Kovner C, Gergen P J
Division of Nursing, School of Education, New York University, NY, USA.
Image J Nurs Sch. 1998;30(4):315-21.
To examine the relationship between nurse staffing and selected adverse events hypothesized to be sensitive to nursing care, while controlling for related hospital characteristics. Efforts in the United States to reduce hospital costs, resulting in strategies to use fewer nurses, have stimulated extensive debate but little evaluation.
Survey using data from a 20% stratified probability sample to approximate U.S. community hospitals. The sample included 589 acute-care hospitals in 10 states.
Discharge data from 1993 for patients aged 18 years and over were used to create hospital-level adverse event indicators. These hospital-level data were matched to American Hospital Association data on community hospital characteristics, including nurse staffing, to examine the relationship between nurse staffing and adverse events.
A large and significant inverse relationship was found between full-time-equivalent RNs per adjusted inpatient day (RNAPD) and urinary tract infections after major surgery (p < .0001) as well as pneumonia after major surgery (p < .001). A significant but less robust inverse relationship was found between RNAPD and thrombosis after major surgery (p < .01), as well as pulmonary compromise after major surgery (p < .05).
Inverse relationships between nurse staffing and these adverse events provide information for managers to use when redesigning and restructuring the clinical workforce employed in providing inpatient care.
在控制相关医院特征的同时，研究护士配备与选定的据推测对护理敏感的不良事件之间的关系。美国为降低医院成本而采取的减少护士使用的策略引发了广泛争论，但评估较少。
使用来自20%分层概率样本的数据进行调查，以近似美国社区医院的情况。样本包括10个州的589家急症护理医院。
使用1993年18岁及以上患者的出院数据创建医院层面的不良事件指标。这些医院层面的数据与美国医院协会关于社区医院特征（包括护士配备）的数据相匹配，以研究护士配备与不良事件之间的关系。
每调整住院日的全职等效注册护士（RNAPD）与大手术后的尿路感染（p < .0001）以及大手术后的肺炎（p < .001）之间存在显著的负相关关系。RNAPD与大手术后的血栓形成（p < .01）以及大手术后的肺部功能损害（p < .05）之间存在显著但不太显著的负相关关系。
护士配备与这些不良事件之间的负相关关系为管理人员在重新设计和重组提供住院护理的临床工作人员时提供了有用信息。
