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Associations of 4 Nurse Staffing Practices With Hospital Mortality.

Authors
  • Rochefort, Christian M1, 2, 3
  • Beauchamp, Marie-Eve4
  • Audet, Li-Anne1, 2, 3
  • Abrahamowicz, Michal4, 5
  • Bourgault, Patricia1, 3
  • 1 School of Nursing, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke.
  • 2 Research Center Charles-Le Moyne-Saguenay-Lac-Saint-Jean on Health Innovations.
  • 3 Research Center of the Sherbrooke University Hospital Center.
  • 4 Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre.
  • 5 Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada. , (Canada)
Type
Published Article
Journal
Medical care
Publication Date
Oct 01, 2020
Volume
58
Issue
10
Pages
912–918
Identifiers
DOI: 10.1097/MLR.0000000000001397
PMID: 32833938
Source
Medline
Language
English
License
Unknown

Abstract

Cross-sectional studies of hospital-level administrative data have suggested that 4 nurse staffing practices-using adequate staffing levels, higher proportions of registered nurses (RNs) (skill mix), and more educated and experienced RNs-are each associated with reduced hospital mortality. To increase the validity of this evidence, patient-level longitudinal studies assessing the simultaneous associations of these staffing practices with mortality are required. A dynamic cohort of 146,349 adult medical, surgical, and intensive care patients admitted to a Canadian University Health Center was followed for 7 years (2010-2017). We used a multivariable Cox proportional hazards model to estimate the associations between patients' time-varying cumulative exposure to measures of RN understaffing, skill mix, education, and experience, each relative to nursing unit and shift means, and the hazard of in-hospital mortality, while adjusting for patient and nursing unit characteristics, and modeling the current nursing unit of hospitalization as a random effect. Overall, 4854 in-hospital deaths occurred during 3,478,603 patient-shifts of follow-up (13.95 deaths/10,000 patient-shifts). In multivariable analyses, every 5% increase in the cumulative proportion of understaffed shifts was associated with a 1.0% increase in mortality (hazard ratio: 1.010; 95% confidence interval: 1.002-1.017; P=0.009). Moreover, every 5% increase in the cumulative proportion of worked hours by baccalaureate-prepared RNs was associated with a 2.0% reduction of mortality (hazard ratio: 0.980; 95% confidence interval: 0.965-0.995, P=0.008). RN experience and skill mix were not significantly associated with mortality. Reducing the frequency of understaffed shifts and increasing the proportion of baccalaureate-prepared RNs are associated with reduced hospital mortality.

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