Case for hospital nurse-to-patient ratio legislation in Queensland, Australia, hospitals: an observational study

ObjectivesTo determine whether there was variation in nurse staffing across hospitals in Queensland prior to implementation of nurse-to-patient ratio legislation targeting medical-surgical wards, and if so, the extent to which nurse staffing variation was associated with poor outcomes for patients a...

Full description

Saved in:
Bibliographic Details
Published in:BMJ open Vol. 10; no. 9; p. e036264
Main Authors: McHugh, Matthew D, Aiken, Linda H, Windsor, Carol, Douglas, Clint, Yates, Patsy
Format: Journal Article
Language:English
Published: England British Medical Journal Publishing Group 06.09.2020
BMJ Publishing Group LTD
BMJ Publishing Group
Series:Original research
Subjects:
Australia
Burnout, Professional - epidemiology
Clinical outcomes
Cross-Sectional Studies
health policy
Hospitals
Humans
international health services
Job Satisfaction
Legislation
Mortality
Nurses
Nursing
Nursing Staff, Hospital
Observational studies
Patient safety
Personnel Staffing and Scheduling
quality in health care
Quality of Health Care
Queensland
Ratios
Workforce planning
Workloads
Australia
Queensland
California
Queensland Australia
United States > US
international health services
quality in health care
health policy
ISSN:2044-6055, 2044-6055
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:ObjectivesTo determine whether there was variation in nurse staffing across hospitals in Queensland prior to implementation of nurse-to-patient ratio legislation targeting medical-surgical wards, and if so, the extent to which nurse staffing variation was associated with poor outcomes for patients and nurses.DesignAnalysis of cross-sectional data derived from nurse surveys linked with admitted patient outcomes data.SettingPublic hospitals in Queensland.Participants4372 medical-surgical nurses and 146 456 patients in 68 public hospitals.Main outcome measures30-day mortality, quality and safety indicators, nurse outcomes including emotional exhaustion and job dissatisfaction.ResultsMedical-surgical nurse-to-patient ratios before implementation of ratio legislation varied significantly across hospitals (mean 5.52 patients per nurse; SD=2.03). After accounting for patient characteristics and hospital size, each additional patient per nurse was associated with 12% higher odds of 30-day mortality (OR=1.12; 95% CI 1.01 to 1.26). Each additional patient per nurse was associated with poorer outcomes for nurses including 15% higher odds of emotional exhaustion (OR=1.15; 95% CI 1.07 to 1.23) and 14% higher odds of job dissatisfaction (OR=1.14; 95% CI 1.02 to 1.28), as well as higher odds of concerns about quality of care (OR=1.12; 95% CI 1.01 to 1.25) and patient safety (OR=1.32; 95% CI 1.11 to 1.57).ConclusionsBefore ratios were implemented, nurse staffing varied considerably across Queensland hospital medical-surgical wards and higher nurse workloads were associated with patient mortality, low quality of care, nurse emotional exhaustion and job dissatisfaction. The considerable variation across hospitals and the link with outcomes suggests that taking action to improve staffing levels was prudent.
Bibliography:Original research
ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 14
content type line 23
ObjectType-Undefined-3
ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2019-036264