Associations between rates of unassisted inpatient falls and levels of registered and non-registered nurse staffing.

ABSTRACT

OBJECTIVE: To enhance understanding of how nurse staffing relates to unassisted falls by exploring non-linear associations between unassisted fall rates and levels of registered nurse (RN) and non-RN staffing on 5 nursing unit types, thereby enabling managers to improve patient safety by making better-informed decisions about staffing. DESIGN: Cross-sectional analysis of routinely collected data using hierarchical negative binomial regression. SETTING: 8069 nursing units in 1361 U.S. hospitals participating in the National Database of Nursing Quality Indicators(®). Main outcome measure Rate of unassisted falls per inpatient day. RESULTS: Associations between unassisted fall rates and nurse staffing varied by unit type. For medical-surgical units, higher RN staffing was weakly associated with lower fall rates. On step-down and medical units, the association between RN staffing and fall rates depended on the level of staffing At lower staffing levels, the fall rate increased as staffing increased, but at moderate and high staffing levels, the fall rate decreased as staffing increased. Higher levels of non-RN staffing were generally associated with higher fall rates.. CONCLUSIONS: Increasing non-RN staffing seems ineffective at preventing unassisted falls. Increasing RN staffing may be effective, depending on the unit type and the current level of staffing.