Acuity, nurse staffing and workforce, missed care and patient outcomes: A cluster‐unit‐level descriptive comparison
Maria‐Eulàlia Juvé‐Udina, Maribel González‐Samartino, María‐Magdalena López‐Jiménez, Maria Planas‐Canals, Hugo Rodríguez‐Fernández, Irene Joana Batuecas Duelt, Marta Tàpia‐Pérez, Mònica Pons Prats, Emilio Jiménez‐Martínez, Miquel Àngel Barberà Llorca, S. Asensio-Flores, Carme Berbís‐Morelló, Esperanza Zuriguel‐Pérez, Pilar Delgado‐Hito, Óscar Rey Luque, Adelaida Zabalegui, Núria Fabrellas, Jordi Adamuz
Abstract
AIM: To compare the patient acuity, nurse staffing and workforce, missed nursing care and patient outcomes among hospital unit-clusters. BACKGROUND: Relationships among acuity, nurse staffing and workforce, missed nursing care and patient outcomes are not completely understood. METHOD: Descriptive design with data from four unit-clusters: medical, surgical, combined and step-down units. Descriptive statistics were used to compare acuity, nurse staffing coverage, education and expertise, missed nursing care and selected nurse-sensitive outcomes. RESULTS: Patient acuity in general (medical, surgical and combined) floors is similar to step-down units, with an average of 5.6 required RN hours per patient day. In general wards, available RN hours per patient day reach only 50% of required RN hours to meet patient needs. Workforce measures are comparable among unit-clusters, and average missed nursing care is 21%. Patient outcomes vary among unit-clusters. CONCLUSION: Patient acuity is similar among unit-clusters, while nurse staffing coverage is halved in general wards. While RN education, expertise and missed care are comparable among unit-clusters, mortality, skin injuries and risk of family compassion fatigue rates are higher in general wards. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers play a pivotal role in hustling policymakers to address structural understaffing in general wards, to maximize patient safety outcomes.