Associations of 4 Nurse Staffing Practices With Hospital Mortality. Issue 10 (October 2020)

• Record Type: Journal Article
• Authors: Rochefort, Christian M.; Beauchamp, Marie-Eve; Audet, Li-Anne; Abrahamowicz, Michal; Bourgault, Patricia
• Is Part Of: Medical care. Volume 58:Issue 10(2020)
• Publication Date: 2020-10
• Subjects: nurse staffing -- nursing skill mix -- nurse education -- nurse experience -- mortality -- acute care hospitals -- longitudinal study; Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000001397
• Languages: English
• ISSNs: 0025-7079

Abstract

Abstract : Background: Cross-sectional studies of hospital-level administrative data have suggested that 4 nurse staffing practices—using adequate staffing levels, higher proportions of registered nurses (RNs) (skill mix), and more educated and experienced RNs—are each associated with reduced hospital mortality. To increase the validity of this evidence, patient-level longitudinal studies assessing the simultaneous associations of these staffing practices with mortality are required. Methods: A dynamic cohort of 146, 349 adult medical, surgical, and intensive care patients admitted to a Canadian University Health Center was followed for 7 years (2010–2017). We used a multivariable Cox proportional hazards model to estimate the associations between patients' time-varying cumulative exposure to measures of RN understaffing, skill mix, education, and experience, each relative to nursing unit and shift means, and the hazard of in-hospital mortality, while adjusting for patient and nursing unit characteristics, and modeling the current nursing unit of hospitalization as a random effect. Results: Overall, 4854 in-hospital deaths occurred during 3, 478, 603 patient-shifts of follow-up (13.95 deaths/10, 000 patient-shifts). In multivariable analyses, every 5% increase in the cumulative proportion of understaffed shifts was associated with a 1.0% increase in mortality (hazard ratio: 1.010; 95% confidence interval: 1.002–1.017; P =0.009). Moreover, every 5% increase in the cumulative proportion of worked hours by baccalaureate-prepared RNs was associated with a 2.0% reduction of mortality (hazard ratio: 0.980; 95% confidence interval: 0.965–0.995, P =0.008). RN experience and skill mix were not significantly associated with mortality. Conclusion: Reducing the frequency of understaffed shifts and increasing the proportion of baccalaureate-prepared RNs are associated with reduced hospital mortality. Abstract : Supplemental Digital Content is available in the text.