Heslop, Liza

Name not available

Australian direct care nurses can make cost savings and improve health-care quality if they have access to meaningful data

Victoria University Eprints Repository

ED ITORIALAustralian direct care nurses can make costsavings and improve health-care quality if theyhave access to meaningful dataHealth Workforce Australia (HWA) reports1 showgrowing demand for registered nurses (RN)a in Australiaassociated with an ageing population. Adequate suppliesof nursing professionals will be needed in the future.Streamlining or optimizing the work processes of regis-tered nurses to work efficiently and productively hasbecome a prominent theme for the better management ofnursing workforce supply to meet this demand. Thisnecessitates reconfiguration of the nursing ‘skill mix’ orthe proportion of registered nurses in relation to enrollednurses and other nursing support workers.The Grattan Institute in a recent report,2 for example,has proposed major changes to the configuration ofnursing roles in Australia. But while there may be a placefor support services to nurses, international researchshows that such a proposal may bring serious risks if stepsare not taken first to monitor nursing workforce dataon a national scale. It is these data—currently lacking inAustralia—which are needed to inform and underpin sucha large-scale change to nursing roles.Minimum nursing data related to nursing quality andperformance are readily accessible in many countries,including the United States. These data can take the formof around 10 basic measures known as ‘nursing-sensitive’structural and outcome indicators. Structural indicatorsare nursing staff measures, including nursing hours, skillmix and nurse patient ratios. Outcome measures areadverse event indicators, such as pressure injuries, medi-cation errors, falls and infections, which are established asvalid and reliable evidence of the impact of direct careactivity of nurses in hospital units.In the United States, Belgium and elsewhere, aminimum information structure of key nursing carequality performance measurements is used by nurses toevaluate their contributions to health outcomes, by pro-viders to monitor and improve care delivery and byemployers to reward high performance. If registerednurse levels are compromised on some hospital wards,then quality outcome measures on pressure injury preva-lence, medication errors, infection and other adverseevents may rise. Evidence from a decade of nursingresearch has shown dependencies between registerednurse levels and adverse events—confirmed mostrecently by Linda Aiken and colleagues, showing thatreduced nurse staffing in European hospitals led to highermortality rates after common surgeries.3Through HWA4 and other best practice initiatives, reg-istered nurses have provided examples of how their roleshave expanded their scope of practice in emergencydepartments and other settings. ENs’ roles have beenoptimized in many health-care settings so they can under-take additional functions, including medication adminis-tration that were previously the domain of RNs.Nurses are supportive of allowing health-care supportworkers to help with basic patient care under their direc-tion; however, solid evidence either way on the signifi-cance of RN levels in maintaining quality is lacking,making it difficult for the nursing profession to elaboratethe processes or mechanisms that link nurse staffing levelswith patient risk. Given this lack of information, nurseworkforce solutions, including those offered by theGrattan Institute, should be monitored to ensure they areas safe and effective as planned.RNs may be easy targets for cost savings in Australia asthey represent both the largest health-care workforce anda significant element of health-care costs. RN roles inhospital settings are not only concerned with direct care,but have pivotal roles in managing quality and patient risk.It is estimated that adverse events in Australian hospitalscost $2 billion, of which half may even be preventable.5Pressure injuries are among these and their prevalencerates in the Australian acute care sector can range between4.5% and 36.7%.6 In the State of Western Australia, thecosts of hospital-acquired pressure injuries in bed daysbs_bs_bannerInternational Journal of Nursing Practice 2014; 20: 337–338doi:10.1111/ijn.12359 © 2014 Wiley Publishing Asia Pty Ltdalone for 2011 were $12.2 million.7 Data from the fourthState-wide Wound Prevalence Survey conducted inWestern Australia identified, also, an increase of 7.6% inthe prevalence of potentially preventable pressure injuriesand skin tears. In that year, the survey identified also anincrease of 7.6% in the prevalence of potentially prevent-able pressure injuries and skin tears, with a 30% increasein the number of patients receiving a pressure injury riskassessment on admission. Importantly, it was noted thatcompared with 2009, there was a decrease of 11% in theuse of pressure-relieving devices.It has been shown that if nurses have timely access tobasic nurse-sensitive outcomes data, they have acted onthe information. For example, data from a US nursingminimum dataset shows a significant reduction in hospital-acquired pressure injuries in adults from 78 acute carehospitals over 8 years (2003–2010).8 Hospital-acquiredpressure ulcer surveillance based on US nurse minimumdata teamed with RN prevention initiatives has provided anet saving of $127.51 per patient.9What is needed as a priority is investment in basicminimum nursing data structures to reduce the cost ofcare through quality and safety improvements. Policy ini-tiatives must be directed to nurture the development ofnational nursing minimum data structures for quality andperformance measurement. Some of these data may becurrently available in hospital information repositories asactivity or case-mix data, but their use has been under-utilized and better use of its application requires explora-tion.10 The development of nursing quality measurementswill not only provide empirical evidence to policy officialswho seek meaningful information on the effectiveness ofworkforce change initiatives, but would also provide vitalinformation for nurses to reduce patient cost and risk.Liza HeslopAssociate Professor, College of Health and Biomedicine, VictoriaUniversity, Melbourne, Victoria, AustraliaWestern Center for Health Research and Education (CHRE),Sunshine Hospital, Level 3, 176 Furlong Road, St. Albans,Victoria, Australia, 3021NOTEaIn the main, there are two different levels of qualified nursesin Australia. Registered nurses (RNs) are the highest level,followed by second-level nurses, enrolled nurses (ENs).Nursing support workers tend to be designated as Assistantsin Nursing (AINs) or other forms of personal care attendantsand nursing assistants.REFERENCES1 Health Workforce Australia. Health Workforce 2025—Doctors, Nurses and Midwives. 2012. Available from URL:https://www.hwa.gov.au/our-work/health-workforce-planning/health-workforce-2025-doctors-nurses-and-midwives. Accessed 22 July 2014.2 Duckett S, Breadon P. Unlocking skills in hospitals: betterjobs, more care. 2014. Available from URL: http://grattan.edu.au/publications/reports/post/unlocking-skills-in-hospitals-better-jobs-more-care/. Accessed 22 July 2014.3 Aiken L, Sloane D, Bruyneel L et al. Nurse staffing andeducation and hospital mortality in nine European coun-tries: a retrospective observational study. Lancet 2014; 383:1824–1830. MEDLINE with Full Text, EBSCOhost,viewed 17 March 2014 (epub ahead of print).4 Health Workforce Australia. Expanded Scope of Practiceand Aged Care Reform Progress Report. 2014. Availablefrom URL: https://www.hwa.gov.au/sites/uploads/Expanded0Scope-Practice-and-Aged-Care-Workforce-Reform-Progress-Repo-201403.pdf. Accessed 22 July2014.5 Ehsani JP, Jackson T, Duckett SJ. The incidence and cost ofadverse events in Victorian hospitals 2003–04. The MedicalJournal of Australia 2006; 184: 551–555.6 Prentice JL, Stacey MC, Lewin G. An Australian model forconducting pressure ulcer prevalence surveys. PrimaryIntention 2003; 11: 87–88, 90–91, 93–96, 98–100, 102–109. Available from URL: http://www.awma.com.au/journal/1102_03.pdf. Accessed 22 July 2014.7 Mulligan S, Prentice J, Scott L. WoundsWest WoundPrevalence Survey 2011 State-wide Overview Report.Ambulatory Care Services, Department of Health 2011:Perth, Western Australia.8 Stotts NA, Brown DS, Donaldson N, Aydin C, FridmanM. Eliminating hospital-acquired pressure ulcers: withinour reach. Advances in Skin and Wound Care 2013; 26: 13–18.9 Spetz J, Brown DS, Aydin C, Donaldson N. The value ofreducing hospital-acquired pressure ulcer prevalence: anillustrative analysis. The Journal of Nursing Administration2013; 43: 235–241.10 Heslop L. Outcome detection using hospital activitydata: implications for development of nursing-sensitivequality monitoring and reporting in Australia. Inter-national Journal of Nursing Studies 2014; 15: 470–478. doi:10.1016/j.ijnurstu.2014.04.007. Available from URL:http://authors.elsevier.com/sd/article/S0020748914000832. Accessed 22 July 2014.338 Editorial© 2014 Wiley Publishing Asia Pty Ltd

Australian direct care nurses can make cost savings and improve health-care quality if they have access to meaningful data

Abstract

Similar works

Full text

Available Versions

Name not available

Victoria University Eprints Repository

Crossref

Victoria University Institutional Repository (VUIR)