Nurse staffing; needle-stick injuries; surgical site infections; surgical boots - Evidence For Practice

AORN Journal,  August, 2002  by Suzanne C. Beyea

• E-mail
• Print
• Link

Editor's note: Starling in the July issue, "Research Corner" is no longer being published; however, a new monthly column titled "Evidence for Practice" will bring you research briefs about the latest research published related to perioperative nursing. The intent of these briefs is to provide clinicians with up-to-date information to consider when updating policies, procedures, and practices. Readers who consider basing policies, procedures, and practices on these findings should refer to the original research article and critique the study for its applicability to a specific clinical setting or population.

NURSE-STAFFING LEVELS AND QUALITY

The New England Journal of Medicine, May 30, 2002

This study examined the relationship between nurse staffing and patient morbidity and mortality. (1) Researchers used 1997 administrative data from 799 hospitals in 11 states (ie, 5,075,969 discharges of medical patients and 1,104,659 discharges of surgical patients) to examine the relationship of nursing care to patient outcomes. To control for differences among hospitals, patient level data were controlled to address variations in patient mix. Levels of nurse staffing also were adjusted to develop consistent, reliable measures across clinical settings.

Findings. Researchers reported that a higher proportion and greater absolute number of hours of care per day provided by RNs to medical patients resulted in shorter lengths of stay and lower rates of urinary tract infection and upper gastrointestinal bleeding. Among these patients, a higher proportion of hours of care provided by RNs also was associated with lower rates of pneumonia; shock; cardiac arrest; and "failure to rescue," which is defined as death from pneumonia, shock, cardiac arrest, upper gastrointestinal bleeding, sepsis, or deep venous thrombosis. Among surgical patients, a higher proportion of hours of care provided by RNs was associated with lower rates of urinary tract infection, and a greater number of hours of care was associated with lower rates of "failure to rescue." No association was found between increased RN staffing levels and the rate of in-hospital death or between increased staffing of licensed practical nurses or nurses' aides and the rate of adverse outcomes.

Clinical implications. This study should help hospital administrators more clearly understand that hospitals with a higher proportion and greater absolute number of hours of care per day provided by RNs are associated with better patient care and outcomes. Efforts should be made to provide adequate nurse staffing in both medical and surgical areas and to better understand the relationship between nurse staffing and nursing-sensitive outcomes. Although this study does not address perioperative nurse staffing specifically, one would expect that a higher proportion of RNs in the OR and other perioperative settings is critical to reduce patient morbidity and mortality. The researchers also emphasize the importance of developing systems for routine monitoring of hospital outcomes that are sensitive to nurse staffing levels. Perioperative nurses need to be aware of opportunities to monitor their contributions to patient outcomes and work toward collecting related data. Managers who are concerned about quality and patient outcomes should believe that RNs are worth the extra salary when making hiring decisions.

PREDICTING NEEDLE-STICK INJURIES AND NEAR MISSES

American Journal of Infection Control, June 2002

This research study surveyed 2,287 medical-surgical unit nurses in 22 US hospitals with excellent reputations. (2) The purpose was to assess staffing levels and organizational climate in these facilities and their relationship to patient and nurse outcomes, including needle-stick injuries. Hospitals involved in the study provided data about the types of protective devices available to nurses at the time of the study. A variety of statistical methods were used to examine the relationship between nurse and hospital characteristics and protective equipment and the likely occurrence of needle-stick injuries and near-miss incidents.

Findings. The results suggest that the risk of sharps injuries is related strongly to nurse staffing levels and working environment. It appears that both safety equipment and general working conditions play important roles in reducing injuries. In this study, the use of safety equipment was associated with a 20% to 30% reduction in the risk of injuries or near-miss incidents, respectively. Furthermore, nurses in hospitals with poor staffing levels and work climate noted a 50% or greater increased risk of injuries.

Clinical implications. When hospitals and clinical units address nurse safety, they must address the issues of staffing, morale, and working environment. The single intervention of providing safety equipment is not adequate to decrease the risks that nurses encounter and the injuries they sustain. Addressing organizational factors and providing equipment will result in the best possible outcomes.