Musy, Sarah N; Endrich, Olga; Leichtle, Alexander B; Griffiths, Peter; Nakas, Christos T.; Simon, Michael (2021). The association between nurse staffing and inpatient mortality: A shift-level retrospective longitudinal study. International journal of nursing studies, 120, p. 103950. Elsevier 10.1016/j.ijnurstu.2021.103950
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BACKGROUND
Worldwide, hospitals face pressure to reduce costs. Some respond by working with a reduced number of nurses or less qualified nursing staff.
OBJECTIVE
This study aims at examining the relationship between mortality and patient exposure to shifts with low or high nurse staffing.
METHODS
This longitudinal study used routine shift-, unit-, and patient-level data for three years (2015-2017) from one Swiss university hospital. Data from 55 units, 79,893 adult inpatients and 3646 nurses (2670 registered nurses, 438 licensed practical nurses, and 538 unlicensed and administrative personnel) were analyzed. After developing a staffing model to identify high- and low-staffed shifts, we fitted logistic regression models to explore associations between nurse staffing and mortality.
RESULTS
Exposure to shifts with high levels of registered nurses had lower odds of mortality by 8.7% [odds ratio 0.91 95% CI 0.89-0.93]. Conversely, low staffing was associated with higher odds of mortality by 10% [odds ratio 1.10 95% CI 1.07-1.13]. The associations between mortality and staffing by other groups was less clear. For example, both high and low staffing of unlicensed and administrative personnel were associated with higher mortality, respectively 1.03 [95% CI 1.01-1.04] and 1.04 [95% CI 1.03-1.06].
DISCUSSION AND IMPLICATIONS
This patient-level longitudinal study suggests a relationship between registered nurses staffing levels and mortality. Higher levels of registered nurses positively impact patient outcome (i.e. lower odds of mortality) and lower levels negatively (i.e. higher odds of mortality). Contributions of the three other groups to patient safety is unclear from these results. Therefore, substitution of either group for registered nurses is not recommended.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Institute of Clinical Chemistry |
UniBE Contributor: |
Endrich, Olga, Leichtle, Alexander Benedikt (B), Nakas, Christos T. |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1873-491X |
Publisher: |
Elsevier |
Language: |
English |
Submitter: |
Karin Balmer |
Date Deposited: |
16 Nov 2021 11:59 |
Last Modified: |
02 Mar 2023 23:35 |
Publisher DOI: |
10.1016/j.ijnurstu.2021.103950 |
PubMed ID: |
34087527 |
Uncontrolled Keywords: |
Electronic health records Mortality Nurses Patient safety Personnel staffing and scheduling Routinely collected health data |
BORIS DOI: |
10.48350/160530 |
URI: |
https://boris.unibe.ch/id/eprint/160530 |
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