Concurrent and Lagged Effects of Registered Nurse Turnover and Staffing on Unit‐Acquired Pressure Ulcers. (30th January 2014)

• Record Type: Journal Article
• Authors: Park, Shin Hye; Boyle, Diane K.; Bergquist‐Beringer, Sandra; Staggs, Vincent S.; Dunton, Nancy E.
• Is Part Of: Health services research. Volume 49:Number 4(2014)
• Page Start: 1205
• Page End: 1225
• Publication Date: 2014-01-30
• Subjects: Medical care -- Periodicals; Medical care -- Evaluation -- Periodicals; Hospital care -- Periodicals; Health services administration -- Periodicals; 362
• DOI: 10.1111/1475-6773.12158
• Languages: English
• ISSNs: 0017-9124

Abstract

<abstract abstract-type="main" id="hesr12158-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="hesr12158-sec-0001" sec-type="section"> <title>Objective</title> <p>We examined the concurrent and lagged effects of registered nurse (RN) turnover on unit‐acquired pressure ulcer rates and whether RN staffing mediated the effects.</p> </sec> <sec id="hesr12158-sec-0002" sec-type="section"> <title>Data Sources/Setting</title> <p>Quarterly unit‐level data were obtained from the National Database of Nursing Quality Indicators for 2008 to 2010. A total of 10, 935 unit‐quarter observations (2, 294 units, 465 hospitals) were analyzed.</p> </sec> <sec id="hesr12158-sec-0003" sec-type="section"> <title>Methods</title> <p>This longitudinal study used multilevel regressions and tested time‐lagged effects of study variables on outcomes.</p> </sec> <sec id="hesr12158-sec-0004" sec-type="section"> <title>Findings</title> <p>The lagged effect of RN turnover on unit‐acquired pressure ulcers was significant, while there was no concurrent effect. For every 10 percentage‐point increase in RN turnover in a quarter, the odds of a patient having a pressure ulcer increased by 4 percent in the next quarter. Higher RN turnover in a quarter was associated with lower RN staffing in the current and subsequent quarters. Higher RN staffing was associated with lower pressure ulcer rates, but it did not mediate the relationship between turnover and pressure ulcers.</p> </sec> <sec id="hesr12158-sec-0005" sec-type="section"> <title>Conclusions</title> <p>We suggest that RN turnover is an important factor that affects pressure ulcer rates and RN staffing needed for high‐quality patient care. Given the high RN turnover rates, hospital and nursing administrators should prepare for its negative effect on patient outcomes.</p> </sec> </abstract>