: Nurse staffing levels in acute care hospitals is associated with patient safety outcomes. Focusing solely on staffing levels ignores critical characteristics of the nursing workforce. These characteristics are components of human capital, which include the role of tenure, prior experience, education of registered nurses (RNs), and the impact of contract nurses on patient care. Experienced interdisciplinary researchers on this mentoring team are concurrently examining the variables of human capital and their effects on patient care. Furthermore, hospitals provide 24-hour 7-day a week service. However, little is known about how best to staff nursing care units on off-shifts (i.e., nights, weekends, and holidays). This dissertation research project will use a unique, longitudinal, unit-specific dataset created by the mentoring team and examine the effects of staffing and human capital characteristics of RNs working off-shifts on nursing-sensitive patient outcomes.
The specific aim i s: Controlling for confounding variables, examine the relationships between the nursing inputs (i.e., staffing levels, general human capital, facility-and unit-specific human capital, and team-specific human capital) on off-shifts (i.e., nights, weekends, and holidays) and nursing-sensitive patient outcomes in the VA acute care settings. Nurses working the off-shifts will be identified using the shift differential for night, weekend, or holiday shift indicators that are available in the Veterans Association (VA) payroll data. Staffing and human capital variables will be constructed for the off-shifts, (all those for which a shift differential is paid). The primary analysis will be based on using the aggregate off-shift variables. Data will be analyzed using a fixed-effects framework to control for unit-specific effects that might otherwise affect the parameter estimates. This analysis allows to more accurately measuring the impact of nursing inputs on patient outcomes. Dissemination of results through presentations at national quality meetings and publications will allow administrators, clinicians, and health service researchers to learn more about how best to deliver care on off-shifts. These results will serve as a foundation for future interdisciplinary research.
Guided by the theory of human capital, this dissertation research project examines the effect of off-shifts (i.e., nights, weekends, and holidays) on nursing-sensitive patient outcomes. Because hospital care is 24 hour/7 day-a-week service, it is important to understand the impact of the delivery of care on off-shifts and patient safety in acute care hospitals. The study builds on concurrent interdisciplinary research that examines nursing sensitive patient outcomes with the goal of promoting patient safety.
| de Cordova, Pamela B; Phibbs, Ciaran S; Schmitt, Susan K et al. (2014) Night and day in the VA: associations between night shift staffing, nurse workforce characteristics, and length of stay. Res Nurs Health 37:90-7 |
| de Cordova, Pamela B; Phibbs, Ciaran S; Stone, Patricia W (2013) Perceptions and observations of off-shift nursing. J Nurs Manag 21:283-92 |
| de Cordova, Pamela B; Phibbs, Ciaran S; Bartel, Ann P et al. (2012) Twenty-four/seven: a mixed-method systematic review of the off-shift literature. J Adv Nurs 68:1454-68 |
