Impact of level of nurse experience on falls in medical surgical units

Opportunities to strengthen resilience of health care workers regarding patient safety

BACKGROUND

The COVID-19 pandemic endangered the quality of health care and the safety of patients and health care workers (HCWs). This provided challenges for HCWs' resilience and for hospital management and probably increased risks for patient safety incidents (PSI). HCWs may also have experienced psychological consequences as second victims of PSI, but evidence on this is lacking. Therefore, we mapped HCWs' experiences with PSI during the second wave of COVID-19, the associations of these experiences with the hospital management of patient safety culture and HCWs' interests in receiving further training.

METHODS

We obtained data from 193 HCWs working at the COVID-related departments of one large hospital in eastern Slovakia via a questionnaire developed in direct collaboration with them. We measured PSI experiences as various HCWs' experiences with near miss and adverse events and the hospital management of patient safety culture using indicators such as risk of recurrence, open disclosure and second victim experiences. For analysis, we used logistic regression models adjusted for age and gender of the HCWs.

RESULTS

One-third of the hospital HCWs had experienced PSI; these were more likely to expect adverse events to recur (odds ratio, OR = 2.7-3.5). Regarding the hospital management of patient safety culture, the HCWs' experiencing openly disclosed PSI was associated with one negative outcome, i.e. conflicts among colleagues (OR = 2.8), and one positive outcome, i.e. patients' acceptance of their explanation and apologies (OR = 2.3). We found no associations for any other essential domains after disclosure. PSI experiences were strongly associated with psychological indicators of second victimhood, such as sadness, irritability, anxiety and depression (OR = 2.2-4.3), while providing support was not. The majority of the HCWs would like to participate in the suggested trainings (83.4%).

CONCLUSION

HCWs with PSI experiences reported poor hospital management of the patient safety culture, which might reflect they missed the opportunities to strengthen their resilience, especially during the COVID-19 pandemic.

The impact of safety culture, quality of care, missed care and nurse staffing on patient falls: A multisource association study

AIMS

To examine the association between nursing unit safety culture, quality of care, missed care and nurse staffing levels, and inpatient falls using two data sources: incidence of falls and nurses' perceptions of fall frequency in their units. The study explores the association between the two sources of patient falls and identifies if nurses' perceptions of patient fall frequency reflect the actual patient falls recorded in the incident management system.

BACKGROUND

Inpatient falls are associated with severe complications that result in extended hospitalisation and increased financial consequences for patients and healthcare services.

DESIGN

A multi-source cross-sectional study guided by the STROBE guidelines.

METHODS

A purposive sample of 33 nursing units (619 nurses) from five hospitals completed an online survey from August to November 2021. The survey measured safety culture, quality of care, missed care, nurse staffing levels and nurses' perceptions of patient fall frequency. In addition, secondary data on falls from participating units between 2018 and 2021 were also collected. Generalised linear models were fitted to examine the association between study variables.

RESULTS

Nursing units with strong safety climate and working conditions and lower missed care were associated with lower rates of falls using both data sources. Nurses' perceptions of the frequency of falls in their units were reflective of the actual incidence rate of falls, but the association was not statistically significant.

CONCLUSION

Nursing units with a strong safety climate and better collaborations between nurses and other professionals, including physicians and pharmacists, were associated with lower incidents of patient falls.

RELEVANCE TO CLINICAL PRACTICE

This study provided evidence for healthcare services and hospital managers to minimise patient falls.

PATIENT OR PUBLIC CONTRIBUTION

Patients who had experienced a fall, which was reported in the incident management system, from the included units in the five hospitals were part of this study.

The Impact of Nurse Staffing on Falls Performance within a Healthcare System: A Descriptive Study

AIM

The purpose of this study was to examine the impact of nurse staffing on inpatient falls performance across a multi-hospital system.

BACKGROUND

Evidence to support which staffing variables influence fall performance so that healthcare organizations can better allocate resources is lacking.

METHOD

A descriptive study design was used to analyze the impact of nurse staffing and falls performance, with units dichotomized as either high or low performing based on national benchmarking data. The impact was evaluated using 10 nurse staffing variables.

RESULTS

A total of 9 units were included (5 high and 4 low performing). Higher performing units showed less use of sitters and travelers, had fewer nurses working overtime hours, and employed more expert-level clinical nurses and combined nursing assistant/health unit coordinator positions, than lower performing units.

CONCLUSION

Findings provide evidence of how staffing variables affect a unit's falls performance. While significant relationships were found, further evaluation is needed to explore the relationship of staffing variables and quality outcomes.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing managers may consider trying to reduce use of sitters and travelers, and utilize innovative staffing models, such as using combined nursing assistant/health unit coordinator positions, to help improve their falls performance.

Nurse staffing legislation: Empirical evidence and policy analysis

Unsafe nurse staffing conditions in hospitals have been shown to increase the risk of adverse patient events, including mortality. Consequently, United States and international professional nursing organizations often advocate for safer staffing conditions. There are a variety of factors to consider when staffing nurses for patient safety, such as the number of patients per nurse, nurse preparation, patient acuity, and nurse autonomy. The complex issue of staffing nurses often is compounded by cost issues and can become politicized. When nurse organizations' recommendations for safe staffing measures are disregarded by hospital administrations, nurse lobbyists and interest groups often pursue legislative action to protect patients and nurses from unsafe staffing conditions. This article presents a narrative review of safe nurse staffing factors and an analysis of nurse staffing legislation. Using a patient-centric lens, three state-level nurse staffing policies (mandated nurse-to-patient ratios, public reporting of staffing plans, and nurse staffing committees) were evaluated by empirical evidence, cost to hospitals and state governments, political feasibility, and potential to affect patient populations. Although nurse staffing policy analysis can be conducted in several ways, it is crucial that nurses consider empirical evidence related to staffing policies as well as evaluations of implemented policies and political influences.

The effect of the reformed nurse staffing policy on employment of nurses in Korea

Aim

This study aims to analyse the employment effect of reformed nurse staffing policy which is the “Integrated Nursing and Care Service” scheme that was introduced by the Korean government.

Design

Economic evaluation study focusing on employment effect.

Method

An input–output model was used to estimate the employment‐inducing effect of the new staffing policy. The analysed data of 26,381 beds, of 400 hospitals that are participated in the Integrated Nursing and Care Service scheme were retrieved from the Korean National Health Insurance claims database.

Results

The job‐creation effect of the new staffing policy was estimated to be 48.5 persons per USD 1 million expenditure, which means 28,154 persons were employed when USD 580.15 million expenditures was paid to the hospitals by the National Health Insurance Service. In addition, the policy had an employment‐inducing effect which is as high as 3.09~6.07 times higher than that of similar industries and all industries.

Effects of self-rated workload and nurse staffing on work engagement among nurses: A cross-sectional survey

AIM

To analyse net effects of self-rated workload and nurse staffing (nurse-to-patient ratio and staff skill mix) on work engagement among clinical nurses.

BACKGROUND

Improving nurses' engagement is necessary to enhance patient outcomes, so factors that influence engagement should be explored.

METHODS

A cross-sectional study was conducted in 1,428 registered nurses from 145 units of 11 hospitals. A hierarchical linear model was used to analyse the data.

RESULTS

Self-rated workload had a negative effect on engagement (β = -0.353, p < .001, effect size (f² ) = 14.20%), while only one index of skill mix (percentage of nurses with ≤ 5 work years) had a significant effect on engagement, which was positive (β = 0.258, p < .05, f²  = 8.50%). These two variables explained 22.7% of the variance of engagement at the unit level (R² _between  = 22.7%, p < .05). No significant effect of staffing on self-rated workload was found.

CONCLUSIONS

Self-rated workload had more effect on engagement than did staffing, and factors that influence self-rated workload need to be explored.

IMPLICATIONS FOR NURSING MANAGEMENT

Balancing the mix of experience levels in nursing teams may improve work engagement. Managers should pay attention to multiple strategies to motivate nurses to engage in work in clinical practice.

Assessing the Effect of Unit Champion-Initiated Audits on Fall Rates: Improving Awareness

BACKGROUND

Inpatient falls remain challenging with repercussions that can include patient injury and increased hospital expense. Fall rates were consistently above the national benchmark. An initiative to reduce fall rates was use of Fall Champion Audits (FCAs).

PURPOSE

The aim of this study was to assess the effect of FCAs on patient fall rates.

METHODS

FCAs were piloted on a medical-oncology unit. An interrupted time series design was used to assess the effect of FCAs on fall rates.

INTERVENTION

FCA is an audit conducted by the unit fall champion that assesses fall risk, interventions, and barriers among staff and patients.

RESULTS

Analysis suggested a significant decrease in fall rates from pre- (3.75) to postimplementation (1.62). FCAs worked in conjunction with a division-wide fall program in reducing fall rate.

CONCLUSIONS

FCAs, in conjunction with a fall program, are a feasible intervention in reducing fall rates.

Nurses' knowledge, attitude, and fall prevention practices at south Korean hospitals: a cross-sectional survey

Background

Fall-prevention activities are nursing interventions which are designed to improve patient safety. The introduction of evaluations of medical institutions and an increase in medical litigation has led institutions to emphasize the importance of fall-prevention activities. The current situation regarding falls among patients in small and medium-sized hospitals is poorly understood. This study assessed knowledge and attitudes regarding falls, and fall-prevention activities of nurses working in small- and medium-sized hospitals.

Methods

Nurses (N = 162) from seven small- and medium-sized hospitals participated in the study. Data on participants’ characteristics, education regarding patient falls, knowledge of stretcher cart use, attitudes regarding patient falls, and fall-prevention activities were collected from August 1 to September 1, 2016.

Results

Nurses’ knowledge of patient falls was positively correlated with their experience with inpatient falls. Furthermore, nurses’ attitudes regarding falls were influenced by their nursing experience and fall prevention education. Attitudes positively correlated with fall-prevention activities, but knowledge did not. Nurses’ attitudes regarding patient falls were correlated with fall-prevention activities.

Conclusion

Hospitals should develop incentive programs to improve nurses’ attitudes which are based on their subjective norms and tailored to each hospital’s specific circumstances to ensure engagement in fall prevention activities. In short, we recommend that consistent, repeated, and custom fall-prevention education should be implemented in small- and medium-sized hospitals to promote engagement in fall-prevention activities. Patient safety activities in small- and medium-sized hospitals can be enhanced by creating an environment that encourages active and self-directed participation in developing fall-prevention strategies using motivation and rewards.

Association of Use of Contract Nurses With Hospitalized Patient Pressure Injuries and Falls

BACKGROUND

Hospital-acquired pressure injuries (HAPIs) and falls are outcomes sensitive to quality of nursing care. Use of contract (traveler) nurses varies among organizations, but there is little research on the effect of contract nurses on nurse-sensitive outcomes.

OBJECTIVES

To explore the relationship between use of contract nurses and two key nurse-sensitive outcomes, HAPIs and falls.

RESEARCH DESIGN

This was a cross-sectional study of unit-level nursing, patient, and hospital factors versus HAPIs and falls from a national nursing data consortium from 2015 to 2016. We used cluster analysis to identify similar units, and compared outcomes between clusters.

SUBJECTS

605 nursing units in 166 hospitals, 3.2 patients per nurse, and 5.3% contract nurses.

MEASURES

Prevalence and incidence of HAPIs and number of falls, adjusted by patient days.

RESULTS

For both prevalence and incidence of HAPIs, there was a statistically significant difference between the five independent cluster groups (p = .012 and p = .001, respectively). The cluster with the highest percentage of nurse travelers (>7%) had the highest HAPI prevalence (0.84%) and incidence (0.055 per 1,000 patient days) despite higher nurse staffing, compared to HAPI prevalence of 0.32% and incidence of 0.017 per 1,000 patient days in the cluster with the lowest percentage of nurse travelers (<2%). We did not identify a consistent relationship between use of contract nurses and falls.

CONCLUSIONS

Use of contract nurses was associated with higher HAPI prevalence and incidence, independent of staffing levels.

CLINICAL RELEVANCE

Our results suggest that institutions should either minimize the use of contract nurses, or engage in extensive training to confirm that contract nurses have understanding of the institutional practices around HAPIs.

A qualitative descriptive inquiry of the influences on nurses' missed care decision-making processes in acute hospital paediatric care

AIM

To explore influences on nurses' missed care decision-making processes in acute hospital paediatric care.

BACKGROUND

Many contemporary studies describe the phenomenon of missed care. It is clear that environment and organizational culture influence the nursing activities; however, what influences their decision-making processes has not been investigated.

METHOD

A descriptive qualitative inquiry was performed using semi-structured interviews with paediatric nurses (n = 20) from one Italian paediatric hospital.

FINDINGS

Thematic analysis revealed four themes: nurses' value system; hospital logistics, structures and resources; prioritization processes; and the informal caregiver's role.

CONCLUSION

This paper offers insights into the various factors involved in nurses' decision-making process when contemplating missed care that will be of use to managers when planning care or addressing missed care in the paediatric clinical setting.

IMPLICATIONS FOR NURSING MANAGEMENT

Knowledge and awareness of missed care in children's nursing needs greater exploration, especially in relation to what influences nurses' decision-making choices around missed care. Overall, a greater understanding of this will help managers to manage situations effectively and ethically so that missed care does not impact on outcomes for children in health care.