Acuity, nurse staffing and workforce, missed care and patient outcomes: A cluster‐unit‐level descriptive comparison

• Published in: Journal of nursing management Vol. 28; no. 8; pp. 2216 - 2229
• Main Authors: Juvé‐Udina, Maria‐Eulàlia, González‐Samartino, Maribel, López‐Jiménez, Maria Magdalena, Planas‐Canals, Maria, Rodríguez‐Fernández, Hugo, Batuecas Duelt, Irene Joana, Tapia‐Pérez, Marta, Pons Prats, Mònica, Jiménez‐Martínez, Emilio, Barberà Llorca, Miquel Àngel, Asensio‐Flores, Susana, Berbis‐Morelló, Carme, Zuriguel‐Pérez, Esperanza, Delgado‐Hito, Pilar, Rey Luque, Óscar, Zabalegui, Adelaida, Fabrellas, Núria, Adamuz, Jordi
• Format: Journal Article
• Language: English
• Published: England Hindawi Limited 01.11.2020; John Wiley and Sons Inc
• Subjects: acuity; Averages; Clinical outcomes; Clustering; Experts; Fatigue; Medical education; Medical errors; missed nursing care; Nurse managers; Nursing; Nursing administration; Nursing care; patient outcomes; patient safety; Patients; Policy making; Ratios; Special Issue Paper; Special Issue Papers; Staffing; Sympathy; Workforce; Workforce planning; Working hours; missed nursing care; patient safety; patient outcomes; acuity; staffing
• ISSN: 0966-0429; 1365-2834
• DOI: 10.1111/jonm.13040

Aim To compare the patient acuity, nurse staffing and workforce, missed nursing care and patient outcomes among hospital unit‐clusters. Background Relationships among acuity, nurse staffing and workforce, missed nursing care and patient outcomes are not completely understood. Method Descriptive design with data from four unit‐clusters: medical, surgical, combined and step‐down units. Descriptive statistics were used to compare acuity, nurse staffing coverage, education and expertise, missed nursing care and selected nurse‐sensitive outcomes. Results Patient acuity in general (medical, surgical and combined) floors is similar to step‐down units, with an average of 5.6 required RN hours per patient day. In general wards, available RN hours per patient day reach only 50% of required RN hours to meet patient needs. Workforce measures are comparable among unit‐clusters, and average missed nursing care is 21%. Patient outcomes vary among unit‐clusters. Conclusion Patient acuity is similar among unit‐clusters, while nurse staffing coverage is halved in general wards. While RN education, expertise and missed care are comparable among unit‐clusters, mortality, skin injuries and risk of family compassion fatigue rates are higher in general wards. Implications for Nursing Management Nurse managers play a pivotal role in hustling policymakers to address structural understaffing in general wards, to maximize patient safety outcomes.