Improving nurse staffing measures: Discharge day measurement in adjusted patient days of care

Previous research cannot account for the discrepancy between registered nurse (RN) reports of understaffing and studies showing slight improvement. One reason may be that adjusted patient days of care (APDC) underestimates patient load. Using data from all Pennsylvania acute care general hospitals for the years 1994 through 1997, we found that APDC is underestimated by two hours. After adjusting APDC, we examined the difference in nurse staffing over the period 1991-2000 before and after the adjustment. We found a significant difference between unadjusted and adjusted measures. However, when applied to the changes in nurse staffing between 1991 and 2000, the difference was not enough to account for the discrepancy between reports and data. Other measurement and conceptual problems may exist in terms of patients\u27 increasing acuity levels, patients\u27 declining lengths of stay and the associated greater proportion of nurse time devoted to admission and discharge, and lack of recent data in some empirical studies

Challenges facing the United States of America in implementing universal coverage

In 2010, immediately before the United States of America (USA) implemented key features of the Affordable Care Act (ACA), 18% of its residents younger than 65 years lacked health insurance. In the USA, gaps in health coverage and unhealthy lifestyles contribute to outcomes that often compare unfavourably with those observed in other high-income countries. By March 2014, the ACA had substantially changed health coverage in the USA but most of its main features - health insurance exchanges, Medicaid expansion, development of accountable care organizations and further oversight of insurance companies - remain works in progress. The ACA did not introduce the stringent spending controls found in many European health systems. It also explicitly prohibits the creation of institutes - for the assessment of the cost-effectiveness of pharmaceuticals, health services and technologies - comparable to the National Institute for Health and Care Excellence in the United Kingdom of Great Britain and Northern Ireland, the Haute Autorite de Sante in France or the Pharmaceutical Benefits Advisory Committee in Australia. The ACA was - and remains - weakened by a lack of cross-party political consensus. The ACA\u27s performance and its resulting acceptability to the general public will be critical to the Act\u27s future

Newly Licensed Registered Nurses\u27 Perceptions Of Job Difficulties, Demands And Control: Individual And Organizational Predictors

Aims To determine predictors of newly licensed registered nurses\u27 perceptions of job difficulties, job demands and job control. Background In previous studies, new registered nurses describe their work environment as stressful, yet little is known about factors that influence these experiences. Methods We surveyed a random sample of newly licensed registered nurses in Florida. Dependent variables included indicators of job difficulty, job demand and job control. Independent variables included individual and organizational characteristics hypothesized to be related to the dependent variables. Logistic and ordinary least squares regressions were used to analyse survey data. Results Inadequate orientation, working the day shift, working a greater number of hours and caring for a higher number of patients were significantly related to a greater likelihood of perceptions of job difficulty and job demand. Less adequate orientation and a greater number of float shifts were related to a lower likelihood of perceptions of job control. Conclusions and implications Adequacy of orientation, patient load, work hours, shift work and floating are priority items that need improvement in the work environment of newly licensed registered nurses. Implications for Nursing Management The present study identified factors involved with newly licensed registered nurses\u27 perceptions of job difficulties, job demands and job control which will help managers redesign work settings to retain new nurses. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd

Patient Turnover And Nursing Staff Adequacy

Objective. To assess the relative validity of patient turnover adjustments and the difference in nurse staffing using measures that adjust for patient turnover and severity versus those that do not. Data Sources. Numbers of registered nurses (RNs), adjusted patient days of care (APDC), length of stay, and patient severity information from acute care general hospitals in Pennsylvania 1994-2001, obtained from the Pennsylvania Department of Health, the American Hospital Association, and the Atlas MediQual system. Study Design. After examining the trends in patient turnover and severity and their relationship to RN staffing, we apply two-patient turnover indices, with and without patient severity adjustments, to RN staffing measures, and test the difference between the original and adjusted measures using paired sample t-tests. Data Extraction Methods. Data sets were match merged by hospital ID, and patient turnover and severity indices were created, using 1994 as the base year. RN staffing measures were developed using unadjusted APDC, and APDC adjusted for patient turnover and both patient turnover and severity. Principal Findings. Patient turnover increased significantly from 1994 to 2001. The difference between RN staffing measures adjusted for patient turnover and severity and those not adjusted was increasingly significant from 1995 onward. Unadjusted RN staffing showed a 1 percent decline over the 8-year-period compared with decreases of from 9 to 26 percent after adjustments. Conclusions. These results indicate that the assessment of unadjusted RN staffing by RN to patient ratios alone underestimates nursing workload and overstates RN staffing levels. Patient turnover, as well as severity, should be taken into account in staffing assessment and decision making. © Health Research and Educational Trust

MEASURES OF NURSE STAFFING: SHOULD WE ACCOUNT FOR PATIENT TURNOVER?

Objective. To assess the difference in nurse staffing using measures that adjust for patient turnover and severity versus those that do not. Data Sources. Numbers of registered nurses (RNs), adjusted patient days of care (APDC), length of stay, and patient severity information from acute-care general hospitals in Pennsylvania 1994-2001, obtained from the Pennsylvania Department of Health, the American Hospital Association, and the Atlas MediQual system. Study Design. After examining the trends in patient turnover and severity and their relationship to RN staffing, we apply two patient turnover indices with and without patient acuity adjustments to RN staffing measures, and test the difference between the original and adjusted measures using paired sample t-tests. Data Extraction Methods. Data sets were match-merged by hospital ID, and patient turnover and severity indices were created, using 1994 as the base year. RN staffing measures were developed using unadjusted APDC and APDC adjusted for patient turnover and both patient turnover and severity. Principal Findings. Patient turnover increased significantly from 1994 to 2001. The difference between RN staffing measures adjusted for patient turnover and severity and those not adjusted was increasingly significant from 1999 on. Unadjusted RN staffing showed a 1 percent decline over the eight year period compared to decreases of from 10 to 26 percent after adjustments. Conclusions. These results indicate that the assessment of unadjusted RN staffing by RN to patient ratios alone significantly underestimates nursing needs and overstates RN staffing levels. Patient turnover, as well as acuity, should be taken into account in staffing assessment and decision-making

Newly Licensed Registered Nurse Job Turnover And Turnover Intent

Through survey data, this study examines job leaving behaviors of newly licensed registered nurses and identifies educational and managerial issues that need to be addressed to retain them. Within 1.5-2.5 years of graduating, one third of all respondents had left their first job, most for work-related reasons. Predictors of job leaving or intentions to leave included not having had a good orientation, information issues, having difficulties doing a good job, not being rewarded fairly, and low job satisfaction

Measures Of Nurse Staffing: Should We Account For Patient Turnover?

Objective. To assess the difference in nurse staffing using measures that adjust for patient turnover and severity versus those that do not. Data Sources. Numbers of registered nurses (RNs), adjusted patient days of care (APDC), length of stay, and patient severity information from acute-care general hospitals in Pennsylvania 1994-2001, obtained from the Pennsylvania Department of Health, the American Hospital Association, and the Atlas MediQual system. Study Design. After examining the trends in patient turnover and severity and their relationship to RN staffing, we apply two patient turnover indices with and without patient acuity adjustments to RN staffing measures, and test the difference between the original and adjusted measures using paired sample t-tests. Data Extraction Methods. Data sets were match-merged by hospital ID, and patient turnover and severity indices were created, using 1994 as the base year. RN staffing measures were developed using unadjusted APDC and APDC adjusted for patient turnover and both patient turnover and severity. Principal Findings. Patient turnover increased significantly from 1994 to 2001. The difference between RN staffing measures adjusted for patient turnover and severity and those not adjusted was increasingly significant from 1999 on. Unadjusted RN staffing showed a 1 percent decline over the eight year period compared to decreases of from 10 to 26 percent after adjustments. Conclusions. These results indicate that the assessment of unadjusted RN staffing by RN to patient ratios alone significantly underestimates nursing needs and overstates RN staffing levels. Patient turnover, as well as acuity, should be taken into account in staffing assessment and decision-making

Nurse Staffing And Patient Safety In Hospitals: New Variable And Longitudinal Approaches

Background: Most studies of the relationship between nurse staffing and patient outcomes in hospitals have shown that worse patient outcomes are associated with lower registered nurse (RN) staffing. However, inconsistent results exist, possibly because of the use of a variety of nurse staffing and patient outcomes measures and because of statistical methods that employ static, instead of change, relationships. Objectives: The aim of the study was to examine the relationship between changes in RN staffing and patient safety events in Florida hospitals from 1996 through 2004. Methods: Using 9 years of data from 124 Florida hospitals, latent growth curve models were used to assess the impact on patient safety of RN staffing changes in hospitals. Patient safety measures were 4 of the 20 provider-level patient safety indicators (PSIs) developed by the Agency for Healthcare Research and Quality. Two measures of RN staffing - RN full-time equivalents and RN per adjusted patient day - were analyzed. Results: Changes in RN full-time equivalents were positively related to changes in RN per adjusted patient day. All PSIs were negatively and significantly related to one or both RN staffing measures. Failure to rescue had the strongest relationship to RN staffing. Models of change relationships between staffing and PSIs were more likely to show significant relationships than models using initial levels. Initial levels of RN staffing tended to be unrelated to initial levels of PSIs. Discussion: A negative relationship between RN staffing and PSIs was strongly supported with failure to rescue and was weakly supported with decubitus ulcers, selected infections, and postoperative sepsis. The PSIs should be retested in an expanded change model study using multistate or national sample Healthcare Cost and Utilization Project data. Copyright © 2011 Lippincott Williams & Wilkins