The association between nurse staffing and hospital outcomes in injured patients

The enormous fiscal pressures facing trauma centers may lead trauma centers to reduce nurse staffing and to make increased use of less expensive and less skilled personnel. The impact of nurse staffing and skill mix on trauma outcomes has not been previously reported. The goal of this study was to e...

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Bibliographic Details
Published in:BMC health services research 2012-08, Vol.12 (1), p.247-247, Article 247
Main Authors: Glance, Laurent G, Dick, Andrew W, Osler, Turner M, Mukamel, Dana B, Li, Yue, Stone, Patricia W
Format: Article
Language:English
Subjects:
Adult
Aged
Analysis
Care and treatment
Codes
Comorbidity
Cross infection
Cross Infection - epidemiology
Cross-Sectional Studies
Diagnosis related groups
DRGs
Emergency medical care
Emergency medical services
Female
Hospital Mortality - trends
Hospitals
Humans
Infections
Injuries
Logistic Models
Male
Medical care
Medical care, Cost of
Medical research
Medicine, Experimental
Middle Aged
Mortality
Nosocomial infections
Nurses
Nursing care
Nursing homes
Nursing services
Nursing Staff, Hospital - organization & administration
Nursing Staff, Hospital - supply & distribution
Outcome Assessment (Health Care)
Patient outcomes
Patients
Personnel Staffing and Scheduling
Pneumonia
Practical nurses
Preventive medicine
Quality management
Quality of Health Care
Ratios
Risk factors
Sepsis
Skilled labor
Studies
Supply and demand
Surgeons
Trauma
Trauma care
Trauma Centers
Treatment Outcome
United States
United States - epidemiology
Workforce planning
Wounds and injuries
Wounds and Injuries - mortality
Wounds and Injuries - nursing
Wounds and Injuries - physiopathology
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Summary:The enormous fiscal pressures facing trauma centers may lead trauma centers to reduce nurse staffing and to make increased use of less expensive and less skilled personnel. The impact of nurse staffing and skill mix on trauma outcomes has not been previously reported. The goal of this study was to examine whether nurse staffing levels and nursing skill mix are associated with trauma patient outcomes. We used data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample to perform a cross-sectional study of 70,142 patients admitted to 77 Level I and Level II centers. Logistic regression models were used to examine the association between nurse staffing measures and (1) mortality, (2) healthcare associated infections (HAI), and (3) failure-to-rescue. We controlled for patient risk factors (age, gender, injury severity, mechanism of injury, comorbidities) and hospital structural characteristics (trauma center status - Level I versus Level II, hospital size, ownership, teaching status, technology level, and geographic region). A 1% increase in the ratio of licensed practical nurse (LPN) to total nursing time was associated with a 4% increase in the odds of mortality (adj OR 1.04; 95% CI: 1.02-1.06; p = 0.001) and a 6% increase in the odds of sepsis (adj OR 1.06: 1.03-1.10; p 
ISSN:1472-6963
1472-6963
DOI:10.1186/1472-6963-12-247