School of Nursing, University of Maryland, Baltimore, MD 21201, USA.
Nurs Res. 2011 Jan-Feb;60(1):1-8. doi: 10.1097/NNR.0b013e3181fff15d.
Although nurse staffing has been found to be related to patient mortality, there has been limited study of the independent effect of work schedules on patient care outcomes.
To determine if, in hospitals where nurses report more adverse work schedules, there would be increased patient mortality, controlling for staffing.
A cross-sectional design was used, with multilevel data from a 2004 survey of 633 nurses working in 71 acute nonfederal hospitals in North Carolina and Illinois. Mortality measures were the risk-adjusted Agency for Healthcare Research and Quality Inpatient Quality Indicators, and staffing data were from the American Hospital Association Annual Survey of hospitals. Principal components analysis was conducted on the 12 work schedule items to create eight independent components. Generalized estimating equations were used to examine the study hypothesis.
Work schedule was related significantly to mortality when staffing levels and hospital characteristics were controlled. Pneumonia deaths were significantly more likely in hospitals where nurses reported schedules with long work hours (odds ratio [OR] = 1.42, 95% confidence interval [CI] = 1.17-1.73, p < .01) and lack of time away from work (OR = 1.24, 95% CI = 1.03-1.50, p < .05). Abdominal aortic aneurysm was also associated significantly with the lack of time away (OR = 1.39, 95% CI = 1.11-1.73, p < .01). For patients with congestive heart failure, mortality was associated with working while sick (OR = 1.39, 95% CI = 1.13-1.72, p < .01), whereas acute myocardial infarction was associated significantly with weekly burden (hours per week; days in a row) for nurses (OR = 1.33, 95% CI = 1.09-1.63, p < .01).
In addition to staffing, nurses' work schedules are associated with patient mortality. This suggests that work schedule has an independent effect on patient outcomes.
尽管护士人员配备与患者死亡率有关，但关于工作安排对患者护理结果的独立影响的研究有限。
确定在报告工作安排更不利的医院中，是否会增加患者死亡率，同时控制人员配备。
使用 2004 年对北卡罗来纳州和伊利诺伊州 71 家急性非联邦医院的 633 名护士进行的横断面设计和多层次数据。死亡率测度是调整后的医疗机构医疗质量和患者安全调查机构住院患者质量指标，人员配备数据来自美国医院协会年度医院调查。对 12 项工作时间表项目进行主成分分析，创建 8 个独立组件。使用广义估计方程检验研究假设。
在控制人员配备水平和医院特征后，工作安排与死亡率显著相关。在护士报告工作时间长（比值比 [OR] = 1.42，95%置信区间 [CI] = 1.17-1.73，p <.01）和缺乏工作时间的医院中，肺炎死亡的可能性明显更高，并且没有离开工作（OR = 1.24，95%CI = 1.03-1.50，p <.05）。腹主动脉瘤也与缺乏时间显著相关（OR = 1.39，95%CI = 1.11-1.73，p <.01）。对于充血性心力衰竭患者，与生病时工作相关（OR = 1.39，95%CI = 1.13-1.72，p <.01），而急性心肌梗死与护士每周工作量（每周工作小时数；连续天数）显著相关（OR = 1.33，95%CI = 1.09-1.63，p <.01）。
除人员配备外，护士的工作安排与患者死亡率有关。这表明工作安排对患者结果有独立影响。
