Academic journal article Online Journal of Issues in Nursing

The Relationship of Nursing Workforce Characteristics to Patient Outcomes

Academic journal article Online Journal of Issues in Nursing

The Relationship of Nursing Workforce Characteristics to Patient Outcomes

Article excerpt

Abstract

Three reports from the Institute of Medicine found that errors in hospital care were more common than previously thought; that health care delivery should be reorganized to improve the quality of care; and that, operationally, nurses have a critical role in securing patient safety. Now the contribution of nursing to the reduction of adverse events must be established empirically, so that nursing-sensitive indicators can be incorporated in such health care-improvement strategies as public reporting of hospital quality and performance-based payment systems. This article reviews what is known from previous nursing outcomes research and identifies gaps in the current state of knowledge. It then describes the contribution to research that can be made through the National Database of Nursing Quality Indicators TM (NDNQI®). Next it reports an NDNQI study that found three nursing workforce characteristics to be related significantly to patient outcomes: total nursing hours per patient day, percentage of hours supplied by RNs, and years of experience in nursing, and concludes with a discussion of the implications of these findings for both for nursing administrators and outcomes-based, quality-improvement initiatives.

Citation: Dunton, N., Gajewski, B., Klaus, S., Pierson, B., (September 30, 2007) "The Relationship of Nursing Workforce Characteristics to Patient Outcomes" OJIN: The Online Journal of Issues in Nursing. Vol. 12 No. 3, Manuscript 3. Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/NursingWorkforceCharacteristics.aspx

Key words: fall rate, health care quality, National Database of Nursing Quality Indicators, (NDNQI), nurse experience, nurse staffing, nursing hours, nursing outcomes, nursing-sensitive indicators, nursing workforce, outcome indicators, pay for performance, performance measures, pressure ulcer rate, skill mix, staffing ratios, value-based payment

The release of two reports from the National Institute of Medicine (1999, 2001) focused the nation's attention on the quality of hospital care and the problem of patient safety. These reports found that errors in hospital care were more common than the public had realized and recommended that health care delivery be reorganized to improve the quality of care. In response to the reports, federal and state governments, insurers, regulators, and health care providers are implementing health care-indicator initiatives to promote improvement in health care quality. Public reporting of quality indicators can help guide consumer choice among hospitals and assist businesses and insurers make purchasing and reimbursement decisions. However, most of the indicators included in public reporting initiatives reflect medical processes. Moreover, quality incentive programs for hospitals, generally known as pay-for-performance or value-based purchasing, are focused exclusively on physician-driven activities and medical outcomes (Centers for Medicare & Medicaid Services [CMS], 2007a). Under these programs, hospitals demonstrating good outcomes and efficient health care practices receive incentives, such as higher reimbursement rates, than hospitals with lesser performance. Recently, CMS announced that it will not provide reimbursement for care related to hospital-acquired complications (Centers for Medicare & Medicaid Services, 2007b).

A third report from the Institute of Medicine (2004) stated that, operationally, nurses have a critical role in securing patient safety. With 2.4 million practicing registered nurses (RNs) in the United States, nursing is the largest of the health care professions. Although nurse staffing and indicators of nursing-sensitive outcomes (patient outcomes that vary in response to changes in nurse staffing) are included in some public reporting initiatives, nursing indicators represent a small proportion of the pool of quality indicators. …

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