Low Nurse and Support Staffing Tied to Higher Inpatient Mortality
WEDNESDAY, Aug. 28, 2019 -- Low levels of nurse and nursing support staffing are associated with increased inpatient mortality, according to a study published online Aug. 7 in BMJ Quality & Safety.
Jack Needleman, Ph.D., from the Fielding School of Public Health at the University of California in Los Angeles, and colleagues examined the association of inpatient mortality with patients' cumulative exposure to shifts with low registered nurse (RN) staffing, low nursing support staffing, and high patient turnover. The analysis included data from a three-campus U.S. academic medical center (2007 to 2012). Low staffing was defined as staffing below 75 percent of annual median unit staffing for each staff category and shift type, while high patient turnover per day was defined as admissions, discharges, and transfers one standard deviation above unit annual daily averages.
The researchers found that the hazard ratio (HR) of inpatient mortality was 1.027 (95 percent confidence interval [CI], 1.002 to 1.053; P = 0.035) for exposure to shifts with low RN staffing only, 1.030 (95 percent CI, 1.017 to 1.042; P < 0.001) for shifts with low nursing support only, and 1.025 (95 percent CI, 1.008 to 1.043; P = 0.004) for shifts with both low RN and nursing support staffing. For cumulative exposure during the second to fifth days of an admission, the HR of inpatient mortality was 1.048 (95 percent CI, 0.998 to 1.100; P = 0.061) for exposure to shifts with low RN staffing only, 1.032 (95 percent CI, 1.008 to 1.057; P = 0.01) for shifts with low nursing support only, and 1.136 (95 percent CI, 1.089 to 1.185; P < 0.001) for shifts with both low RN and nursing support staffing. There was no association between high patient turnover and mortality.
"The results should encourage hospital leadership to assure both adequate RN and nursing support staffing," the authors write.
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Posted: August 2019