Patient falls and pressure ulcers are designated as """"""""nursing-sensitive quality indicators"""""""" by national groups such as the American Nurses Association and the National Quality Forum. Yet research linking the occurrence of falls and pressure ulcers to differences in nurse staffing has yielded equivocal findings. Unreliable measurement of adverse events and inadequate measures of nurse staffing could account for the inconclusive findings. Prior studies have analyzed these effects at hospital and nursing unit levels, but never simultaneously. Differences in the nursing practice environment may moderate the link between staffing and adverse events, although this has not been tested. The proposed study builds on evidence developed by this research team that nurse staffing and the practice environment influence patient outcomes. This study advances our understanding of the relationship between staffing and patient adverse events by 1) calculating adverse events using secondary data from observational prevalence studies and incident reports, 2) using a comprehensive set of nurse staffing measures that account for qualitative as well as quantitative differences among RNs, 3) examining these relationships at both the nursing unit and hospital levels, and 4) exploring the influence of a formally-recognized favorable nursing practice environment on these relationships. Multi-level models will be used to predict the effects of staffing on rate of falls at the nursing unit level and pressure ulcers at both the patient and the nursing unit levels using data from 4,300 nursing units in 650 community hospitals in the ANA-sponsored National Database of Nursing Quality Indicators. American Nurses Credentialing Center Magnet Designation status will be used to differentiate the nursing practice environment across hospitals and explored as a hospital-level factor moderating the associations between staffing and outcomes. This study will strengthen the evidence base on how nurse staffing patterns and practice environments support the quality and safety of patient care.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
5R01NR009068-02
Application #
7099626
Study Section
Nursing Science: Adults and Older Adults Study Section (NSAA)
Program Officer
Huss, Karen
Project Start
2005-08-01
Project End
2008-01-30
Budget Start
2006-08-01
Budget End
2007-07-31
Support Year
2
Fiscal Year
2006
Total Cost
$288,878
Indirect Cost
Name
University of Pennsylvania
Department
Type
Schools of Nursing
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Lake, Eileen T; Shang, Jingjing; Klaus, Susan et al. (2010) Patient falls: Association with hospital Magnet status and nursing unit staffing. Res Nurs Health 33:413-25
Patrician, Patricia A; Shang, Jingjing; Lake, Eileen T (2010) Organizational determinants of work outcomes and quality care ratings among Army Medical Department registered nurses. Res Nurs Health 33:99-110
Lake, Eileen T (2007) The nursing practice environment: measurement and evidence. Med Care Res Rev 64:104S-22S
Lake, Eileen T; Cheung, Robyn B (2006) Are patient falls and pressure ulcers sensitive to nurse staffing? West J Nurs Res 28:654-77