My long term goal is to ensure Hospital Administrators have readily accessible, meaningful data to support cost effective staffing decisions that ensure the best outcomes for patients. Healthcare costs have escalated, largely due to negative care-associated outcomes such as never events (e.g., pressure ulcers, falls). Historically nursing services were reorganized to counteract these costs. Reorganization efforts included use of lower nurse-to-patient ratios, decreasing RN care hours, and replacing RNs with less educated assistive personnel. This reorganization has resulted in a care delivery system that is increasingly fragmented by varied shift lengths, nurse schedules, and diverse care providers leading to a loss of care continuity and compromising one of healthcare's most important functions, protecting patients from harm when they receive hospital care. Researchers have examined several RN staffing variables integral to reorganization efforts such as nursing education, experience, or nurse-to-patient ratios but failed to demonstrate convincing evidence to explain how changes in nurse staffing may influence care associated outcomes such as never events. An examination of nurse continuity may provide the missing link to demonstrate that connection. The purpose of this study is to examine the relationship between nurse continuity and hospital-acquired pressure ulcers. For this study nurse continuity is defined as a consistent nurse caregiver who provides care to the patient during the hospitalization. By virtue of the coordinated, seamless care resulting from nurse continuity, the central study hypothesis is that when nurse continuity is present there will be fewer pressure ulcers than when nurse continuity is absent. The nurse staffing variable number of shifts cared for by the same/single RN is used to measure nurse continuity. The innovative Hands on Automated Nursing Data System (HANDS) with its standardized nursing data will allow the examination of the influence of nurse continuity because a variety of nurse staffing measures, including nurse continuity, are linked with an individual patient's predictors and pressure ulcer outcomes across the hospitalization.
The specific aims of this study are:
Aim 1 To determine which patient predictors in the HANDS database (Age, Nutrition, Mobility, Hydration, Continence) influence pressure ulcer development for the purpose of creating an analytic dataset;
and Aim 2 Using the analytic dataset and controlling for the patient predictors, to determine the influence of nurse continuity (number of shifts cared for by the same/single RN) and nurse staffing variables (worked hours per patient day, nurse-to-patient ratio, RN experience, RN education, shift length [8 versus 12 hours], and number of shifts cared for by very part time [.3 FTE or less] versus part/full time staf [.5 - 1.0 FTE] on the presence of hospital-acquired pressure ulcers. The study findings are urgently needed because future nursing services reorganization could adversely affect patient safety and care, unless health services scientists demonstrate a clear link between nurse continuity and improved patient outcomes.

Public Health Relevance

The purpose of this study is to examine the relationship between nurse continuity and hospital-acquired pressure ulcers. The goal of this study is to see if patients who have the same nurse taking care of them while in the hospital develop fewer bed sores. The study leader will look at nursing care plans from patients'charts to answer this question. The study leader will look at the care plans and see how many pressure sores formed in patients who had the same nurse more than one time during the hospital stay versus how many pressure sores developed in patients who had a different nurse every day while in the hospital.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Dissertation Award (R36)
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HSR Health Care Research Training SS (HCRT)
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Willis, Tamara
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University of Illinois at Chicago
Schools of Nursing
United States
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