The Association between Nurse Staffing and Selected Patient Outcomes in Hospitals in Central Thailand
Keywords:
nurse staffing, nosocomial infection, length of stay, pressure ulcer, readmissionAbstract
Objective: This study aimed to examine the association between nurse staffing and patient outcomes in hospitals in central Thailand.
Methods: This descriptive correlational study was conducted in 74 adult inpatient wards within tertiary hospitals in central Thailand. Data were collected from hospital databases. Spearman rank correlation was used to analyze the relationships between nurse staffing variables and selected patient outcome variables.
Results: Statistically significant correlations were observed:
- A positive correlation was found between patient severity and both nursing hours per patient day (NHPPD) (r = 0.384, p < .01) and the percentage of registered nurses (%RN)
(r = 0.331, p < .01).
- Mortality rate and pressure ulcer incidence showed positive correlations with NHPPD
(r = 0.426, p < .01; r = 0.328, p < .01, respectively).
- Readmission rate had a negative correlation with %RN (r = -0.263, p < .05).
- Nosocomial infections, including ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CAUTI), exhibited positive correlations with lower NHPPD (r = 0.275, p < .05; r = 0.369, p < .01, respectively).
The findings highlight significant relationships between nurse staffing and various patient outcomes, underscoring the importance of adequate staffing levels and the proportion of registered nurses in improving patient safety and care quality in tertiary hospitals.
References
Aiken, L., Ceron, C., Simonetti, M., Lake, E., Galiano, A., & Garbarini, A., et al. (2018). Hospital nurse staffing and patient outcomes. Revista Medica Clinica Las Condes, 29(3), 322-327.
Aiken, L., Clarke, S., Sloane, D., Sochalski, J., Silber, J. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job satisfaction. JAMA, 288, 1987-1993.
American Nurses Association (ANA). (1996). Nursing quality indicators: Definitions and implications: Patient safety nursing quality. Washington, DC: Author.
American Nurses Association (ANA). (2007). National Databased for Nursing Quality Indicators (NDNQI). Retrieved from htpps://www.ncvhs.gov/wp-content/uploads/2014/05/070619p8.pdf.
Chitpakdee, B., Kunaviktikul, W., Srisaphan, W., & Akkadechanunt, T. (2008). Nurse staffing and adverse patient outcomes. Chiang Mai University Journal of Natural Sciences, 7(1), 59-71.
Cho, E., Chin, D. L., Kim, S., Kong, O. (2016). The relationships of nurse staffing level and work environment with patient adverse events. Journal of Nursing Scholarship, 48(1),74-82. https://doi.org/10.1111/jnu.12183
Cho, E., Sloane, D. M., Kim, E., Kim, S., Choi, M., Yoo, I. Y., et al. (2015). Effects of nurse staffing, work environments, and education on patient mortality: An observational study. International Journal of Nursing Studies, 52(2), 535-542.
Choi, J., & Staggs, V. (2014). Comparability of nurse staffing measures in examining the relationship between RN staffing and unit-acquired pressure ulcers: A unit-level descriptive, correlational study. International Journal of Nursing Studies, 51(10), 1344-1352. https://doi.org/10.1016/ j.ijnurstu.2014.02.011
Dall’Ora, C., Saville, C., Rubbo, B., Turner, L., Jones, J., & Griffiths, P. (2022). Nurse staffing levels and patient outcomes: A systemic review of longitudinal studies. International Journal of Nursing Studies, 134. https://doi.org/10.1016/j.ijnurstu. 2022.104311
Donabedian, A. (1992). The role of outcomes in quality assessment and assurance. Quality Review Bulletin, 18(11), 356-360. https://doi.org/10.1016/s0097-5990 (16)30560-7
Donabedian, A. (1998). The quality of care: How can it be assessed? JAMA, 260(12), 1743-1748. https://doi.org/10.1001/jama.260. 12.1743
Giuliano, K., Danesh, V., & Funk, M. (2016). The relationship between nurse staffing and 30-day readmission for adults with heart failure. Journal of Nursing Administration, 46(1), 25-29. https://doi.org/10.1097/NNA.0000000000000289
He, J., Staggs, V. S., Berquist-Beringer, S., & Dunton, N. (2016). Nurse staffing and patients outcomes:
A longitudinal study on trend and seasonality. BMC Nursing, 15, 60-70.
Khamsribut, P. (2010). Situation analysis of nurse staffing in pediatric intensive care unit in a university hospital. (Master Thesis, Graduate School, Mahidol University, Bangkok).
Kouatly, I. A., Nassar, N., Nizam, M., & Badr, K. L. (2018). Evidence on nurse staffing ratios and patient outcomes in a low-income country: Implications for future research and practice. Worldviews on Evidence-Based Nursing, 15(5), 353-360.
Lasater, K. B., Aiken, L. H., Sloane, D., French, R., Martin, B., Alexander, M., et al. (2021). Patient outcomes and cost savings associated with hospital safe nurse staffing legislation: An observational study. BMJ Open, 11(12). https://doi.org/10.1136/bmjopen-2021-052899
Morioka, N., Okubo, S., Moriwaki, M., & Hayashida, K. (2022). Evidence of the association between nurse staffing levels and patient and nurse’s outcomes in acute care hospitals across Japan: A scoping review. Healthcare, 10(6), 1052-1064. https://doi.org/10.3390/ healthcare10061052
Pongpattaraporn, R. (2010). Association between nurse staffing and pressure ulcer. (Master Thesis in Nursing Administration, Sukhothai Thammathirat Open University).
(in Thai)
Sawaengdee, K., Jaichuen, W., & Daecha, N. (2019). Manpower reform plan and health mission of the Ministry of Public Health. Nonthaburi: Suetawan. (in Thai)
Sportsman, S. (2023). Staffing & scheduling. In P. S. Yoder-Wise & S. Sportsman (Eds.), Leading and managing in nursing (8th ed., pp. 244-267). St. Louis: Elsevier.
Staggs, V. S., & Dunton, N. (2014). Associations between rates of unassisted inpatient falls and levels of registered and non-registered nurse staffing. International Journal for Quality in Health Care, 26(1), 87-92. https://doi.org/10.1093/ intqhc/mzt080
Sujijantararat, R. (2019). Nurse staffing and scheduling. In R. Sukadecha & R. Sujijantararat (Eds.), Nursing administration (pp. 139-162). Nakhon Ratchasima: Somboon Publishing. (in Thai)
Sujijantararat, R., Booth, Z. R., & Davis, L. L. (2006). Nosocomial urinary tract infection: Nursing sensitive quality indicator in a Thai hospital. Journal of Nursing Care Quality, 20(2), 134-139.
Sujijantararat, R., Chansiri, K., Sukadaecha, R., Sumdangrith, P., & Wipak, C. (2023). The relationship between nurse staffing and nosocomial infection outcome in Central Thailand hospitals. Princess Naradhiwas University Journal, 15(2), 118-135. (in Thai)
Sujijantararat, R., Thepna, A., & Hankunasets, W. (2018). Nurse staffing and nosocomial infection outcome. Journal of Nursing Siam University, 19(37), 6-21. (in Thai)
Twigg, D. E., Kutzer, Y., Jacob, E., & Seaman, K. (2019). A quantitative systematic review of the association between nurse skill mix and nursing-sensitive patient outcomes in the acute care setting. Journal of Advanced Nursing, 75, 3404-3423. https://doi.org/10.1111/ jan.14194
Van, T., Annis, A. M., Yosef, M., Robinson, C. H., Duffy, S. A., & Li, Y. F., et al. (2020). Nurse staffing and healthcare-associated infections in a national healthcare system that implemented a nurse staffing directive: Multi-level interrupted time series analyses. International Journal of Nursing Studies, 104, 103531. https://doi.org/10.1016/ j.ijnurstu.2020.103531
Yosthong, D. (2019). Nursing shortage and management: Personal level management. Journal of Nursing Siam University, 20(38), 134-143.
(in Thai)
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