1. Twigg, D et al (2010)
The impact of nurses on patient
morbidity and mortality - the need for a policy change in response to the
nursing shortage
Australian Health Review, 2010, 34, p
312-316
Outline - this
extensive article reviews research
and literature relating to registered nurse patient ratios, the impact of
increasing or decreasing the ratios and the considerations this information
presents for policy makers. Results
strongly suggest improved ratios lead to improved patient outcomes, that
increased length of stay occurred with decreased staffing ratios (and therefore
higher costs) and higher staffing with registered nurses was associated with
lower rates of unit specific complications. The analysis also examines the lack
of an appropriate policy response. It argues that patient safety is also the
responsibility of policy makers, health departments, Chief Executives and Nurse
Leaders and therefore they must make sure there are adequate numbers of
registered nurses to help prevent adverse events.
2. Twigg et al (2011)
The Impact of the nursing hours per
patient day (NHPPD) staffing method on patient outcomes: a retrospective
analysis of patient and staffing data
International
Journal of Nursing Studies 48 (2011) 540-548
http://tiny.cc/j11rv
Outline - This article
presents the results of a study into the impact of introducing Nursing Hours Per
Patient Day (NHPPD) in West Australian public hospitals - a retrospective analysis
of improvements to nurse-sensitive outcomes including prevention of central
nervous system complications, wound infections, pulmonary failure, urinary
tract infection, pressure ulcer, pneumonia, deep vein thrombosis, ulcer/gastritis/upper
gastrointestinal bleed, sepsis, physiologic/metabolic derangement, shock/cardiac
arrest, mortality, failure to rescue and length of stay. The study also found
increases in nursing hours improved patient outcomes and concludes that the
introduction of arbitrated minimum staffing levels may improve patient outcomes
over time.
3. Aiken, LH PhD et al (2002)
Hospital nurse staffing and patient
mortality, nurse burnout, and job dissatisfaction
Journal of the American Medical
Association 22 October 2002
http://tiny.cc/j2ae1
Outline
- This
article provides a retrospective research analysis of the relationship between
nurse patient ratios and patient mortality, failure to rescue, and nurse
turnover. Research linked data from 168 Pennsylvania hospitals with nurse
patient ratios of 1:8 and 1:4 finding improvements to ratios lead to reductions
in patient mortality and failure to rescue and improvements to staff retention
rates.
4.
Duffield C and O'Brien-Pallas L. (2002)
The causes and consequences of nursing
shortages: a helicopter view of the research
Australian Health Review [Vol 26
• No 1] 2003
http://tiny.cc/z889x
Outline - This article outlines
issues connected with Australia's
nursing shortage and the associated consequences including an ageing workforce,
lifestyle choices, patient acuity and public hospital pressures, skill mix,
quality of work life and workload and the impact of changing organisational and
management practices.
5. Tourangeau AE, Doran DM, McGillis Hall L,
O'Brien-Pallas L, Pringle D, Tu JV, Cranley LA (2006)
Impact of hospital nursing care on
30-day mortality for acute medical patients
Journal of Advanced Nursing; 57(1): 32-44
http://tiny.cc/aev2i
Outline - This retrospective
study examines the impact of nursing care on 30-day mortality rates for medical
patients in the US. Study concluded that the proportion of registered nurses
and their level of qualifications, amongst other initiatives, contributed to a
reduction in preventable patient death.
6. Needleman J, Buerhaus P, Mattke S, Stewart M, Zelevinsky K. 2002
Nurse-staffing levels and the quality of
care in hospitals
New England Journal of Medicine;
346(22): 1715-22
http://tiny.cc/vdg3u
Outline - this retrospective
research analyses the impact of nursing hours on patient outcomes. Study
concluded that a higher proportion of hours of nursing care provided by RNs are
associated with better care for hospitalised patients and lower rates of
adverse events. This study also found increasing the numbers of unregistered
nursing hours did not lead to improvements in care or lower rates of adverse
events.
7. Duffield C, Roche M, O'Brien-Pallas L, Diers D,
Aisbett C, King M, Aisbett K, Hall J. 2007
Glueing it together: nurses, their work environment
and patient safety
Centre for Health Services Management University of Technology, Sydney
http://tiny.cc/mxiu9
Outline - This research
report was commissioned by the NSW Department of Health to assist with the
development of nursing workforce policy. The key findings include, but are not limited to:
-
Patient acuity and complexity has risen
-
There is considerable movement of patients on and off nursing wards;
this increases the work burden for nurses.
-
Skill mix (the proportion of RNs, as defined in previous research overseas)
is more critical to patient outcomes than hours of nursing provided.
8. Duffield C, Roche M, O'Brien-Pallas L, Diers D, Aisbett
C, Aisbett K, Homer C. (2009)
Nursing workload and staffing: impact on
patients and staff
Centre for Health Services Management, University of Technology, Sydney
http://tiny.cc/z79si
Outline - This study,
commissioned by ACT Health, analyses nursing workforce influences including the
impact of skill mix, patient acuity and staffing levels on job satisfaction,
patient outcomes & error rates. With reference to outcomes potentially sensitive to nursing it was found, among other
things, that increasing RN hours by 10% decreased adverse event rates by 11% to
45%.
9.Rafferty AM, Clarke SP, Coles J, Ball J, James P,
McKee M, Aiken LH
Outcomes of variation in hospital nurse
staffing in English hospitals: cross-sectional analysis of survey data and
discharge records
International Journal of Nursing Studies 2007; 44(2): 175-82
http://tiny.cc/4pvwt
Outline - This research
article examines the effects of hospital-wide nurse staffing levels (nurse
patient ratios) on patient mortality, failure to rescue (mortality risk for
patients with complicated stays) and nurse job dissatisfaction, burnout and nurse-rated
quality of care in the UK. The results show that patients and nurses in the
hospitals with the highest nurse patient ratios had consistently better
outcomes than those in hospitals with less nurses. Patients in the hospitals
with less nurses had 26% higher mortality and the nurses in those hospitals
were approximately twice as likely to be dissatisfied with their jobs, to show
high burnout levels, and to report low or deteriorating quality of care on
their wards and hospitals.
10. Linda
H. Aiken, et al 2003
Educational Levels of Hospital Nurses and Surgical Patient Mortality
Journal of the American Medical Association, September 24, 2003-Vol 290,
No. 12 p. 1617- 1623
http://jama.ama-assn.org/content/290/12/1617.full.pdf
Outline - Study covering 168 Pennsylvania hospitals examining
the relationship between registered nurse education and patient outcomes. The
article concludes that hospitals with higher proportions of nurses educated at
the baccalaureate level or higher, surgical patients experienced lower
mortality and failure to rescue rates.
