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...
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| Published in: | BMJ open Vol. 10; no. 9; p. e036264 |
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| Language: | English |
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06.09.2020
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| ISSN: | 2044-6055, 2044-6055 |
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| Abstract | 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. |
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| AbstractList | 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. To 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.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.Analysis of cross-sectional data derived from nurse surveys linked with admitted patient outcomes data.DESIGNAnalysis of cross-sectional data derived from nurse surveys linked with admitted patient outcomes data.Public hospitals in Queensland.SETTINGPublic hospitals in Queensland.4372 medical-surgical nurses and 146 456 patients in 68 public hospitals.PARTICIPANTS4372 medical-surgical nurses and 146 456 patients in 68 public hospitals.30-day mortality, quality and safety indicators, nurse outcomes including emotional exhaustion and job dissatisfaction.MAIN OUTCOME MEASURES30-day mortality, quality and safety indicators, nurse outcomes including emotional exhaustion and job dissatisfaction.Medical-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).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).Before 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.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. To 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. Analysis of cross-sectional data derived from nurse surveys linked with admitted patient outcomes data. Public hospitals in Queensland. 4372 medical-surgical nurses and 146 456 patients in 68 public hospitals. 30-day mortality, quality and safety indicators, nurse outcomes including emotional exhaustion and job dissatisfaction. Medical-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). Before 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. Objectives To 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.Design Analysis of cross-sectional data derived from nurse surveys linked with admitted patient outcomes data.Setting Public hospitals in Queensland.Participants 4372 medical-surgical nurses and 146 456 patients in 68 public hospitals.Main outcome measures 30-day mortality, quality and safety indicators, nurse outcomes including emotional exhaustion and job dissatisfaction.Results Medical-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).Conclusions Before 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. |
| Author | Yates, Patsy McHugh, Matthew D Windsor, Carol Aiken, Linda H Douglas, Clint |
| AuthorAffiliation | 2 School of Nursing , Queensland University of Technology , Brisbane , Queensland , Australia 1 School of Nursing, Center for Health Outcomes and Policy Research , University of Pennsylvania , Philadelphia , Pennsylvania , USA 3 Metro North Hospital and Health Service , Royal Brisbane and Women’s Hospital , Herston , Queensland , Australia |
| AuthorAffiliation_xml | – name: 2 School of Nursing , Queensland University of Technology , Brisbane , Queensland , Australia – name: 3 Metro North Hospital and Health Service , Royal Brisbane and Women’s Hospital , Herston , Queensland , Australia – name: 1 School of Nursing, Center for Health Outcomes and Policy Research , University of Pennsylvania , Philadelphia , Pennsylvania , USA |
| Author_xml | – sequence: 1 givenname: Matthew D orcidid: 0000-0002-1263-0697 surname: McHugh fullname: McHugh, Matthew D email: mchughm@nursing.upenn.edu organization: School of Nursing, Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA – sequence: 2 givenname: Linda H surname: Aiken fullname: Aiken, Linda H organization: School of Nursing, Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA – sequence: 3 givenname: Carol surname: Windsor fullname: Windsor, Carol organization: School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia – sequence: 4 givenname: Clint surname: Douglas fullname: Douglas, Clint organization: Metro North Hospital and Health Service, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia – sequence: 5 givenname: Patsy orcidid: 0000-0001-8946-8504 surname: Yates fullname: Yates, Patsy organization: School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32895270$$D View this record in MEDLINE/PubMed |
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| Snippet | ObjectivesTo determine whether there was variation in nurse staffing across hospitals in Queensland prior to implementation of nurse-to-patient ratio... To determine whether there was variation in nurse staffing across hospitals in Queensland prior to implementation of nurse-to-patient ratio legislation... Objectives To determine whether there was variation in nurse staffing across hospitals in Queensland prior to implementation of nurse-to-patient ratio... |
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| SubjectTerms | 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 |
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| Title | Case for hospital nurse-to-patient ratio legislation in Queensland, Australia, hospitals: an observational study |
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