Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania, USA.
BMJ Qual Saf. 2021 Aug;30(8):639-647. doi: 10.1136/bmjqs-2020-011512. Epub 2020 Aug 18.
Efforts to enact nurse staffing legislation often lack timely, local evidence about how specific policies could directly impact the public's health. Despite numerous studies indicating better staffing is associated with more favourable patient outcomes, only one US state (California) sets patient-to-nurse staffing standards. To inform staffing legislation actively under consideration in two other US states (New York, Illinois), we sought to determine whether staffing varies across hospitals and the consequences for patient outcomes. Coincidentally, data collection occurred just prior to the COVID-19 outbreak; thus, these data also provide a real-time example of the public health implications of chronic hospital nurse understaffing.
Survey data from nurses and patients in 254 hospitals in New York and Illinois between December 2019 and February 2020 document associations of nurse staffing with care quality, patient experiences and nurse burnout.
Mean staffing in medical-surgical units varied from 3.3 to 9.7 patients per nurse, with the worst mean staffing in New York City. Over half the nurses in both states experienced high burnout. Half gave their hospitals unfavourable safety grades and two-thirds would not definitely recommend their hospitals. One-third of patients rated their hospitals less than excellent and would not definitely recommend it to others. After adjusting for confounding factors, each additional patient per nurse increased odds of nurses and per cent of patients giving unfavourable reports; ORs ranged from 1.15 to 1.52 for nurses on medical-surgical units and from 1.32 to 3.63 for nurses on intensive care units.
Hospital nurses were burned out and working in understaffed conditions in the weeks prior to the first wave of COVID-19 cases, posing risks to the public's health. Such risks could be addressed by safe nurse staffing policies currently under consideration.
制定护士人员配备法规的工作往往缺乏有关特定政策如何直接影响公众健康的及时、本地证据。尽管有许多研究表明更好的人员配备与更有利的患者结果相关，但只有一个美国州（加利福尼亚州）设定了患者与护士人员配备标准。为了为正在美国另外两个州（纽约州、伊利诺伊州）积极考虑的人员配备立法提供信息，我们试图确定医院之间的人员配备情况是否存在差异，以及对患者结果的影响。巧合的是，数据收集恰好在 COVID-19 爆发之前进行；因此，这些数据还提供了慢性医院护士人员配备不足对公共卫生的实时影响的示例。
2019 年 12 月至 2020 年 2 月期间，在纽约和伊利诺伊州的 254 家医院中，从护士和患者那里收集的调查数据记录了护士人员配备与护理质量、患者体验和护士倦怠之间的关联。
内科病房的平均人员配备从每位护士 3.3 至 9.7 名患者不等，纽约市的平均人员配备最差。两个州的一半以上护士经历了高度倦怠。一半的护士给他们的医院打了不称职的安全等级，三分之二的人不会肯定推荐他们的医院。三分之一的患者对他们的医院评价不高，也不会肯定向其他人推荐。在调整了混杂因素后，每位护士每增加一名患者，护士和患者报告不良的几率就会增加；内科病房护士的比值比（OR）范围从 1.15 到 1.52，重症监护病房护士的 OR 范围从 1.32 到 3.63。
在 COVID-19 病例的第一波之前的几周内，医院护士已经精疲力尽，工作人手不足，这对公众健康构成了风险。目前正在考虑的安全护士人员配备政策可以解决这些风险。
