Biostatistics and Epidemiology, Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, Missouri.
School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri.
Res Nurs Health. 2019 Oct;42(5):410-415. doi: 10.1002/nur.21979. Epub 2019 Aug 20.
The purpose of this study was to examine national trends and variation in nurse staffing on inpatient psychiatric units in US general hospitals from 2005-2017. The National Database of Nursing Quality Indicators provided data on nurse staffing from 1,143 psychiatric units in 610 US hospitals. A weighted linear mixed model was fitted for each of two staffing measures: Registered nurse (RN) hours per patient day (HPPD) and non-RN HPPD. Monthly staffing levels were modeled as a function of study year, unit type, and hospital bed size, teaching status, government ownership, for-profit status, metropolitan location, and US census division. Very gradual upward trends in staffing were observed. Compared with adult units, child/adolescent units had lower RN staffing and higher non-RN staffing. Levels of both types of staffing were lower in for-profit facilities. The Pacific census division had higher RN staffing than every other census division by an estimated margin of 0.52-1.54 HPPD, and census divisions with the lowest levels of RN staffing had the highest levels of non-RN staffing. Despite concerns expressed over the past 15 years about patient violence, staffing levels, and use of seclusion and restraint on psychiatric units, average staffing levels have apparently increased only modestly since 2005, and increases in RN staffing on psychiatric units have not kept pace with increases in general care units. Marked regional differences in staffing merit further investigation.
本研究旨在考察 2005 年至 2017 年期间美国综合医院住院精神科病房护士人力配置的全国趋势和变化。国家护理质量指标数据库提供了来自美国 610 家医院 1143 个精神科病房的护士人力配置数据。对两种人员配备措施（每患者护理时数和非注册护士每患者护理时数）中的每一种都拟合了加权线性混合模型。每月人员配备水平被建模为研究年份、单位类型和医院床位数、教学状态、政府所有、营利性、大都市位置和美国人口普查分区的函数。人员配备呈现出非常缓慢的上升趋势。与成人病房相比，儿童/青少年病房的注册护士配备较少，非注册护士配备较多。营利性机构的这两种人员配备水平都较低。与其他每个普查分区相比，太平洋普查分区的注册护士配备人数估计高出 0.52-1.54 个每患者护理时数，而注册护士配备人数最低的普查分区的非注册护士配备人数最高。尽管在过去 15 年中，人们对精神科病房的患者暴力、人员配备和使用隔离约束表示担忧，但自 2005 年以来，人员配备水平仅略有增加，精神科病房的注册护士配备增加速度并未跟上一般护理病房的增加速度。人员配备方面明显的地区差异值得进一步调查。
