NURSE STAFFING AND PATIENT OUTCOMES

Background: Nursing studies have shown that nursing care delivery chan ges affect staff and organizational outcomes, but the effects on clien t outcomes have not been studied sufficiently. Objective: To describe, at the level of the nursing care unit, the relationships among total hours of nursing care, registered nurse (RN) skill mix, and adverse pa tient outcomes. Methods: The adverse outcomes included unit rates of m edication errors, patient falls, skin breakdown,patient and family com plaints, infections, and deaths. The correlations among staffing varia bles and outcome variables were determined, and multivariate analyses, controlling for patient acuity, were completed.Results: Units with hi gher average patient acuity had lower rates of medication errors and p atient falls but higher rates of the other adverse outcomes. With aver age patient acuity on the unit controlled, the proportion of hours of care delivered by RNs was inversely related to the unit rates of medic ation errors, decubiti, and patient complaints. Total hours of care fr om all nursing personnel were associated directly with the rates of de cubiti, complaints, and mortality. An unexpected finding was that the relationship between RN proportion of care was curvilinear; as the RN proportion increased, rates of adverse outcomes decreased up to 87.5%. Above that level, as RN proportion increased, the adverse outcome rat es also increased. Conclusions: The higher the RN skill mix, the lower the incidence of adverse occurrences on inpatient care units.