bleeding and hospital costs (p < 0.05). Conclusions: Thoracic surgery nurses require more specialized training to adapt to the development of sophisticated.

Nursing students' expectations of group supervision while writing a bachelor thesis: A pre-post survey

BACKGROUND

Writing a bachelor thesis has a central role in nursing education. Nursing students require both information and academic literacy in order to write their theses, and there is an expectation that these skills will contribute to putting their knowledge into practice.

OBJECTIVES

To describe students' perceptions of the student and supervisor roles and to investigate students' experienced self-efficacy during the supervision of their bachelor thesis.

DESIGN

A cross-sectional pre-post design.

SETTINGS

Four universities were included. All four had bachelor thesis courses organized as a group supervision process, with a student active approach. Nursing students met together one hour prior to meeting with their supervisor, in order to discuss concerns, try to solve upcoming problems, and plan the agenda for the upcoming supervision session.

PARTICIPANTS

A total of 472 undergraduate nursing students were invited to participate.

METHODS

A web-based questionnaire was used, incorporating the Supervision of Thesis Questionnaire and the General Self-Efficacy Scale. Data were collected at two points: before and after the thesis course. Descriptive statistics and frequencies were calculated, and the independent t-test and Mann-Whitney U test were used for analytic analysis.

RESULTS

The response rate was 39 % (160/472) pre-course and 28 % (130/472) post-course. Nursing students had high expectations of supervision at both time points. Students reporting high self-efficacy had higher expectations of the supervisor's knowledge of the subject and the methods, compared to those reporting lower self-efficacy.

CONCLUSIONS

Nursing students reported high expectations for the supervision process, the supervisor, and themselves, both when entering and when ending the bachelor thesis course. Self-efficacy may contribute to these expectations. Active learning in a group (i.e., collaborative learning) may contribute to nursing students' commitment during the group supervision process in a bachelor thesis course. Further studies are warranted on the optimal group composition to support learning during bachelor thesis courses.

Knowledge and practical skills for cancer pain management among nurses on remote islands in Japan and related factors nationwide

OBJECTIVE

To clarify the knowledge and practical skills needed for cancer pain management among nurses on remote islands in Japan and related factors nationwide.

SETTING

Due to geographical factors, nurses working on remote islands in Japan have few opportunities to attend training programs, which makes it difficult to acquire the knowledge and practical skills needed to provide pain management for patients with cancer.

METHODS

We conducted a self-administered questionnaire survey regarding knowledge and practical skills in pain management for patients with cancer.

DESIGN

Cross-sectional study.

PARTICIPANTS

Nurses working in cancer pain care in medical facilities and home care on remote islands throughout Japan.

RESULTS

We analysed 128 responses. Regarding knowledge, the average accuracy level was 49.1%. Items with a low accuracy rate included selecting medicine according to the type of pain and the patient's condition. Regarding practice, the items with low scores included analgesics appropriate for the type of pain and relating physical pain to mental, social and spiritual aspects. The most common significant factor in both knowledge and practice was related to postgraduate training.

CONCLUSIONS

These findings suggest that to improve the knowledge and practical skills for cancer pain management among nurses on remote islands in Japan, it is necessary to incorporate clinical reasoning into basic education and establish remote education systems and consultation systems with other facilities.

Implementing a gerontological nursing competencies programme in aged care: Participant experiences

AIMS

To explore the experience of registered nurses and their mentors in the implementation of the Gerontological Nursing Competencies in long-term aged care and the perceived effectiveness and suitability of the programme to support nurse development.

BACKGROUND

The global population is ageing and needs a reliable aged-care nursing workforce.

INTRODUCTION

Opportunities for education and mentorship for newly qualified and experienced aged-care nurses warrant investigation.

METHODS

Qualitative evaluation using semi-structured focus groups was conducted following the implementation of the programme into five not-for-profit long-term aged-care organisations and analysed by a reflexive qualitative thematic approach and reported according to COREQ criteria.

RESULTS

A total of 21 nurses (7 mentors and 14 mentees) participated in six focus groups. Five themes were generated: (1) nurses gained confidence and competence through the programme; (2) the facilitation of suitable mentoring activities and approaches was crucial to success; (3) the programme helps nurses recognise gerontology as a specialty; (4) the programme contributes to building a strategy of recruitment/retention/quality improvement in the sector; (5) barriers, challenges, changes and recommendations were identified.

DISCUSSION

The Gerontological Nursing Competency model, which combined adaptive mentoring supported by reflective practice embedded in a gerontological nursing competencies framework, was perceived to improve nurse confidence and competence to lead and improve nursing standards of care.

CONCLUSION AND IMPLICATIONS FOR NURSING AND HEALTH POLICY

The evidence-based competencies are an acceptable and effective method for supporting gerontological nurse development. Expansion of, and accessibility to, the programme may aid global responses to aged-care reform, by building the recognition of gerontological nursing as a specialty and contributing towards recruitment, retention and quality care improvements.

Measuring the PULSE of Nursing: Development of a Dashboard to Evaluate and Monitor Nursing Care Models

BACKGROUND

Critical nursing shortages have required many health care organizations to restructure nursing care delivery models. At a tertiary health care center, 150 registered practical nurses were integrated into acute inpatient care settings.

PROBLEM

A mechanism to continuously monitor the impact of this staffing change was not available.

APPROACH

Leveraging current literature and consultation with external peers, metrics were compiled and categorized according to Donabedian's Structure Process Outcome Framework. Consultation with internal subject matter experts determined the final metrics.

OUTCOMES

The Patient care, Utility, Logistics, Systemic Evaluation (PULSE) electronic dashboard was developed, capturing metrics from multiple internal databases and presenting real-time composites of validated indicators.

CONCLUSION

The PULSE dashboard is a practical means of enabling nursing leadership to evaluate the impact of change and to make evidence-informed decisions about nursing care delivery at our organization.

A bachelor's degree for entering the nursing profession: A scoping review for supporting informed health care policies

BACKGROUND

Numerous studies have emphasized the relevance of work environment, staffing, and educational level in nursing as determinants of safe, timely, effective, equitable, and efficient patient-centered care. However, an overview of the evidence focusing on the nursing education level is still lacking.

OBJECTIVE

To provide an overview of the existing evidence regarding bachelor's degree as an entry level for the nursing profession.

DESIGN

This was a scoping review.

METHODS

We conducted a systematic search of CINAHL, Medline via PubMed, Cochrane, and Web of Science Core Collection. Additionally, we conducted a free web search using Google and contacted international nursing associations via email. We summarized the evidence narratively. For reporting guidelines, we used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews.

RESULTS

We included 10 studies, 12 response letters, 24 position papers, three books, and one webpage. The sources of evidence identified agreed that the inclusion of a higher number of nurses with a bachelor's degree would lead to a higher quality of care.

CONCLUSIONS

Using a bachelor's degree education as a minimum requirement to enter the nursing profession in the future is essential to generate a respected, competent, and satisfied nursing workforce that can impact the quality and safety of care; and positively influence outcome indicators for patients, nurses, healthcare organizations, and society.

TWEETABLE ABSTRACT

Policy makers and healthcare organizations should set bachelor's degrees as standards for registration and entry to nursing.

Hospital Performance on Hospital Consumer Assessment of Healthcare Providers and System Ratings: Associations With Nursing Factors

OBJECTIVE

To determine which hospital nursing resources (staffing, skill mix, nurse education, and nurse work environment) are most predictive of hospital Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) performance.

BACKGROUND

HCAHPS surveying is designed to quantify patient experience, a measure of patient-centered care. Hospitals are financially incentivized through the Centers for Medicare and Medicaid Services to achieve high HCAHPS ratings, but little is known about what modifiable hospital factors are associated with higher HCAHPS ratings.

PATIENTS AND METHODS

Secondary analysis of multiple linked data sources in 2016 providing information on hospital HCAHPS ratings, hospital nursing resources, and other hospital attributes (eg, size, teaching, and technology status). Five hundred forty non-federal adult acute care hospitals in California, Florida, New Jersey, and Pennsylvania, and 11,786 registered nurses working in those hospitals. Predictor variables included staffing (ie, patient-to-nurse ratio), skill mix (ie, the proportion of registered nurses to all nursing staff), nurse education (ie, percentage of nurses with a bachelor's degree or higher), and nurse work environment (ie, the quality of the environment in which nurses work). HCAHPS ratings were the outcome variable.

RESULTS

More favorable staffing, higher proportions of bachelor-educated nurses, and better work environments were associated with higher HCAHPS ratings. The work environment had the largest association with higher HCAHPS ratings, followed by nurse education, and then staffing. Superior staffing and work environments were associated with higher odds of a hospital being a "higher HCAHPS performer" compared with peer hospitals.

CONCLUSION

Improving nursing resources is a strategic organizational intervention likely to improve HCAHPS ratings.

A cross-sectional study quantifies the independent contribution of nurses and midwives in child health outcomes

INTRODUCTION

As the largest profession within the healthcare industry, nursing and midwifery workforce (NMW) provides comprehensive healthcare to children and their families. This study quantified the independent role of NMW in reducing under-5 mortality rate (U5MR) worldwide.

DESIGN

A retrospective, observational and correlational study to examine the independent role of NMW in protecting against U5MR.

METHODS

Within 266 "countries", the cross-sectional correlations between NMW and U5MR were examined with scatter plots, Pearson's r, nonparametric, partial correlation and multiple regression. The affluence, education and urban advantages were considered as the potential competing factors for the NMW-U5MR relationship. The NMW-U5MR correlations in both developing and developed countries were explored and compared.

RESULTS

Bivariate correlations revealed that NMW negatively and significantly correlated to U5MR worldwide. When the contributing effects of economic affluence, urbanization and education were removed, the independent NMW role in reducing U5MR remained significant. NMW independently explained 9.36% U5MR variance. Multilinear regression selected NMW as a significant factor contributing an extra 3% of explanation to U5MR variance when NMW, affluence, education and urban advantage were incorporated as the predicting variables. NMW correlated with U5MR significantly more strongly in developing countries than in developed countries.

CONCLUSION

NMW, indexing nursing and midwifery service, was a significant factor for reducing U5MR worldwide. This beneficial effect explained 9.36% of U5MR variance which was independent of economic affluence, urbanization and education. The NMW may be a more significant risk factor for protecting children from dying under 5 years old in developing countries. As a strategic response to the advocacy of the United Nations to reduce child mortality, it is worthy for health authorities to consider a further extension of nurses and midwives' practice scope to enable communities to have more access to NMW healthcare services.

Perceived Barriers and Strategies to Increasing the BSN-Prepared Nursing Workforce

ABSTRACT

Care provided by Bachelor of Science in Nursing (BSN)-prepared Registered Nurses (RNs) has been shown to lead to more positive patient outcomes compared to care provided by non-BSN-prepared RNs. A Fall 2021 study explored barriers of requiring a BSN degree of staff nurses from the perspective of hospital and long-term care facility nurse leaders in Tennessee (N = 89), strategies to increase the number of nurses with BSNs, and association between leadership goals and the number of BSN-prepared nurses in the facilities. Seven barriers to requiring the BSN and nine strategies to increase BSNs were identified. Significant association was found between having plans to increase the number of BSN nurses and the percentage of nurses in the facility with BSN degrees.

Neonatal Nursing Care from a Global Perspective

Neonatal nurses play an essential role in small and sick newborn care. In the last few years, especially during the pandemic, neonatal mortality stayed relatively static. Recognition is growing that neonatal nurses represent a specialty that requires unique, consistent, competency-based training and education to provide the best possible care. The Council of International Neonatal Nurses, Inc collaborates with many global stakeholders to raise the standards of neonatal nursing care, especially in Africa.

Effect of Discharge Readiness on 30-Day Readmissions Among Older Adults Living With Multiple Chronic Conditions

BACKGROUND

Despite decreases in readmissions among Medicare beneficiaries after the implementation of the Hospital Readmissions Reduction Program, older adults living with multiple chronic conditions (MCCs) continue to experience higher readmission rates. Few strategies leverage nursing to identify patients at risk for readmission.

OBJECTIVES

Examine the effect of nurse assessments of discharge readiness on 30-day readmissions.

RESEARCH DESIGN

Cross-sectional study linking 3 secondary data sources (ie, nurse survey, hospital survey, and Medicare claims data) representing 424 hospitals.

SUBJECTS

A total of 188,806 Medicare surgical patients with MCCs.

MEASURES

Discharge readiness was derived from the 2016 RN4CAST-US survey. Medicare claims data was used to determine the MCC count. The outcome was 30-day readmissions across the MCC count.

RESULTS

The average discharge readiness score was 0.45 (range=0-0.86) indicating that, in the average hospital, <50% of nurses were confident their patient or caregiver could manage their care after discharge. Nearly 8% of patients were readmitted within 30 days of discharge; the highest rates of readmissions were among individuals with ≥5 MCCs (4293, 13.50%). For each 10% increase in the proportion of nurses in a hospital who were confident in their patients' discharge readiness, the odds of 30-day readmission decreased by 2% (95% CI: 0.96-1.00; P =0.028) for patients with 2-4 MCCs and 3% (95% CI: 0.94-0.99; P =0.015) for patients with ≥5 MCCs, relative to patients with 0-1 MCCs.

CONCLUSIONS

Nurse assessments of discharge readiness may be a useful signal for hospitals to reduce readmissions and examine factors interfering with discharge processes.

Nurses retrospective view on nursing education: A repeated cross-sectional study over three decades

Background

As the healthcare landscape undergoes transformative shifts due to factors like ageing demographics, technological innovations, rapid global dissemination of infectious diseases, and imperatives for accessible, cost-effective care, a pressing need emerges for the contemporisation of nursing education. Notably, there is a paucity of research delving into nurses' introspective evaluations of their educational experiences after their immersion in professional settings.

Objective

This study aimed to examine nurses' evaluations of their educational background over 30 years and identify relationships between their assessments and their demographic.

Design

The study embraced a recurrent cross-sectional survey methodology, encompassing three distinct quantitative cross-sectional evaluations conducted in the years 1999, 2009, and 2021.

Context/participants

The cohort for this inquiry consisted of nurses stationed in Estonian general hospitals and inpatient departments of developmental plan institutions, each with at least one year of professional experience. Cumulatively, 832 nurses were engaged across three sequential evaluations: Study I (n = 463), Study II (n = 198), and Study III (n = 171).

Methods

Data procurement was executed via a structured survey, with subsequent analytical procedures encompassing descriptive and correlational methodologies.

Results

A discernible augmentation in the educational calibre of nurses was observed with each successive evaluation. This escalation concomitated enhanced positive assessments in areas like evidence-informed education, skill development, and autonomous operational capabilities. Yet, a critical appraisal persisted concerning their competencies in navigating complex patient interactions and addressing socio-religious dilemmas.

Conclusions

The merit of this investigation lies in its illumination of nursing education's evolution, as perceived retrospectively by nurses who have operationalized their academic learnings in real-world scenarios. Their vantage point, inherently informed by practice, uniquely positions them to earmark avenues of refinement. This exploration paves the way for enrichments in nursing education, spotlighting the imperative of equipping nurses to adeptly manage intricate situations.

Nursing workforce characteristics and effect on life expectancy and under-five mortality in the ASEAN

AIM

To assess the effects of the nursing workforce and advanced nursing practice on the outcomes of patients and life expectancy, including mortality rates of under-five children in Cambodia, and to develop policy recommendations to increase the influence of the nursing workforce.

BACKGROUND

In low-middle-income nations, life expectancy and under-five mortality are important measures of public health. However, there is still a dearth of literature related to the nursing workforce in Southeast Asia.

METHOD

The authors retrieved the data from the World Nursing Report produced by the World Health Organization 2020 for 10 member states. The transparent reporting of a multivariable prediction model for individual prognosis or diagnosis checklist has guided this study. The univariate linear regression model was applied to categorize the potential predictors for each outcome assessment. In addition, the Spearman rank correlation test was selected to assess the potential predictors, and a multivariate statistical analysis was carried out for each of the five outcomes.

RESULTS

According to the study's findings, nurse density and advanced practice nursing improve both female and male life expectancy. The existence of advanced nursing roles is associated with decreased under-five mortality.

CONCLUSIONS

There are great opportunities to improve the nursing workforce within Cambodia and other Association of Southeast Asian Nations member states to increase patient outcomes. Investment in nursing is essential for improved patient outcomes.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Health policy investments in these projects and future initiatives intended to advance nurse density, education, and practice are based on this study's results. Policy initiatives should focus on increasing density because nursing appears to impact life expectancy and other outcomes.

Patient Outcomes and Hospital Nurses’ Workload: A Cross-Sectional Observational Study in Slovenian Hospitals Using the RN4CAST Survey

Introduction

Higher nursing workload increases the odds of patient deaths, as the work environment has a significant effect on patient outcomes. The aim of the study was to explore the relation between patient outcomes and nurses’ working conditions in hospitals.

Methods

Administrative data on discharges of surgical patients for the year 2019 in eight general hospitals and two university medical centres in Slovenia were collected to determine in-hospital mortality within 30 days of admission. The RN4CAST survey questionnaire was used to gather data from nurses in these hospitals, with 1,010 nurses participating. Data was collected at the beginning of 2020. The number of nurses per shift and the nurse-to-patient ratio per shift were calculated. Univariate, bivariate and multivariate statistical methods were used to analyse the data.

Results

The 30-day in-hospital mortality for surgical patients was 1.00% in the hospitals sampled and ranged from 0.27% to 1.62%. The odds ratio for staffing suggests that each increase of one patient per RN is associated with a 6% increase in the likelihood of a patient dying within 30 days of admission. The mean patient-to-RN ratio was 15.56 (SD=2.50) and varied from 10.29 to 19.39. Four of the 13 tasks checked were not performed on patients during the last shift.

Conclusion

The results are not encouraging, with an extremely critical shortage of RNs and thus a high RN workload. The number of patients per RN is the highest in Europe and also higher than in some non-European countries, and represents an extreme risk to the quality of nursing and healthcare as a whole. The recommendation for acute non-emergency internal medicine and surgery departments is four patients per RN per shift.

Nurse Education and Hospital Readmissions for Children With and Without a Mental Health Condition

OBJECTIVES

In adults, receiving care in a hospital with more baccalaureate-prepared nurses improves outcomes. This relationship is magnified in adults with serious mental illness or cognitive impairment. Whether the same is true in children with and without a mental health condition is unknown. The study purposes were to determine 1) whether the proportion of baccalaureate-prepared nurses affected the odds of readmission in children; and 2) whether this relationship differed for children with a mental health condition.

PATIENTS AND METHODS

We linked cross-sectional data from the 2016 Healthcare Cost and Utilization Project State Inpatient Databases, the RN4CAST-US nurse survey in Florida, and the American Hospital Association. Inclusion criteria were ages 3 to 21 years. Mental health conditions were defined as psychiatric or developmental/behavioral diagnoses. These were identified using the Child and Adolescent Mental Health Disorders Classification System. We used multivariable, hierarchical logistic regression models to assess the relationship between nurse training and readmissions.

RESULTS

In 35 081 patients admitted to 122 hospitals with 4440 nurses, 21.0% of patients had a mental health condition and 4.2% had a 7-day readmission. For individuals without a mental health condition, each 10% increase in the proportion of baccalaureate-prepared nurses was associated with 8.0% lower odds of readmission (odds ratio = 0.92, 95% confidence interval = 0.87-0.97). For those with a mental health condition, each 10% increase in the proportion of baccalaureate-prepared nurses was associated with 16.0% lower odds of readmission (odds ratio = 0.84, 95% confidence interval = 0.78-0.91).

CONCLUSIONS

A higher proportion of baccalaureate-educated nurses is associated with lower odds of readmission for pediatric patients. This association has a larger magnitude in patients with a mental health condition.

Uniformity along the way: A scoping review on characteristics of nurse education programs worldwide

BACKGROUND

The changing demands on healthcare require continuous development and education in the nursing profession. Homogeneity in nursing qualifications reduces educational inconsistencies between and within countries. However, despite various initiatives, modifying nurse education remains challenging because different countries have their own legislations, structures, motivations, and policies.

OBJECTIVES

To summarize the characteristics of nurse education programs around the globe and analyze the similarities and differences between them.

DESIGN AND METHODS

A scoping review was performed to identify different characteristics of nurse education programs in Organization for Economic Co-operation and Development (OECD) countries. Records published between January 2016 and July 2021 were searched in the PubMed, Cinahl, and ERIC databases. The reference lists of all included articles were also searched manually for relevant studies. Articles were eligible if they described nurse education in one or more of the selected countries with a focus on nursing degrees (both undergraduate and postgraduate programs), nursing titles, program duration, study load hours, or practice hours. Data were independently extracted using a predefined extraction sheet. We asked the respective nursing associations for confirmation and to provide any additional information.

RESULTS

After searching 9769 records, 117 were included in the synthesis. The included records described characteristics of undergraduate nursing educational programs (n = 50), postgraduate programs (n = 30), or both (n = 37). In total, 86 undergraduate and 82 postgraduate programs were described, with a great variety in degrees, nursing titles, study load hours, and practice hours.

CONCLUSIONS

This study demonstrates that there is still considerable variation in nurse education programs between countries. These diverse educational pathways lead to different nursing titles and internationally standardized definitions of nursing roles have not been established. This makes it difficult to understand the healthcare role of nurses. Hence, efforts are needed to increase the quality and uniformity of nurse education around the world.

The voices of online RN-BS students during the COVID-19 pandemic

The need for associate degree nurses to advance their education to replace the nursing workforce will be critical in the next decade. This qualitative descriptive study explored the experiences and challenges of nurses completing their educational journey in a RN-BS program during the COVID-19 pandemic. Four focus group interviews were conducted with a total of 20 RN-BS students. Data analysis revealed four themes; pulled in many directions, faculty understanding, resilience and opening doors. The COVID-19 pandemic and the current nursing shortage presented increased challenges not experienced before for these nurses pursuing a bachelor's degree. The importance of faculty support and a caring presence during this time was a significant factor for student success.

Countering Structural Racism Through Alternative Approaches to Baccalaureate Nursing Education

The baccalaureate degree has been touted as the preferred minimum entry into professional nursing practice in the United States. Although the number of Black registered nurses is increasing overall, Black nurses are disproportionately represented at the associate degree level. This article describes how structural racism and Eurocentric gatekeeping have historically created barriers in nursing education. We propose alternative pathways to diversify nursing education that promote equitable access to the profession.

Association between nursing cost and patient outcomes in intensive care units: A retrospective cohort study of Belgian hospitals

INTRODUCTION

Hospitals with better nursing resources report more favourable patient outcomes with almost no difference in cost as compared to those with worse nursing resources. The aim of this study was to assess the association between nursing cost per intensive care unit bed and patient outcomes (mortality, readmission, and length of stay).

METHODOLOGY

This was a retrospective cohort study using data collected from the intensive care units of 17 Belgian hospitals from January 01 to December 31, 2018. Hospitals were dichotomized using median annual nursing cost per bed. A total of 18,235 intensive care unit stays were included in the study with 5,664 stays in the low-cost nursing group and 12,571 in the high-cost nursing group.

RESULTS

The rate of high length of stay outliers in the intensive care unit was significantly lower in the high-cost nursing group (9.2% vs 14.4%) compared to the low-cost nursing group. Intensive care unit readmission was not significantly different in the two groups. Mortality was lower in the high-cost nursing group for intensive care unit (9.9% vs 11.3%) and hospital (13.1% vs 14.6%) mortality. The nursing cost per intensive care bed was different in the two groups, with a median [IQR] cost of 159,387€ [140,307-166,690] for the low-cost nursing group and 214,032€ [198,094-230,058] for the high-cost group. In multivariate analysis, intensive care unit mortality (OR = 0.80, 95% CI: 0.69-0.92, p < 0.0001), in-hospital mortality (OR = 0.82, 95% CI: 0.72-0.93, p < 0.0001), and high length of stay outliers (OR = 0.48, 95% CI: 0.42-0.55, p < 0.0001) were lower in the high-cost nursing group. However, there was no significant effect on intensive care readmission between the two groups (OR = 1.24, 95% CI: 0.97-1.51, p > 0.05).

CONCLUSIONS

This study found that higher-cost nursing per bed was associated with significantly lower intensive care unit and in-hospital mortality rates, as well as fewer high length of stay outliers, but had no significant effect on readmission to the intensive care unit. .

Nurses' motivations and desired learning outcomes of postgraduate critical care studies: A descriptive exploratory study

BACKGROUND

Education guidelines and professional practice standards inform the design of postgraduate critical care nursing curricula to develop safety and quality competencies for high-quality care in complex environments. Alignment between nurses' motivations for undertaking postgraduate critical care education, and intended course learning outcomes, may impact students' success and satisfaction with programs.

OBJECTIVES

The objectives of this study were to explore nurses' motivations and desired learning outcomes on commencement of a postgraduate critical care course and determine how these align with safety and quality professional attributes.

METHODS

In this exploratory descriptive study, qualitative data were extracted from survey responses of four cohorts of students enrolled in a graduate certificate-level critical care course between 2013 and 2016 (N = 390, 93%), at one Australian university. Summative qualitative content analysis was used to code and quantify textual content followed by synthesis to identify themes and subthemes.

RESULTS

Five themes of motivations were identified: (i) Knowledge development; (ii) Skill development, (iii) Personal outcomes, (iv) Personal professional behaviours, and (v) Interpersonal professional behaviours. Most frequently, students' motivations and desired learning outcomes included 'Understanding' (329 participants [84%], 652 references), 'Development of technical skills' (241 participants [62%], 384 references), 'Development of confidence' (178 participants [46%], 220 references), and 'Career progression' (149 participants [38%], 168 references). Less frequent were motivations related to safety and quality competencies including teamwork, communication, reflective practice, and research skills.

CONCLUSION

Findings suggest students' motivations to undertake postgraduate studies most often related to acquisition of new knowledge and technical skills. Desired skills and behaviours were consistent with many, but not all, of the key course outcomes and attributes specified by health professional education guidelines and nurses' professional practice standards. Understanding the differences between students' motivations and desired safety- and quality-related course learning outcomes informs course orientation, teaching activities, and student support to optimise achievement of essential learning outcomes.

The Association between Nursing Skill Mix and Patient Outcomes in a Mental Health Setting: Protocol for an Observational Feasibility Study

International research on nursing skill mix has focused primarily on medical and surgical patient populations. The association between nursing skill mix and clinical outcomes for psychiatric inpatients has not been explored. The aim of this study is to establish the feasibility of extracting and linking nurse and inpatient data from hospital administrative data sources. This is an observational study. Data will be extracted from hospital administrative sources and linked together. Patient information will include duration and number of psychiatric hospital admissions. We will extract information on the educational preparation of nurses working in the participating hospitals to enable us to calculate estimates of the nursing skill mix. The study will be conducted in two psychiatric inpatient services in Australia. Our study will test the feasibility of extracting and linking nursing skill mix and patient data in a mental health setting and will inform the methodological development of an appropriately powered observational study. Australian and New Zealand clinical trial registry: ACTRN12619001337167p.

The Influence of Nurse Education Level on Hospital Readmissions-A Cost-Effectiveness Analysis

Background: Readmissions are adverse, costly, and potentially preventable. The study aimed to evaluate the cost-effectiveness of reducing readmissions resulting from missed care, depending on the level of education of nurses, from the perspective of the service provider. Methods: We calculated missed care resulting in additional readmissions based on the longitudinal study conducted between 2012 and 2014, as well as readmissions that could have been potentially prevented by adding a 10% increase in hours of nursing care provided by BSN/MSc nurses for 2014. The cost-effectiveness analysis (CEA) was performed to calculate the cost-effectiveness of preventing one hospitalization in non-surgical and surgical wards by increasing the number of nursing hours provided by BSN/MSc nurses. Cost−benefit analysis (CBA) was performed, and the CBR (cost−benefit ratio) and BCR (benefit−cost ratio) were calculated. Results: Increasing the number of hours of nursing care (RN) by 10% decreased the chance for an unplanned readmission by 11%; (OR = 0.89; 95% CI: 0.78−1.01; p = 0.08) in non-surgical wards and 43% (OR = 0.57; 95% CI: 0.49−0.67; p < 0.001) in surgical wards. In non-surgical wards, the number of readmissions that were preventable with extra hours provided by BSN/MSc nurses was 52, and the cost-effectiveness ratio (CER) was USD 226.1. The number of preventable readmissions in surgical wards was 172, and the CER was USD 54.96. In non-surgical wards, the CBR was USD 0.07, while the BCR was USD 1.4. In surgical wards, the CBR was USD 0.02, and the BCR was USD 4.4. Conclusions: The results of these studies broaden the understanding of the relationship among nursing education, patient readmission, and the economic outcomes of hospital care. According to the authors, the proposed intervention has an economic justification. Hence, the authors recommend it for approval by the service provider.

The association between hospital nursing resource profiles and nurse and patient outcomes

AIMS

To identify and describe profiles of nursing resources and compare nurse and patient outcomes among the identified nursing resource profiles.

BACKGROUND

Research linking nurse education, staffing, and the work environment treats these nursing resources as separate variables. Individual hospitals exhibit distinct profiles of these resources.

METHODS

This cross-sectional secondary analysis used 2006 data from 692 hospitals in four states. Latent class mixture modeling was used to identify resource profiles. Regression models estimated the associations among the profiles and outcomes.

RESULTS

Three profiles were identified (better, mixed, and poor) according to their nursing resource levels. Hospitals with poor profiles were disproportionately mid-sized, not-for-profit, non-teaching, urban, and had lower technology capability. Nurse job outcomes, patient mortality and care experiences were significantly improved in hospitals with better resource profiles.

CONCLUSIONS

Hospitals exhibit distinct profiles of nursing resources that reflect investments into nursing. Nurse and patient outcomes and patients' experiences are improved in hospitals with better nursing resource profiles. This finding is consistent with the literature that has examined these resources independently.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers can identify their nursing resource profile and the associated outcomes. Our results show the advantages of improving one's hospital nursing resource profile, motivating managers to make an informed decision regarding investments in nursing resources.

Variations in nursing baccalaureate education and 30-day inpatient surgical mortality

BACKGROUND

In 2010, the IOM recommended an increase in the proportion of bachelor's-prepared (BSN) nurses to 80% by 2020. This goal was largely based on evidence linking hospitals with higher proportions of BSN nurses to better patient outcomes. Though, evidence is lacking on whether outcomes differ by a hospital's composition of initial BSN and transitional RN-to-BSN nurses.

PURPOSE

The purpose of this study is to determine whether risk-adjusted odds of surgical mortality are associated with a hospital's proportion of initial BSN and transitional RN-to-BSN nurses.

METHODS

Logistic regression models were used to analyze cross-sectional data of general surgical patients, nurses, and hospitals in four large states in 2015 to 2016.

FINDINGS

Higher hospital proportions of BSN nurses, regardless of educational pathway, are associated with lower odds of 30-day inpatient surgical mortality.

DISCUSSION

Findings support promoting multiple BSN educational pathways to reach the IOM's recommendation of at least an 80% BSN workforce.