Ratios and more RNs boost patient outcomes

Cover story - ratios and more RNs boost patient outcomes - _MG_5003There have been numerous studies that show the benefit of higher nurse staffing and a higher proportion of RNs in the skill mix.

Urinary tract infection (UTI) – A study of 235 Californian hospitals by Esparza (2012) found that with increased nursing hours per patient day (NHPPD) the odds of UTI decreased 1.013 times, and as RN proportion of skill mix increased, odds of UTI decreased by 4.25 times.

Pressure ulcers – Australian research by Duffield (2011) using data from 80 units in 19 NSW hospitals found increased RN/CNS (Clinical Nurse Specialist) staff was associated with significantly decreased rates of pressure ulcers and increased RN/CNS staff as a proportion of nursing hours was associated with significantly decreased rates of pressure ulcers.

Pneumonia – A US meta-study by Kane (2007) reviewed data from 94 studies conducted between 1990-2006 and found that every additional patient per RN per shift was associated with a 7% increase in relative risk of hospital-acquired pneumonia.

Upper gastrointestinal bleeding – A retrospective study of three adult tertiary hospitals in Perth by Twigg (2010) utilised 236,454 patient records and 150,925 nurse staffing records and found that increased NHPPD lead to a 37% decrease in ulcer/gastritis/upper GI bleeds.

Failure to rescue – An analysis of data by Aitken and colleagues (2013) from 10,184 nurses and 232,342 patients in 168 hospitals in the US found that each additional patient per nurse was associated with a 7% increase in failure to rescue in surgical patients.

Hospital mortality rates – Twigg’s Perth study also found that increased NHPPD patient day was significantly associated with a 25-26% decrease in mortality rates.