Nurse Acuity, Phase III

1. Nurse Acuity, Phase III The impact of nurse staffing on patient outcomes in Pediatric Intensive Care Units

2. Nurse Acuity Phase I • Agreement among staffing models • Purpose: “…this study will provide the baseline knowledge for the follow-up study of nursing to patient staffing ratios and the relationship, if any, to patient outcomes.

3. Nurse Acuity, Phase II • Nursing Workload Perceptions • Purpose: to compare staff nurses’ perceptions of their own nursing workload to the actual staffing expectations of institutions, using surveys of staff nurses’ perceptions compared to the actual staffing provided by the charge nurses. Another goal is to determine nurses’ satisfaction with their workload in relation to whether they feel it is too heavy or not heavy enough.

4. Proposed Purposes • To determine the impact of staffing ratios on patient outcomes • To integrate best practice strategies identifeid in PICU Focus Group Projects • Skin Integrity • CA-BSI • Unplanned Extubations

5. Previous Studies • Aiken, L., Clarke, S., Sloane, D., Sochalski, J. & Silber, J. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of the American Medical Association, 288(16), 1987-1993. • Each additional patient per nurse was associated with a 7% increase in the likelihood of dying within 30 days of admission and a 7% incresae in the odds of failure to rescue

6. Previous Studies • Aiken, L., Clarke, S., Sloane, D., Sochalski, J. Busse, R., Clarke, H., Giovannetti, P., Hunt, J., Rafferty, A. & Shamian, J. (2001). Nurses’ reports on hospital care in five countries [Electronic version]. Health Affairs, 20(3), 43-53. • “…problems in work design and workforce management…contribute to uneven quality of care, medical errors, and adverse patient outcomes.”

7. Previous Studies • Van den Heede, K., Clarke, S., Sermeus, W., Vleugels, A., and Aiken, L. (2007). International experts’ perspectives on the state of the nurse staffing and patient outcomes literature. Journal of Nursing Scholarship, 39(4), 290-297. • 85% level of consensus was reached for 32 patient outcomes, 10 nurse staffing measures, and 29 background variables

8. Nursing Variables • Nursing hours per patient day • Nurse to patient ratio • Proportion of RNs to all nursing staff • Proportion of RNs with BSN

9. Patient Outcome Variables • Medical/Surgical Complications • Shock or Cardiac Arrest • Aspiration Pneumonia • Postoperative Complications • Safety and Integrity • Pressure Ulcers • Falls

10. Patient Outcome Variables • Nosocomial Infections • CA-BSI • Urinary Catheter Associate UTI • VAP • Mortality/Failure to Rescue

11. Patient Outcome Variables • Process/Safety of Care Measures • Medication Errors • Unplanned Extubations • Reintubations • Restraint Prevalence • Summary Measures • Length of Stay • Readmission

12. Patient Outcome Variables • Global Subjective Indicators • Patient Satisfaction • Nurse-Perceived Quality of Care

13. Next Steps • Select Nurse Variables to include • Select Patient Outcome Variables to measure • Questions?