The Relationships of Nurse Staffing Level and Work Environment With Patient Adverse Events.
PURPOSE The purpose of this study was to examine the relationships of nurse staffing level and work environment with patient adverse events. DESIGN This cross sectional study used a combination of nurse survey data (N 4,864 nurses) facility data (N 58 hospitals) and patient hospital discharge data (N 113,426 patients) in South Korea. METHODS The three most commonly nurse reported adverse events included administration of the wrong medication or dose to a patient, pressure ulcers, and injury from a fall after admission. Multilevel ordinal logistic regression was employed to explore the relationships of nurse staffing level (number of patients assigned to a nurse) and work environment (Practice Environment Scale of the Nursing Work Index) with patient adverse events after controlling for nurse, hospital, and patient characteristics. FINDINGS A larger number of patients per nurse was significantly associated with a greater incidence of administration of the wrong medication or dose (odds ratio [OR] 1.01, 95% confidence interval [CI] 1.007 1.016) pressure ulcer (OR 1.01, 95% CI 1.007 1.016) and patient falls with injury (OR 1.02, 95% CI 1.013 1.022) A better work environment had a significant inverse relationship with adverse events; the odds of reporting a higher incidence of adverse events were 45% lower for administration of the wrong medication or dose (OR 0.55, 95% CI 0.400 0.758) followed by 39% lower for pressure ulcer (OR 0.61, 95% CI 0.449 0.834) and 32% lower for falls with injury after admission (OR 0.68, 95% CI 0.490 0.939) CONCLUSIONS This study found that a larger number of patients per nurse and poor work environment increase the incidence of patient adverse events, such as administration of the wrong medication or dose to a patient, pressure ulcers, and injury from falling after admission. The findings suggest that South Korean hospitals could prevent patient adverse events by improving nurse staffing and work environment. CLINICAL RELEVANCE Healthcare strategies and efforts to modify adequate nurse staffing levels and better work environments for nurses are needed to improve patient outcomes.
Journal of nursing scholarship an official publication of Sigma Theta Tau International Honor Society of Nursing