The Impact of Nursing Resources on Chronic Wound Management: A Cross-Sectional Analysis.

AIM

Evaluate the relationship between hospital nursing resources and outcomes among patients with chronic wounds.

DESIGN

Cross-sectional observational.

METHODS

Hospital-level predictors included the nurse work environment, proportion of Bachelor of Science (BSN)-prepared nurses, and skill mix (i.e., registered nurses [RN] as proportion of nursing personnel). Outcomes included in-hospital and 30-day mortality, discharging to a higher level of care and length of stay. Individual-level nurse data were aggregated to create hospital-level measures of nursing resources. We utilised multi-level modelling with nurses nested within hospitals and outcomes at the patient level.

DATA

Three datasets from 2021: RN4CAST-New York/Illinois survey, Medicare Provider Analysis and Review claims and American Hospital Association Annual Survey.

RESULTS

The sample included 34,113 patients with chronic wounds in 215 hospitals in New York and Illinois. In adjusted models, a 1 standard deviation improvement in the work environment was associated with 12% lower odds of in-hospital mortality, 8% lower odds of discharging to a higher level of care and a shorter length of stay by a factor of 0.96. A 10% increase in BSN composition was associated with 8% reduced odds of in-hospital mortality and 6% reduced odds of 30-day mortality. A 10% increase in skill mix was associated with 12% lower odds of in-hospital mortality and a shorter length of stay by a factor of 0.91.

CONCLUSION

Improved nursing resources are associated with better outcomes among patients with chronic wounds.

IMPLICATIONS

Nurses manage the care of patients with chronic wounds; thus, hospital investment in nursing resources is imperative for good outcomes.

IMPACT

Modifiable hospital nursing resources are associated with outcomes among patients with chronic wounds, a complex population.

REPORTING

STROBE.