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Kõrgemaa U, Sisask M, Ernits Ü. Nurses retrospective view on nursing education: A repeated cross-sectional study over three decades. Heliyon 2024; 10:e26211. [PMID: 38404896 PMCID: PMC10884450 DOI: 10.1016/j.heliyon.2024.e26211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 02/03/2024] [Accepted: 02/08/2024] [Indexed: 02/27/2024] Open
Abstract
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.
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Affiliation(s)
- Ulvi Kõrgemaa
- Tallinn Health Care College, Chair of Nursing, Estonia
- Tallinn University, School of Governance, Law and Society, Estonia
| | - Merike Sisask
- Tallinn University, School of Governance, Law and Society, Estonia
| | - Ülle Ernits
- Tallinn Health Care College, Chair of Nursing, Estonia
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Hovsepian VE, Sloane DM, Muir KJ, McHugh MD. Mortality Among the Dementia Population in Not-For-Profit Hospitals with Better Nursing Resources. J Aging Soc Policy 2024:1-15. [PMID: 38293888 DOI: 10.1080/08959420.2023.2297596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/23/2023] [Indexed: 02/01/2024]
Abstract
The dementia population has higher rates of mortality during hospital stays than those without dementia. The aim of this study is to examine the relationship between ownership status (i.e. for-profit vs. not-for-profit) and nursing resources (i.e. nurse work environment, nurse-to-patient staffing, and nurse education) on 30-day mortality among post-surgical older adults with dementia. A cross-sectional analysis of linked American Hospital Association, Medicare claims, and nurse survey data was conducted using multi-level logistic regression models. We examined these models to assess the relationship between ownership status and 30-day mortality after adjusting patient and hospital characteristics. We also analyzed the relationship between the hospital ownership status and the 30-day mortality, after considering the three nursing resources. Older adults with dementia who received care in hospitals with not-for-profit status were less likely to die within 30 days of admission following surgery compared to those treated in hospitals with for-profit hospital status (i.e. odds ratio 0.82, 95% confidence interval 0.73-0.92, p = <.001). In addition, the odds ratios estimating the association between ownership and mortality were similar across the different models of the three nursing resources with and without those controls (i.e. 0.88 vs. 0.83 vs. 0.82). Surgical patients with dementia had better outcomes when cared for in not-for-profit hospitals, particularly with greater levels of nurse education and nurse staffing. The relationship between profit status and mortality was partly explained by the lower levels of nurse staffing and education in for-profit vs. not-for-profit hospitals.
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Affiliation(s)
- Vaneh E Hovsepian
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Douglas M Sloane
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - K Jane Muir
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, PA, USA
| | - Matthew D McHugh
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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Muir KJ, Sloane DM, Aiken LH, Hovsepian V, McHugh MD. The association of the emergency department work environment on patient care and nurse job outcomes. J Am Coll Emerg Physicians Open 2023; 4:e13040. [PMID: 37781503 PMCID: PMC10537505 DOI: 10.1002/emp2.13040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/23/2023] [Accepted: 08/31/2023] [Indexed: 10/03/2023] Open
Abstract
Objective To determine the association between emergency nurses' work environments and patient care quality and safety, and nurse burnout, intent to leave, and job dissatisfaction. Methods Cross-sectional study of 221 hospitals in New York and Illinois informed by surveys from 746 emergency nurses and 6932 inpatient nurses with linked data on hospital characteristics from American Hospital Association Annual Hospital Survey. The RN4CAST-NY/IL study surveyed all registered nurses in New York and Illinois between April and June 2021 about patient safety, care quality, burnout, intent to leave, and job dissatisfaction and aggregated their responses to specific hospitals where they practiced. Work environment quality was measured using the abbreviated Practice Environment Scale of the Nursing Work Index. Generalized estimating equations were used to determine the relationship between emergency nurses' work environments on patient care and nurse job outcomes. Results A total of 58% of emergency nurses reported high burnout, 39% reported job dissatisfaction, and 27% indicated intent to leave their job in the next year. Nurses in hospitals with good (vs mixed) or mixed (vs poor) emergency work environments were less likely to report unfavorable patient care quality and hospital safety grades, and were less likely to experience high burnout, job dissatisfaction, and intentions to leave the job, by factors ranging from odds ratio (OR) 0.21 (95% confidence interval [CI], 0.16-0.29) to OR 0.46 (95% CI, 0.34-0.61). Conclusions Given the complex and high stakes nature of emergency nursing care, leaders should place a high priority on organizational solutions targeting improved nurse staffing and work environments to advance better patient and clinician outcomes.
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Affiliation(s)
- K. Jane Muir
- National Clinician Scholars ProgramUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Center for Health Outcomes and Policy ResearchSchool of NursingUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- The Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Douglas M. Sloane
- Center for Health Outcomes and Policy ResearchSchool of NursingUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Linda H. Aiken
- Center for Health Outcomes and Policy ResearchSchool of NursingUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- The Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Vaneh Hovsepian
- Center for Health Outcomes and Policy ResearchSchool of NursingUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- The Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Matthew D. McHugh
- Center for Health Outcomes and Policy ResearchSchool of NursingUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- The Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Kaur R, Geistkemper A, Mitra R, Becker EA. RT education and COVID-19 pneumonia discharge quality. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2023; 59:190-203. [PMID: 37781347 PMCID: PMC10540156 DOI: 10.29390/001c.87641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023]
Abstract
Background There is a lack of data assessing the influence of respiratory therapist (RT) education on clinical outcomes. The primary objective of this study was to evaluate the impact of RTs holding advanced degrees or completing adult critical care competencies on discharge outcomes of patients with COVID-19 pneumonia. Study Design and Methods This retrospective, cross-sectional study included adults with confirmed COVID-19 admitted to the hospital for at least three days between March-May 2020. The academic degree held by each RT was considered advanced (baccalaureate or higher) or associate degree. Discharge outcomes were considered good, compromised, or poor when subjects' hospital discharge was directly to home, long-term care facility/rehabilitation center, or hospice/died, respectively. A time-to-event multi-state regression model was used to determine the impact of RT academic degree and adult critical care competencies on discharge outcomes using α=0.05. Results A total of 260 subjects (median age 59 y; 166 males) received clinical care from 132 RTs. RT median professional experience was six y (IQR 3-11), 70.8% had an advanced degree, and 70.8% completed adult critical care competencies. The time-to-event multi-state regression model showed that patients with >85% exposure to RTs with advanced degrees transitioned 3.72 times more frequently to good outcomes than RTs without advanced degrees (p=.001). Similarly, patients with >85% exposure to RTs with adult critical care competencies transitioned 5.10 times more frequently to good outcomes than RTs without adult critical care competencies (p<.001). Conclusion Patients with COVID-19 pneumonia who received greater than 85% of their care by RTs who earned advanced degrees or completed adult critical care competencies had improved discharge outcomes. This preliminary work suggests that advancing education for the respiratory therapist workforce may improve the discharge quality of patients with acute respiratory failure and should be further explored.
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Affiliation(s)
- Ramandeep Kaur
- Department of Cardiopulmonary Sciences, Division of Respiratory Care Rush University Medical Center
| | - Anne Geistkemper
- Department of Cardiopulmonary Sciences, Division of Respiratory Care Rush University Medical Center
| | - Riten Mitra
- Department of Bioinformatics and Biostatistics University of Louisville
| | - Ellen A Becker
- Department of Cardiopulmonary Sciences, Division of Respiratory Care Rush University Medical Center
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Maganty A, Dunn RL, Bynum JPW, Hollenbeck BK. Accountable care organizations and use of surgery among patients with Alzheimer disease and related dementias. THE AMERICAN JOURNAL OF MANAGED CARE 2023; 29:349-355. [PMID: 37523752 PMCID: PMC10403270 DOI: 10.37765/ajmc.2023.89395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
OBJECTIVE To understand the effects of accountable care organizations (ACOs) on use of surgery in patients with Alzheimer disease and related dementias (ADRD). STUDY DESIGN Retrospective national cohort study of all Medicare beneficiaries identified in a 20% sample between 2010 and 2017. The primary exposure was participation in ACOs. The primary outcome was use of 1 of 6 common surgical procedures (aortic valve replacement [AVR], abdominal aortic aneurysm [AAA] repair, colectomy, carotid artery repair, major joint repair, and prostatectomy). METHODS Multivariable logistic regression models were fit using beneficiary-year as the unit of analysis to estimate the likelihood of undergoing each procedure among patients with ADRD and without ADRD, stratified by ACO participation. Additional models were fit to determine how the relationship between ACO participation and surgery was altered based on procedure urgency and the availability of minimally invasive technology. RESULTS Adjusted odds for use of surgery were lower among patients with ADRD compared with patients without ADRD for all procedures. ACO participation had varying impact on patients with ADRD, with higher odds of AVR and major joint surgery and lower odds of carotid artery repair. Availability of minimally invasive technology increased the likelihood of AVR and AAA repair among patients with ADRD; however, ACO participation reduced these effects. The effect of ACO participation on the likelihood of undergoing surgery did not vary by urgency of the procedure. CONCLUSIONS The likelihood of undergoing surgery is overall lower among patients with ADRD and may vary by ACO participation for specific procedures.
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Affiliation(s)
- Avinash Maganty
- Division of Health Services Research, Department of Urology, University of Michigan, 2800 Plymouth Rd, Bldg 16, Ann Arbor, MI 48109-2800.
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Riman KA, Doupnik SK, Kutney-Lee AM, Lake ET. Nurse Education and Hospital Readmissions for Children With and Without a Mental Health Condition. Hosp Pediatr 2023; 13:72-79. [PMID: 36477797 PMCID: PMC9808724 DOI: 10.1542/hpeds.2022-006602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Kathryn A. Riman
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephanie K. Doupnik
- University of Pennsylvania School of Medicine & Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ann M. Kutney-Lee
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Eileen T. Lake
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
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Kim H, Juarez CA, Meath THA, Quiñones AR, Teno JM. Association of Medicare bundled payment model with joint replacement care for people with dementia. J Am Geriatr Soc 2022; 70:2571-2581. [PMID: 35635471 PMCID: PMC9489623 DOI: 10.1111/jgs.17836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/29/2022] [Accepted: 04/17/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND We examined whether the Comprehensive Care for Joint Replacement (CJR) model was associated with changes in the receipt of joint replacement among people with Alzheimer's disease and related dementias (ADRD) as well as spending, health service use, and postsurgical outcomes among people with ADRD who underwent a joint replacement surgery. METHODS Retrospective cohort study using 2013-2017 Medicare claims and Minimum Data Set. We used a difference-in-differences analysis to compare people with ADRD residing in CJR-participating treatment areas versus nonparticipating control areas on the receipt of joint replacement, episode spending during the index hospitalization and subsequent 90-day post-discharge period, discharges to an institutional post-acute care setting, and readmissions within 90 days of hospital discharge. RESULTS Our sample included 3,361,950 Medicare enrollees with ADRD (2,156,995 women [64%]; mean [SD] age, 83 [8.0] years; 2,646,405 white [78%], 344,478 black [10%], 224,010 Hispanic [7%]). The receipt of replacement among people with ADRD changed similarly between CJR-participating treatment and control areas after CJR model was implemented, suggesting no association of CJR model with the receipt of replacement. Among people with ADRD who received joint replacement, the CJR model was associated with a $1029 decrease in spending per episode (95% confidence interval [CI] -$1577, -$481, p < 0.001), a 1.62 percentage point decrease in discharges to an institutional post-acute care setting (95% CI -3.17, -0.07, p = 0.04), but no changes in 90-day readmission (95% CI -2.68, 0.00, p = 0.051). CONCLUSIONS Despite concerns that the CJR model could hinder people with ADRD from receiving joint replacement, the receipt of joint replacement did not change among people with ADRD under CJR. The CJR model was associated with decreased spending for people with ADRD who received joint replacements, driven by reduced discharges to an institutional post-acute care setting, without any changes in 90-day readmission.
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Affiliation(s)
- Hyunjee Kim
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon, USA
| | - Cesar A Juarez
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon, USA
| | - Thomas H A Meath
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon, USA
| | - Ana R Quiñones
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Joan M Teno
- Department of General Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Nursing Resources Linked to Postsurgical Outcomes for Patients With Opioid Use Disorder. ANNALS OF SURGERY OPEN 2022; 3:e185. [PMID: 36199489 PMCID: PMC9508985 DOI: 10.1097/as9.0000000000000185] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/14/2022] [Indexed: 11/28/2022] Open
Abstract
To determine whether better nursing resources (ie, nurse education, staffing, work environment) are each associated with improved postsurgical outcomes for patients with opioid use disorder (OUD).
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9
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Variations in nursing baccalaureate education and 30-day inpatient surgical mortality. Nurs Outlook 2022; 70:300-308. [PMID: 34763898 PMCID: PMC9095709 DOI: 10.1016/j.outlook.2021.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/29/2021] [Accepted: 09/15/2021] [Indexed: 11/21/2022]
Abstract
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.
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Aiken LH, Sloane DM, Brom HM, Todd BA, Barnes H, Cimiotti JP, Cunningham RS, McHugh MD. Value of Nurse Practitioner Inpatient Hospital Staffing. Med Care 2021; 59:857-863. [PMID: 34432769 PMCID: PMC8446318 DOI: 10.1097/mlr.0000000000001628] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Evidence indicates hospitals with better registered nurse (RN) staffing have better patient outcomes. Whether involving more nurse practitioners (NPs) in inpatient care produces better outcomes is largely unknown. OBJECTIVE The objective of this study was to determine whether the presence of more NPs produces better inpatient outcomes net of RN staffing. RESEARCH DESIGN This was a 2015-2016 cross-sectional data on 579 hospitals linked from: (1) RN4CAST-US nurse surveys; (2) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient surveys; (3) surgical patient discharge abstracts; (4) Medicare Spending per Beneficiary (MSPB) reports; (5) American Hospital Association (AHA) Annual Survey. Hospitals were grouped according to their NP/beds ratios [<1 NP/100 beds (N=132), 1-2.99 NPs/100 beds (N=279), and 3+ NPs/100 beds (N=168)]. SUBJECTS RNs randomly sampled nurses from licensure lists yielded 22,273 RNs in study hospitals; discharge data for 1.4 million surgical patients; HCAHPS data for 86% of study hospitals. MEASURES Mortality, readmissions, lengths of stay, MSPB, patient experience, and quality reported by patients and nurses. RESULTS After adjustments, patients in hospitals with 3+ NPs/100 beds had lower odds than patients in hospitals with <1 NP/100 beds of 30-day mortality [odds ratio (OR)2=0.76; 95% confidence interval (CI)=0.67-0.82; P<0.001] and 7-day readmissions (OR2=0.90; 95% CI=0.86-0.96; P<0.001), shorter average length of stay (incident rate ratio2=0.92; 95% CI=0.88-0.96; P<0.001) and 5.4% lower average MSPB (95% CI=3.8%-7.1%). Patients and nurses in the hospitals with higher NP/bed ratios were significantly more likely to report better care quality and safety, and nurses reported lower burnout, higher job satisfaction, greater intentions of staying in their jobs. CONCLUSIONS Having more NPs in hospitals has favorable effects on patients, staff nurse satisfaction, and efficiency. NPs add value to existing labor resources.
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Affiliation(s)
- Linda H Aiken
- Center for Health Outcomes and Policy Research, The University of Pennsylvania School of Nursing
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Douglas M Sloane
- Center for Health Outcomes and Policy Research, The University of Pennsylvania School of Nursing
| | - Heather M Brom
- Center for Health Outcomes and Policy Research, The University of Pennsylvania School of Nursing
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Villanova University M. Louise Fitzpatrick College of Nursing, Villanova
| | - Barbara A Todd
- Center for Health Outcomes and Policy Research, The University of Pennsylvania School of Nursing
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Hilary Barnes
- Center for Health Outcomes and Policy Research, The University of Pennsylvania School of Nursing
- School of Nursing, University of Delaware, Newark, DE
| | - Jeannie P Cimiotti
- Center for Health Outcomes and Policy Research, The University of Pennsylvania School of Nursing
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Regina S Cunningham
- Center for Health Outcomes and Policy Research, The University of Pennsylvania School of Nursing
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Matthew D McHugh
- Center for Health Outcomes and Policy Research, The University of Pennsylvania School of Nursing
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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Lasater KB, Sloane DM, McHugh MD, Porat-Dahlerbruch J, Aiken LH. Changes in proportion of bachelor's nurses associated with improvements in patient outcomes. Res Nurs Health 2021; 44:787-795. [PMID: 34128242 DOI: 10.1002/nur.22163] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/18/2021] [Accepted: 06/03/2021] [Indexed: 11/11/2022]
Abstract
This study uses data from two cross-sections in time (2006, 2016) to determine whether changes over time in hospital employment of bachelor's of science in nursing (BSN) nurses is associated with changes in patient outcomes. Data sources include nurse survey data, American Hospital Association Annual Survey data, and patient administrative claims data from state agencies in California, Florida, New Jersey, and Pennsylvania. The study sample included general surgical patients aged 18-99 years admitted to one of the 519 study hospitals. Multilevel logistic regression and truncated negative binomial models were used to estimate the cross-sectional and longitudinal effects of the proportion of hospital BSN nurses on patient outcomes (i.e., in-hospital mortality, 7- and 30-day readmissions, length of stay). Between 2006 and 2016, the average proportion of BSN nurses in hospitals increased from 41% to 56%. Patients in hospitals that increased their proportion of BSN nurses over time had significantly reduced odds of risk-adjusted mortality (odds ratio [OR]: 0.95, 95% confidence interval [CI]: 0.92-0.98), 7-day readmission (OR: 0.96, 95% CI: 0.94-0.99) and 30-day readmission (OR: 0.98, 95% CI: 0.95-1.00), and shorter lengths of stay (incident rate ratio [IRR]: 0.98, 95% CI: 0.97-0.99). Longitudinal findings of an association between increased proportions of BSN nurses and improvements in patient outcomes corroborate previous cross-sectional research, suggesting that a better educated nurse workforce may add value to hospitals and patients.
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Affiliation(s)
- Karen B Lasater
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Douglas M Sloane
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew D McHugh
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joshua Porat-Dahlerbruch
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Linda H Aiken
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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12
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Fogg C, Bridges J, Meredith P, Spice C, Field L, Culliford D, Griffiths P. The association between ward staffing levels, mortality and hospital readmission in older hospitalised adults, according to presence of cognitive impairment: a retrospective cohort study. Age Ageing 2021; 50:431-439. [PMID: 32970798 DOI: 10.1093/ageing/afaa133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Lower nurse staffing levels are associated with increased hospital mortality. Older patients with cognitive impairments (CI) have higher mortality rates than similar patients without CI and may be additionally vulnerable to low staffing. OBJECTIVES To explore associations between registered nurse (RN) and nursing assistant (NA) staffing levels, mortality and readmission in older patients admitted to general medical/surgical wards. RESEARCH DESIGN Retrospective cohort. PARTICIPANTS All unscheduled admissions to an English hospital of people aged ≥75 with cognitive screening over 14 months. MEASURES The exposure was defined as deviation in staffing hours from the ward daily mean, averaged across the patient stay. Outcomes were mortality in hospital/within 30 days of discharge and 30-day re-admission. Analyses were stratified by CI. RESULTS 12,544 admissions were included. Patients with CI (33.2%) were exposed to similar levels of staffing as those without. An additional 0.5 RN hours per day was associated with 10% reduction in the odds of death overall (odds ratio 0.90 [95% CI 0.84-0.97]): 15% in patients with CI (OR 0.85 [0.74-0.98]) and 7% in patients without (OR 0.93 [0.85-1.02]). An additional 0.5 NA hours per day was associated with a 15% increase in mortality in patients with no impairment. Readmissions decreased by 6% for an additional 0.5 RN hours in patients with CI. CONCLUSIONS Although exposure to low staffing was similar, the impact on mortality and readmission for patients with CI was greater. Increased mortality with higher NA staffing in patients without CI needs exploration.
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Affiliation(s)
- Carole Fogg
- Research and Development, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Cosham, Hampshire PO6 3LY, UK
- National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care / Applied Research Centre (NIHR CLAHRC / ARC) Wessex, Hampshire SO16 7NP, UK
- School of Health Sciences, Faculty of Environmental and Life Sciences University of Southampton, Hampshire SO17 1BJ, UK
| | - Jackie Bridges
- National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care / Applied Research Centre (NIHR CLAHRC / ARC) Wessex, Hampshire SO16 7NP, UK
- School of Health Sciences, Faculty of Environmental and Life Sciences University of Southampton, Hampshire SO17 1BJ, UK
| | - Paul Meredith
- Research and Development, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Cosham, Hampshire PO6 3LY, UK
| | - Claire Spice
- Department of Medicine for Older People, Rehabilitation and Stroke, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital Cosham, Hampshire PO6 3LY, UK
| | - Linda Field
- Department of Medicine for Older People, Rehabilitation and Stroke, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital Cosham, Hampshire PO6 3LY, UK
| | - David Culliford
- National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care / Applied Research Centre (NIHR CLAHRC / ARC) Wessex, Hampshire SO16 7NP, UK
| | - Peter Griffiths
- National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care / Applied Research Centre (NIHR CLAHRC / ARC) Wessex, Hampshire SO16 7NP, UK
- School of Health Sciences, Faculty of Environmental and Life Sciences University of Southampton, Hampshire SO17 1BJ, UK
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Harrison JM, Aiken LH, Sloane DM, Brooks Carthon JM, Merchant RM, Berg RA, McHugh MD. In Hospitals With More Nurses Who Have Baccalaureate Degrees, Better Outcomes For Patients After Cardiac Arrest. Health Aff (Millwood) 2020; 38:1087-1094. [PMID: 31260358 DOI: 10.1377/hlthaff.2018.05064] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In 2010, prompted by compelling evidence that demonstrated better patient outcomes in hospitals with higher percentages of nurses with a bachelor of science in nursing (BSN), the Institute of Medicine recommended that 80 percent of the nurse workforce be qualified at that level or higher by 2020. Using data from the American Heart Association's Get With the Guidelines-Resuscitation registry (for 2013-18), RN4CAST-US hospital nurse surveys (2015-16), and the American Hospital Association (2015), we found that each 10-percentage-point increase in the hospital share of nurses with a BSN was associated with 24 percent greater odds of surviving to discharge with good cerebral performance among patients who experienced in-hospital cardiac arrest. Lower patient-to-nurse ratios on general medical and surgical units were also associated with significantly greater odds of surviving with good cerebral performance. These findings contribute to the growing body of evidence that supports policies to increase access to baccalaureate-level education and improve hospital nurse staffing.
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Affiliation(s)
- Jordan M Harrison
- Jordan M. Harrison ( ) is a research fellow in the Center for Health Outcomes and Policy Research, a National Clinical Scholar in the Perelman School of Medicine, and an associate fellow in the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania, in Philadelphia
| | - Linda H Aiken
- Linda H. Aiken is the Claire M. Fagin Leadership Professor of Nursing, a professor of sociology, director of the Center for Health Outcomes and Policy Research, and a senior fellow in the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania
| | - Douglas M Sloane
- Douglas M. Sloane is an adjunct professor at the Center for Health Outcomes and Policy Research, University of Pennsylvania
| | - J Margo Brooks Carthon
- J. Margo Brooks Carthon is an associate professor in the Center for Health Outcomes and Policy Research and a senior fellow in the Leonard Davis Institute of Health Economics, University of Pennsylvania
| | - Raina M Merchant
- Raina M. Merchant is an associate professor of emergency medicine in the Perelman School of Medicine, director of the Penn Medicine Center for Digital Health, and a senior fellow in the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania
| | - Robert A Berg
- Robert A. Berg is a professor of anesthesiology and critical care at the Children's Hospital of Philadelphia
| | - Matthew D McHugh
- Matthew D. McHugh is a professor of nursing, the Independence Chair for Nursing Education, associate director of the Center for Health Outcomes and Policy Research, and a senior fellow in the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania
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- The American Heart Association's Get With the Guidelines-Resuscitation Investigators are acknowledged at the end of the article
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Building a Foundation of Evidence to Support Nurses Returning to School: The Role of Empowerment. Nurs Educ Perspect 2020; 41:285-290. [PMID: 32701633 DOI: 10.1097/01.nep.0000000000000704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM The aim of the study was to investigate the role of Kanter's theory of workplace empowerment in nurses' attitude toward returning to school. BACKGROUND Increasing the percentage of BSNs has a positive effect on outcomes, but few hospitals offer formal support systems beyond tuition reimbursement. Workplace empowerment theory may explain attitudes toward returning to school. METHOD A mixed-methods design was used with a cross-sectional survey and focus group. RESULTS Significant predictors of attitude toward returning to school (n = 162) were formal power (p = .003), access to support (p = .007), and access to resources (p = .050). Focus group themes (n = 3) were resources important to returning to school/manager support, timing, becoming aware of opportunities after enrolling, and intrinsic desire to return to school. CONCLUSION Exploring relationships between workplace empowerment and attitudes toward returning to school will guide hospital executives in building support systems for nurses returning to school.
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Zachwieja E, Butler AJ, Grau LC, Summers S, Massel D, Orozco F, Hernandez VH. The association of mental health disease with perioperative outcomes following femoral neck fractures. J Clin Orthop Trauma 2019; 10:S77-S83. [PMID: 31695264 PMCID: PMC6823790 DOI: 10.1016/j.jcot.2019.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/20/2018] [Accepted: 01/02/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Mental illness in the United States is a growing problem, leading to significant implications for those effected as well as direct and indirect costs to the health care system. The association between psychiatric comorbidity and increased risk of perioperative adverse events has previously been described following elective orthopedic surgery, however, there is a paucity of literature evaluating the correlation between mental health disease and outcomes in patients in an orthopedic trauma setting. METHODS Utilizing data from the US National Hospital Discharge Survey, all patients undergoing surgery for femoral neck fracture were identified between the years 1990 and 2007. The association of depression, anxiety, dementia and schizophrenia on surgical outcomes were then analyzed using univariate regression analysis. RESULTS A cohort of 2,432,931 patients was identified. All psychiatric comorbidities were associated with a lower rate of routine discharge home following surgery (p < 0.001). Schizophrenia was associated with increased odds of any adverse event (p < 0.001), acute post-operative mechanical complications (p < 0.001) and increased length of stay (p < 0.001). DISCUSSION Patients undergoing surgery for femoral neck fracture with comorbid psychiatric illness are at increased risk for non-routine discharge. Schizophrenia is independently associated with an increased risk for post-operative complications. An awareness of these risks should optimize preoperative multidisciplinary patient care planning so as to maximize patient outcome and minimize resource utilization.
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Affiliation(s)
- Erik Zachwieja
- University of Miami, Department of Orthopedic Surgery, 1400 NW 12th Ave, Miami, FL, 33136, USA
| | - Alexander J. Butler
- University of Miami, Department of Orthopedic Surgery, 1400 NW 12th Ave, Miami, FL, 33136, USA,Corresponding author.
| | - Luis C. Grau
- University of Miami, Department of Orthopedic Surgery, 1400 NW 12th Ave, Miami, FL, 33136, USA
| | - Spencer Summers
- University of Miami, Department of Orthopedic Surgery, 1400 NW 12th Ave, Miami, FL, 33136, USA
| | - Dustin Massel
- University of Miami, Department of Orthopedic Surgery, 1400 NW 12th Ave, Miami, FL, 33136, USA
| | - Fabio Orozco
- Rothman Orthopaedic Institute, 925 Chestnut St, Philadelphia, PA, 19107, USA
| | - Victor H. Hernandez
- University of Miami, Department of Orthopedic Surgery, 1400 NW 12th Ave, Miami, FL, 33136, USA
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Abstract
BACKGROUND Calculating nurse staffing in the acute hospital has become a key issue but solutions appear distant. Community, mental health and areas such as learning disability nursing have attracted less attention and remain intractable. This review aims to examine current approaches to the issue across many disciplines. DESIGN The approach taken is iterative and in the form of a hermeneutic review. 769 pieces of evidence were reviewed from across disciplines such as nursing, medicine, engineering, statistics, population science, computer science and mathematics where hospital nurse staffing was the subject of the study. RESULTS A number of themes emerged. The first iteration showed the predominance of unit base approaches (eg, nurse numbers, ratios, activity and workload) and the second was the development of methodologies. Subsequent iterations examined issues such as demand, safety, nurse education, turnover, patient outcomes, patient or staff satisfaction, workload and activity. The majority of studies examined (n=767) demonstrated some association between staffing (units or type/skill) and various factors such as staff or patient satisfaction, working conditions, safety parameters, outcomes complexity of work achieved, work left undone or other factors. Many potential areas such as operational safety research were not utilised. CONCLUSION Although the relationship between staffing in acute care and factors such as units, safety or workload is complex, the evidence suggests an interdependent relationship which should only be dismissed with caution. The nature of these relationships should be further examined in order to determine nurse staffing. The body of knowledge appears substantial and complex yet appears to have little impact on policy.
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Affiliation(s)
- Alison Leary
- School of Health and Social Care, London South Bank University, London, UK
- School of Health, University of South Eastern Norway, Oslo, Norway
| | - Geoffrey Punshon
- School of Health and Social Care, London South Bank University, London, UK
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