Effects of nurse staffing, work environments, and education on patient mortality: An observational study

While considerable evidence has been produced showing a link between nursing characteristics and patient outcomes in the U.S. and Europe, little is known about whether similar associations are present in South Korea. To examine the effects of nurse staffing, work environment, and education on patien...

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Published in:International journal of nursing studies Vol. 52; no. 2; pp. 535 - 542
Main Authors: Cho, Eunhee, Sloane, Douglas M., Kim, Eun-Young, Kim, Sera, Choi, Miyoung, Yoo, Il Young, Lee, Hye Sun, Aiken, Linda H.
Format: Journal Article
Language:English
Published: England Elsevier Ltd 01.02.2015
Elsevier Limited
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ISSN:0020-7489, 1873-491X, 1873-491X
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Abstract While considerable evidence has been produced showing a link between nursing characteristics and patient outcomes in the U.S. and Europe, little is known about whether similar associations are present in South Korea. To examine the effects of nurse staffing, work environment, and education on patient mortality. This study linked hospital facility data with staff nurse survey data (N=1024) and surgical patient discharge data (N=76,036) from 14 high-technology teaching hospitals with 700 or more beds in South Korea, collected between January 1, 2008 and December 31, 2008. Logistic regression models that corrected for the clustering of patients in hospitals were used to estimate the effects of the three nursing characteristics on risk-adjusted patient mortality within 30 days of admission. Risk-adjusted models reveal that nurse staffing, nurse work environments, and nurse education were significantly associated with patient mortality (OR 1.05, 95% CI 1.00–1.10; OR 0.52, 95% CI 0.31–0.88; and OR 0.91, CI 0.83–0.99; respectively). These odds ratios imply that each additional patient per nurse is associated with an 5% increase in the odds of patient death within 30 days of admission, that the odds of patient mortality are nearly 50% lower in the hospitals with better nurse work environments than in hospitals with mixed or poor nurse work environments, and that each 10% increase in nurses having Bachelor of Science in Nursing Degree is associated with a 9% decrease in patient deaths. Nurse staffing, nurse work environments, and percentages of nurses having Bachelor of Science in Nursing Degree in South Korea are associated with patient mortality. Improving hospital nurse staffing and work environments and increasing the percentages of nurses having Bachelor of Science in Nursing Degree would help reduce the number of preventable in-hospital deaths.
AbstractList While considerable evidence has been produced showing a link between nursing characteristics and patient outcomes in the U.S. and Europe, little is known about whether similar associations are present in South Korea. To examine the effects of nurse staffing, work environment, and education on patient mortality. This study linked hospital facility data with staff nurse survey data (N=1024) and surgical patient discharge data (N=76,036) from 14 high-technology teaching hospitals with 700 or more beds in South Korea, collected between January 1, 2008 and December 31, 2008. Logistic regression models that corrected for the clustering of patients in hospitals were used to estimate the effects of the three nursing characteristics on risk-adjusted patient mortality within 30 days of admission. Risk-adjusted models reveal that nurse staffing, nurse work environments, and nurse education were significantly associated with patient mortality (OR 1.05, 95% CI 1.00–1.10; OR 0.52, 95% CI 0.31–0.88; and OR 0.91, CI 0.83–0.99; respectively). These odds ratios imply that each additional patient per nurse is associated with an 5% increase in the odds of patient death within 30 days of admission, that the odds of patient mortality are nearly 50% lower in the hospitals with better nurse work environments than in hospitals with mixed or poor nurse work environments, and that each 10% increase in nurses having Bachelor of Science in Nursing Degree is associated with a 9% decrease in patient deaths. Nurse staffing, nurse work environments, and percentages of nurses having Bachelor of Science in Nursing Degree in South Korea are associated with patient mortality. Improving hospital nurse staffing and work environments and increasing the percentages of nurses having Bachelor of Science in Nursing Degree would help reduce the number of preventable in-hospital deaths.
While considerable evidence has been produced showing a link between nursing characteristics and patient outcomes in the U.S. and Europe, little is known about whether similar associations are present in South Korea. To examine the effects of nurse staffing, work environment, and education on patient mortality. This study linked hospital facility data with staff nurse survey data (N = 1024) and surgical patient discharge data (N = 76,036) from 14 high-technology teaching hospitals with 700 or more beds in South Korea, collected between January 1, 2008 and December 31, 2008. Logistic regression models that corrected for the clustering of patients in hospitals were used to estimate the effects of the three nursing characteristics on risk-adjusted patient mortality within 30 days of admission. Risk-adjusted models reveal that nurse staffing, nurse work environments, and nurse education were significantly associated with patient mortality (OR 1.05, 95% CI 1.00-1.10; OR 0.52, 95% CI 0.31-0.88; and OR 0.91, CI 0.83-0.99; respectively). These odds ratios imply that each additional patient per nurse is associated with an 5% increase in the odds of patient death within 30 days of admission, that the odds of patient mortality are nearly 50% lower in the hospitals with better nurse work environments than in hospitals with mixed or poor nurse work environments, and that each 10% increase in nurses having Bachelor of Science in Nursing Degree is associated with a 9% decrease in patient deaths. Nurse staffing, nurse work environments, and percentages of nurses having Bachelor of Science in Nursing Degree in South Korea are associated with patient mortality. Improving hospital nurse staffing and work environments and increasing the percentages of nurses having Bachelor of Science in Nursing Degree would help reduce the number of preventable in-hospital deaths. 28 references
While considerable evidence has been produced showing a link between nursing characteristics and patient outcomes in the U.S. and Europe, little is known about whether similar associations are present in South Korea.BACKGROUNDWhile considerable evidence has been produced showing a link between nursing characteristics and patient outcomes in the U.S. and Europe, little is known about whether similar associations are present in South Korea.To examine the effects of nurse staffing, work environment, and education on patient mortality.OBJECTIVETo examine the effects of nurse staffing, work environment, and education on patient mortality.This study linked hospital facility data with staff nurse survey data (N=1024) and surgical patient discharge data (N=76,036) from 14 high-technology teaching hospitals with 700 or more beds in South Korea, collected between January 1, 2008 and December 31, 2008. Logistic regression models that corrected for the clustering of patients in hospitals were used to estimate the effects of the three nursing characteristics on risk-adjusted patient mortality within 30 days of admission.METHODSThis study linked hospital facility data with staff nurse survey data (N=1024) and surgical patient discharge data (N=76,036) from 14 high-technology teaching hospitals with 700 or more beds in South Korea, collected between January 1, 2008 and December 31, 2008. Logistic regression models that corrected for the clustering of patients in hospitals were used to estimate the effects of the three nursing characteristics on risk-adjusted patient mortality within 30 days of admission.Risk-adjusted models reveal that nurse staffing, nurse work environments, and nurse education were significantly associated with patient mortality (OR 1.05, 95% CI 1.00-1.10; OR 0.52, 95% CI 0.31-0.88; and OR 0.91, CI 0.83-0.99; respectively). These odds ratios imply that each additional patient per nurse is associated with an 5% increase in the odds of patient death within 30 days of admission, that the odds of patient mortality are nearly 50% lower in the hospitals with better nurse work environments than in hospitals with mixed or poor nurse work environments, and that each 10% increase in nurses having Bachelor of Science in Nursing Degree is associated with a 9% decrease in patient deaths.RESULTSRisk-adjusted models reveal that nurse staffing, nurse work environments, and nurse education were significantly associated with patient mortality (OR 1.05, 95% CI 1.00-1.10; OR 0.52, 95% CI 0.31-0.88; and OR 0.91, CI 0.83-0.99; respectively). These odds ratios imply that each additional patient per nurse is associated with an 5% increase in the odds of patient death within 30 days of admission, that the odds of patient mortality are nearly 50% lower in the hospitals with better nurse work environments than in hospitals with mixed or poor nurse work environments, and that each 10% increase in nurses having Bachelor of Science in Nursing Degree is associated with a 9% decrease in patient deaths.Nurse staffing, nurse work environments, and percentages of nurses having Bachelor of Science in Nursing Degree in South Korea are associated with patient mortality. Improving hospital nurse staffing and work environments and increasing the percentages of nurses having Bachelor of Science in Nursing Degree would help reduce the number of preventable in-hospital deaths.CONCLUSIONSNurse staffing, nurse work environments, and percentages of nurses having Bachelor of Science in Nursing Degree in South Korea are associated with patient mortality. Improving hospital nurse staffing and work environments and increasing the percentages of nurses having Bachelor of Science in Nursing Degree would help reduce the number of preventable in-hospital deaths.
While considerable evidence has been produced showing a link between nursing characteristics and patient outcomes in the U.S. and Europe, little is known about whether similar associations are present in South Korea. To examine the effects of nurse staffing, work environment, and education on patient mortality. This study linked hospital facility data with staff nurse survey data (N = 1024) and surgical patient discharge data (N = 76,036) from 14 high-technology teaching hospitals with 700 or more beds in South Korea, collected between January 1, 2008 and December 31, 2008. Logistic regression models that corrected for the clustering of patients in hospitals were used to estimate the effects of the three nursing characteristics on risk-adjusted patient mortality within 30 days of admission. Risk-adjusted models reveal that nurse staffing, nurse work environments, and nurse education were significantly associated with patient mortality (OR 1.05, 95% CI 1.00-1.10; OR 0.52, 95% CI 0.31-0.88; and OR 0.91, CI 0.83-0.99; respectively). These odds ratios imply that each additional patient per nurse is associated with an 5% increase in the odds of patient death within 30 days of admission, that the odds of patient mortality are nearly 50% lower in the hospitals with better nurse work environments than in hospitals with mixed or poor nurse work environments, and that each 10% increase in nurses having Bachelor of Science in Nursing Degree is associated with a 9% decrease in patient deaths. Nurse staffing, nurse work environments, and percentages of nurses having Bachelor of Science in Nursing Degree in South Korea are associated with patient mortality. Improving hospital nurse staffing and work environments and increasing the percentages of nurses having Bachelor of Science in Nursing Degree would help reduce the number of preventable in-hospital deaths.
Author Sloane, Douglas M.
Cho, Eunhee
Kim, Eun-Young
Lee, Hye Sun
Choi, Miyoung
Kim, Sera
Aiken, Linda H.
Yoo, Il Young
AuthorAffiliation g Department of Biostatistics, Yonsei University College of Medicine, Seoul, South Korea
d Health Insurance Review & Assessment Service, Seoul, South Korea
c Dong-A University Department of Nursing, Busan, South Korea
e National Evidence-Based Healthcare Collaborating Agency, Seoul, South Korea
a Nursing Policy Research Institute, Yonsei University College of Nursing, Seoul, South Korea
b Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, PA, USA
f Nursing Policy Research Institute, Yonsei University College of Nursing, Seoul, South Korea
AuthorAffiliation_xml – name: a Nursing Policy Research Institute, Yonsei University College of Nursing, Seoul, South Korea
– name: b Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, PA, USA
– name: e National Evidence-Based Healthcare Collaborating Agency, Seoul, South Korea
– name: d Health Insurance Review & Assessment Service, Seoul, South Korea
– name: g Department of Biostatistics, Yonsei University College of Medicine, Seoul, South Korea
– name: c Dong-A University Department of Nursing, Busan, South Korea
– name: f Nursing Policy Research Institute, Yonsei University College of Nursing, Seoul, South Korea
Author_xml – sequence: 1
  givenname: Eunhee
  surname: Cho
  fullname: Cho, Eunhee
  organization: Nursing Policy Research Institute, Yonsei University College of Nursing, Seoul, South Korea
– sequence: 2
  givenname: Douglas M.
  surname: Sloane
  fullname: Sloane, Douglas M.
  organization: Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, PA, USA
– sequence: 3
  givenname: Eun-Young
  surname: Kim
  fullname: Kim, Eun-Young
  email: eykim@dau.ac.kr
  organization: Dong-A University, Department of Nursing, Busan, South Korea
– sequence: 4
  givenname: Sera
  surname: Kim
  fullname: Kim, Sera
  organization: Health Insurance Review & Assessment Service, Seoul, South Korea
– sequence: 5
  givenname: Miyoung
  surname: Choi
  fullname: Choi, Miyoung
  organization: National Evidence-Based Healthcare Collaborating Agency, Seoul, South Korea
– sequence: 6
  givenname: Il Young
  surname: Yoo
  fullname: Yoo, Il Young
  organization: Nursing Policy Research Institute, Yonsei University College of Nursing, Seoul, South Korea
– sequence: 7
  givenname: Hye Sun
  surname: Lee
  fullname: Lee, Hye Sun
  organization: Department of Biostatistics, Yonsei University College of Medicine, Seoul, South Korea
– sequence: 8
  givenname: Linda H.
  surname: Aiken
  fullname: Aiken, Linda H.
  organization: Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, PA, USA
BackLink https://www.ncbi.nlm.nih.gov/pubmed/25213091$$D View this record in MEDLINE/PubMed
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ContentType Journal Article
Copyright 2014 Elsevier Ltd
Copyright © 2014 Elsevier Ltd. All rights reserved.
Copyright Elsevier Science Ltd. Feb 2015
2014 Elsevier Ltd. All rights reserved. 2014
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Issue 2
Keywords Nursing education
Nurse work environment
Mortality
Patient outcomes
Nurse staffing
Language English
License Copyright © 2014 Elsevier Ltd. All rights reserved.
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Snippet While considerable evidence has been produced showing a link between nursing characteristics and patient outcomes in the U.S. and Europe, little is known about...
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SubjectTerms Avoidable
Beds
Clinical outcomes
Clinical training
Clustering
Data
Deaths
Discharge
Education
Female
Health education
Hospital Mortality
Hospitalization
Hospitals
Humans
Male
Medical personnel
Middle Aged
Mortality
Nurse staffing
Nurse work environment
Nurses
Nursing
Nursing care
Nursing education
Nursing Staff, Hospital - education
Observational studies
Patient admissions
Patient outcomes
Patients
Personnel Staffing and Scheduling
Republic of Korea
Risk adjustment
Staffing
Teaching
Teaching hospitals
Work environment
Workforce planning
Title Effects of nurse staffing, work environments, and education on patient mortality: An observational study
URI https://dx.doi.org/10.1016/j.ijnurstu.2014.08.006
https://www.ncbi.nlm.nih.gov/pubmed/25213091
https://www.proquest.com/docview/1647821976
https://www.proquest.com/docview/1643144047
https://www.proquest.com/docview/1672096801
https://pubmed.ncbi.nlm.nih.gov/PMC4286441
Volume 52
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