Colleen J. Goode

Nurse staffing and patient outcomes.

BACKGROUND Nursing studies have shown that nursing care delivery changes affect staff and organizational outcomes, but the effects on client outcomes have not been studied sufficiently. OBJECTIVE To describe, at the level of the nursing care unit, the relationships among total hours of nursing care, registered nurse (RN) skill mix, and adverse patient outcomes. METHODS The adverse outcomes included unit rates of medication errors, patient falls, skin breakdown, patient and family complaints, infections, and deaths. The correlations among staffing variables and outcome variables were determined, and multivariate analyses, controlling for patient acuity, were completed. RESULTS Units with higher average patient acuity had lower rates of medication errors and patient falls but higher rates of the other adverse outcomes. With average patient acuity on the unit controlled, the proportion of hours of care delivered by RNs was inversely related to the unit rates of medication errors, decubiti, and patient complaints. Total hours of care from all nursing personnel were associated directly with the rates of decubiti, complaints, and mortality. An unexpected finding was that the relationship between RN proportion of care was curvilinear; as the RN proportion increased, rates of adverse outcomes decreased up to 87.5%. Above that level, as RN proportion increased, the adverse outcome rates also increased. CONCLUSIONS The higher the RN skill mix, the lower the incidence of adverse occurrences on inpatient care units.

The Graduate Nurse Experience: Qualitative Residency Program Outcomes

Graduate nurses experience role conflict and stress as they begin practice in work environments of high complexity, nurse shortages, and expectations to become competent rapidly. The authors report outcomes from a study that evaluated qualitative responses to the Casey-Fink Graduate Nurse Experience Survey administered to graduate nurse residents in the University HealthSystem Consortium/American Association of Colleges of Nursing postbaccalaureate nurse residency program at 12 academic hospital sites. Qualitative analysis provided sufficient evidence to convert specific open-ended questions on the Casey-Fink Graduate Nurse Experience Survey instrument to a quantitative format for ease of administration and analysis.

Baccalaureate education in nursing and patient outcomes.

OBJECTIVES: The aim of this study was to examine the effects of registered nurse (RN) education by determining whether nurse-sensitive patient outcomes were better in hospitals with a higher proportion of RNs with baccalaureate degrees. BACKGROUND: The Future of Nursing report recommends increasing the percentage of RNs with baccalaureate degrees from 50% to 80% by 2020. Research has linked RN education levels to hospital mortality rates but not with other nurse-sensitive outcomes. METHODS: This was a cross-sectional study that, with the use of data from 21 University HealthSystem Consortium hospitals, analyzed the association between RN education and patient outcomes (risk-adjusted patient safety and quality of care indicators), controlling for nurse staffing and hospital characteristics. RESULTS: Hospitals with a higher percentage of RNs with baccalaureate or higher degrees had lower congestive heart failure mortality, decubitus ulcers, failure to rescue, and postoperative deep vein thrombosis or pulmonary embolism and shorter length of stay. CONCLUSION: The recommendation of the Future of Nursing report to increase RN education levels is supported by these findings.

Nurse staffing effects on patient outcomes: safety-net and non-safety-net hospitals.

BackgroundNurse staffing has been linked to hospital patient outcomes; however, previous results were inconsistent because of variations in measures of staffing and were only rarely specific to types of patient care units. ObjectiveTo determine the relationship between nurse staffing in general and intensive care units and patient outcomes and determine whether safety net status affects this relationship. Research DesignA cross-sectional design used data from hospitals belonging to the University HealthSystem Consortium. SubjectsData were available for approximately 1.1 million adult patient discharges and staffing for 872 patient care units from 54 hospitals. MeasuresTotal hours of nursing care [Registered Nurses (RNs), Licensed Practical Nurses, and assistants] determined per inpatient day (TotHPD) and RN skill mix were the measures of staffing; Agency for Healthcare Research and Quality risk-adjusted safety and quality indicators were the outcome measures. ResultsTotHPD in general units was associated with lower rates of congestive heart failure mortality (P<0.05), failure to rescue (P<0.10), infections (P<0.01), and prolonged length of stay (P<0.01). RN skill mix in general units was associated with reduced failure to rescue (P<0.01) and infections (P<0.05). TotHPD in intensive care units was associated with fewer infections (P<0.05) and decubitus ulcers (P<0.10). RN skill mix was associated with fewer cases of sepsis (P<0.01) and failure to rescue (P<0.05). Safety-net status was associated with higher rates of congestive heart failure mortality, decubitus ulcers, and failure to rescue. ConclusionsHigher nurse staffing protected patients from poor outcomes; however, hospital safety-net status introduced complexities in this relationship.

Evidence-based clinical practice.

Healthcare professionals are trying to facilitate the use of evidence-based decision making for individual patients and patient populations they are privileged to serve. The authors describe an evidence-based multidisciplinary clinical practice model developed at the University of Colorado Hospital along with a clinical example of how the model was used to improve quality and decrease costs.

Post-baccalaureate nurse residency program.

Increased registered nurse vacancy rates have resulted in new graduates being assigned to care for high acuity patients with complex needs. The authors discuss the research related to new graduate preparation, identify the need for a standardized accredited national residency program, and describe a demonstration project under way in academic health centers.

Postbaccalaureate nurse residency 1-year outcomes.

The authors document the 1-year outcomes of the postbaccalaureate residency program jointly developed and implemented by the University HealthSystem Consortium and the American Association of Colleges of Nursing. Data on 2 cohorts of residents (n = 679) in 12 sites across the country are presented. The 1-year termination rate was 12%, after those lost to the program because of National Council Licensure Examination failure, serious illness, or death were eliminated from the analysis. Additional analyses using data collected at entry to the program, 6 months, and 1 year using 3 instruments, the Casey-Fink Graduate Nurse Experience Survey, the Gerbers Control Over Nursing Practice Scale, and the McCloskey Mueller Satisfaction Scale, are presented and discussed.

Evaluating nursing administration instruments

OBJECTIVE To identify and evaluate available measures that can be used to examine the effects of management innovations in five important areas: autonomy, conflict, job satisfaction, leadership, and organizational climate. BACKGROUND Management interventions target the context in which care is delivered and through which evidence for practice diffuses. These innovations need to be evaluated for their effects on desired outcomes. However, busy nurses may not have the time to locate, evaluate, and select instruments to measure expected nursing administration outcomes without research-based guidance. Multiple and complex important contextual variables need psychometrically sound and easy-to-use measurement instruments identified for use in both practice and research. METHOD An expert focus group consensus methodology was used in this evaluation research to review available instruments in the five areas and evaluate which of these instruments are psychometrically sound and easy to use in the practice setting. RESULTS The result is a portfolio of measures, clustered by concept and displayed on a spreadsheet. Retrieval information is provided. The portfolio includes the expert consensus judgment as well as useful descriptive information. CONCLUSIONS The research reported here identifies psychometrically sound and easy-to-use instruments for measuring five key variables to be included in a portfolio. The results of this study can be used as a beginning for saving time in instrument selection and as an aid for determining the best instrument for measuring outcomes from a clinical or management intervention.

Lessons learned from 10 years of research on a post-baccalaureate nurse residency program.

OBJECTIVES: The aim of this study was to examine outcomes from 10 years of research on a post-baccalaureate new graduate nurse residency program and to report lessons learned. BACKGROUND: Transition to practice programs are recommended by the Future of Nursing report, the Carnegie Foundation study, the Joint Commission, and the National Council of State Boards of Nursing. METHODS: Data from new graduate residents who participated in the University HealthSystem Consortium/American Association of Colleges of Nursing residency from 2002 through 2012 are presented. Analysis of variance results from the Casey-Fink Graduate Nurse Experience Scale and outcomes from the graduate nurse program evaluation instrument are provided. RESULTS: Retention rates for new graduates in the residency increased considerably in the participating hospitals. Residents’ perception of their ability to organize and prioritize their work, communicate, and provide clinical leadership showed statistically significant increases over the 1-year program. CONCLUSION: The recommendations for new graduate nurse residency programs are supported by the findings.

Comparison of patient outcomes in Magnet® and non-Magnet hospitals.

Objective: This study compared patient outcomes and staffing in Magnet® and non-Magnet hospitals. Background: The pursuit of Magnet designation is a highly regarded program for improving staff and patient outcomes. Research has confirmed that Magnet hospitals provide positive work environments for nurses. Research related to patient outcomes in Magnet hospitals is scarce, and results vary. Methods: The University Health Systems Consortium provided the clinical and operational databases for the study. Using bivariate and multivariate analyses, a comparison of patient outcomes and nurse staffing in general units and ICUs of Magnet and non-Magnet hospitals was studied. Outcomes: Non-Magnet hospitals had better patient outcomes than Magnet hospitals. Magnet hospitals had slightly better outcomes for pressure ulcers, but infections, postoperative sepsis, and postoperative metabolic derangement outcomes were worse in Magnet hospitals. Magnet hospitals also had lower staffing numbers. Conclusions: Magnet hospitals in this study had less total staff and a lower RN skill mix compared with non-Magnet hospitals, which contributed to the outcomes.