Adjusted and unadjusted odds ratios showing the effects of nurse staffing and nurse education on 30 day in-hospital mortality_
| Unadjusted model OR 95% CI | p-value | Adjusted model OR 95% CI | p-value | ||
|---|---|---|---|---|---|
| Model - all together | Staffing | 1.008 (0.932-1.090) | 0.838 | 1.059 (1.011-1.110) | 0.016 |
| Education | 1.024 (1.002-1.046) | 0.032 | 1.011 (0.984-1.039) | 0.436 |
Tasks respondents should have performed during their last shift but did not due to lack of time_
| Item | n | % (min - max) | Impact of education (p bold - lower presence in group RNs) |
|---|---|---|---|
| Comfort and talk with patients | 1000 | 588/1,009 (58.3) [41.9 - 72.7] | 0.060 |
| Educating patients and family | 1001 | 563/1,008 (55.9) [32.3 - 61.9] | 0.067 |
| Adequate patient surveillance | 1001 | 362/1,010 (35.8) [22.6 - 47.4] | 0.006 |
| Developing or updating nursing care plans or care pathways | 1000 | 362/1,010 (35.8) [22.6 - 53.3] | <0.001 |
| Frequent changing of patient position | 1001 | 322/1,010 (31.9) [19.7 - 49.1] | 0.043 |
| Oral hygiene | 1001 | 317/1,009 (31.4) [21.1 - 54.4] | 0.501 |
| Adequately document nursing care | 1001 | 294/1,010 (29.1) [15.8 - 42.9] | 0.006 |
| Planning care | 1001 | 272/1,010 (26.9) [9.7 - 50.0] | <0.001 |
| Skin care | 1001 | 275/1,010 (23.2) [7.9 - 40.9] | 0.614 |
| Prepare patients and families for discharge | 1001 | 221/1,010 (21.9) [6.45 - 28.6] | 0.015 |
| Administer medications on time | 1001 | 175/1,009 (17.3) [3.2 - 28.6] | 0.937 |
| Treatments and procedures | 1001 | 138/1,010 (13.7) [6.6 - 21.4] | 0.174 |
| Pain management | 1001 | 105/1,010 (10.4) [2.6 - 19.1] | 0.088 |
| Composite score | Mean=3.9 (SD=0.7) | ||
| Min=2.7 - Max=5.1 |
Patient characteristics (n=36,037) in the included hospitals_
| Number | |
|---|---|
| Men | 18,768 (52.08) |
| Emergency admissions | 10,682 (29.64) |
| Inpatient deaths within 30 days of admission | 359 (1.00) |
| Categories | |
| Injury - S | 9,842 (27.31) |
| Disease of musculoskeletal system - M | 10,680 (29.64) |
| Disease of digestive system - K | 10,322 (28.64) |
| Disease of circulatory system - I | 2,841 (7.88) |
| Malignant neoplasm - C | 2,352 (6.53) |
| Comorbidities | |
| Myocardial infarction | 437 (1.21) |
| Congestive heart failure | 978 (2.71) |
| Peripheral vascular disease | 517 (1.43) |
| Cerebrovascular disease | 483 (1.34) |
| Dementia | 387 (1.07) |
| Chronic pulmonary disease | 667 (1.85) |
| Rheumatic disease | 151 (0.42) |
| Peptic ulcer disease | 50 (0.14) |
| Mild liver disease | 230 (0.64) |
| Diabetes without chronic complication | 1 866 (5.18) |
| Diabetes with chronic complication | 199 (0.55) |
| Hemiplegia or paraplegia | 82 (0.23) |
| Renal disease | 473 (1.31) |
| Malignancy | 677 (1.88) |
| Moderate or severe liver disease | 44 (0.12) |
| Metastatic solid tumour | 591 (1.64) |
| AIDS/HIV | 0 (0) |
Number of deaths and discharges per hospital, overall (%) of RNs and patient-to-RN ratio_
| Hospital | Deaths / Discharges (%) | RNs(%) | Patient-to-RN ratio (M) |
|---|---|---|---|
| AC | 26 / 2,440 (1.05) | 42.22 | 15.7179 |
| AH | 9 / 1,082 (0.82) | 32.25 | 17.1000 |
| BK | 28 / 3,079 (0.90) | 29.26 | 17.5083 |
| BU | 40 / 4,076 (0.97) | 48.76 | 14.0615 |
| DQ | 13 / 1,817 (0.71) | 33.33 | 15.6152 |
| EA | 107 / 10,680 (0.99) | 46.18 | 10.2855 |
| EF | 12 / 2,672 (0.45) | 29.16 | 14.3178 |
| FH | 5 / 1,844 (0.27) | 28.94 | 19.3851 |
| FZ | 102 / 6,193 (1.62) | 42.64 | 17.1487 |
| HG | 17 / 1,795 (0.94) | 23.68 | 14.4306 |
| Total | 359 / 3,6037 (1.00) | 35.65 | 15.56 |
Frequency of different tasks during the most recent work shift and differences in educational level_
| Items | n | Never | Sometimes | Often | RN Often | HCA Often | Education |
|---|---|---|---|---|---|---|---|
| % | % | % | % | % | p | ||
| Delivering and retrieving food trays | 993 | 17.1 | 23.1 | 58.2 | 32.9 | 76.7 | <0.001 |
| Performing non-nursing care | 987 | 6.1 | 49.4 | 44.4 | 40.5 | 46.8 | 0.114 |
| Arranging discharge referrals and transportation (including to long-term care) | 992 | 32.9 | 30.3 | 36.8 | 51 | 27.4 | <0.001 |
| Routine phlebotomy/blood draw for tests | 983 | 48.9 | 13.4 | 37.5 | 76.1 | 11.1 | <0.001 |
| Transporting of patients within hospital | 986 | 22.9 | 37.1 | 39.8 | 32.6 | 44.7 | <0.001 |
| Cleaning patient rooms and equipment | 991 | 16.3 | 36.3 | 47.2 | 28.3 | 59.9 | <0.001 |
| Filling in for non-nursing services not available on off-hours | 976 | 25.5 | 49.1 | 25.4 | 20.3 | 29 | <0.001 |
| Obtaining supplies or equipment | 989 | 12.8 | 40.8 | 46.3 | 49.6 | 44.1 | 0.308 |
| Answering phones, clerical duties | 998 | 2.0 | 15.2 | 82.6 | 89 | 78.4 | <0.001 |