The relationship between staffing and adverse events in Washington State hospitals: a cross-sectional study using linked hospital data.

Objective: To quantify the relationship between staffing characteristics and patient outcomes in acute care hospitals in Washington state. Methods: Retrospective cross-sectional time-series study of linked data from six sources on staffing and outcomes for Washington state hospitals. Key stakeholders provided input on data sources, measures, and outcomes in a four-phase participatory process. After data cleaning and linkage, we used a random effects Poisson regression model to examine the relationship between staffing levels or characteristics and adverse outcomes. Results: The study included 263 hospital-years from 80 distinct hospitals, with 162 hospital-years from general acute care hospitals (n=46) and 101 hospital-years from critical access hospitals (n=34). In general acute care hospitals, a higher ratio of patients to care team staff is associated with a higher number of adverse events (adjusted RR, 1.36 per one SD increase; 95% UI 1.13-1.63), and a lower proportion of RNs on the care team staff is likely associated with a higher number of adverse events (adjusted RR, 1.16 per one SD increase; 95% UI, 0.97-1.39). In critical access hospitals, a lower proportion of RNs on the care team is associated with a higher number of adverse events (adjusted RR, 3.28 per one SD increase; 95% UI, 1.20-7.75). A counterfactual analysis indicated that if all general acute care hospitals had no more than the median staffing ratio of 1.2 patient hours per staff hour, the number of adverse events would be reduced by 10% (95% UI 2.7-16.8). Conclusion: RN staffing is an indisputable component of safe, high quality patient care, and other factors such as availability of care team staff, hospital features, and patient characteristics also impact patient outcomes. This study highlights the utility of merging diverse data sources to provide a comprehensive analysis of the relationships between staffing and patient outcomes.

A Contemporary Model for Improving RN Job Outcomes.

The pandemic has highlighted three critical nursing workforce issues: turnover, wellbeing, and equity. A comprehensive framework is needed to understand the interactions between these concepts. This paper proposes a model that allows for more inclusive understanding of professional outcomes for RNs, with attention not just to job outcomes, but also to equity for underrepresented groups in the workforce and individual wellbeing. The model highlights the importance of systems and societal elements, contextual elements, and individual responses to the dynamic conditions of work and life, and can be used to advance research and practice to create effective retention and support strategies.

COVID-19 Related Job Outcomes for Nurses of Color in the United States.

The purpose of this study was to examine factors associated with negative job outcomes for nurses during the initial phase of the COVID-19 pandemic, with a focus on nurses of color. The study used data from 3,782 nurses in the Current Population Survey to examine the relationship between nurse characteristics and COVID-19-related inability to work or look for work during May through December 2020. The analysis showed that race and gender did not significantly impact nurses' job outcomes. The odds of a negative impact were increased by age (1.5% per year, p < .05), having a child in the home (43%, p < .01), having no spouse present (36%, p < .01), and working in an outpatient role (48%, p < .001). While race alone was not linked to negative outcomes, nurses of color had higher rates of other factors that were associated with negative outcomes, indicating a need for a more nuanced examination of their work and life contexts and job outcomes throughout the pandemic.

Discipline-Specific Writing Support in Graduate Nursing.

BACKGROUND: Scholarly writing is an essential skill for a doctorally prepared nurse. Despite the importance of writing, there are limited data on how best to support students in the process of writing skill acquisition. This article describes the development, growth, and effects of a writing support program for graduate nursing students. METHOD: A writing support program was initiated with a focus on providing discipline-specific support. Activities included oneon-one coaching, workshops, and collaboration with faculty to offer writing content within or alongside courses. RESULTS: Student and faculty evaluations show the benefits of the writing support program to enhance student confidence and skill in writing. CONCLUSION: Development of a writing support program has provided a valuable resource to graduate students and faculty in the school of nursing. Writing must be intentionally included in doctoral programs and supported with an array of practices including discipline-specific feedback. [J Nurs Educ. 2023;62(4):253-256.].

Stakeholder perspectives on factors influencing acute care patient outcomes: A qualitative approach to model refinement.

Background: Health systems have long been interested in the best practices for staffing in the acute care setting. Studies on staffing often focus on registered nurses and nurse-to-patient staffing ratios. There are fewer studies on the relationship between interprofessional team members or contextual factors such as hospital and community characteristics and patient outcomes. This qualitative study aimed to refine a causal model by soliciting hospital stakeholder feedback on staffing and patient outcomes. Methods: We conducted a qualitative study using semi-structured interviews and thematic analysis to understand hospital stakeholder perspectives and their experiences of factors that affect acute care inpatient outcomes. Interviews were conducted in 2022 with 38 hospital stakeholders representing 19 hospitals across Washington State. Results: Findings support a model of characteristics impacting patient outcomes to include the complex and interconnected relationships between community, hospital, patient, and staffing characteristics. Within the model, patient characteristics are nested into hospital characteristics, and in turn these were nested within community characteristics to highlight the importance of setting and context when evaluating outcomes. Together, these factors influenced both staff characteristics and patient outcomes, while these two categories also share a direct relationship. Conclusion: Findings can be applied to hospitals and health systems across the globe to examine how external factors such as community resource availability impact care delivery. Future research should expand on this work with specific attention to how staffing changes and interprofessional team composition can improve patient outcomes.

Using an academic-practice partnership to enhance ambulatory care nursing skills.

BACKGROUND: Ambulatory nursing services are essential to healthcare in communities, but nursing curricula often omit ambulatory care training. The purpose of this project was to enhance ambulatory care competencies among nursing students and provide ongoing education for practicing nurses through an academic-practice partnership. METHODS: A four-year externally funded project targeted enhancements to undergraduate nursing curricula and development activities. Students received didactic content and clinical experiences and were evaluated to assess critical ambulatory care nursing skills. Existing continuing education offerings were enhanced with team-based practice content. RESULTS: Despite pandemic-related clinical training changes, data from multiple quarters showed improvement in students' perceptions of self-efficacy (1.7-4.28-point increases) and actual performance (3.46-4.05-point increases) of core competencies on the 20-point evaluation scales. In addition, students rated simulations favorably, with scores ranging from 1.4 to 1.9 on the 2-point subscales. CONCLUSION: An academic-practice partnership provides mutually beneficial opportunities for enhancing the ambulatory care nursing workforce through undergraduate education and training and professional development for practicing nurses.

A systematic review of registered nurse turnover and retention in the United States.

BACKGROUND: The pandemic has highlighted the struggles of nurses and risks of workforce shortages. Analysis of nurses' job decisions is necessary to mitigate these risks. PURPOSE: The purpose of this systematic review was to understand factors associated with registered nurse (RN) work outcomes in the United States, and to examine the inclusion of equity and wellness concepts in this body of literature. METHODS: This review utilized the Preferred Reporting Items for Systematic reviews and Meta-Analyses protocol. Studies from PubMed and CINAHL were included if they focused on RNs in the United States in the past 10 years. A total of 34 studies are included in the review. FINDINGS: RN work outcomes are impacted by individual, unit level, and organizational factors. Few studies address equity, and many only address RN health in terms of burnout. DISCUSSION: Future work needs to draw samples from broader practice settings, focus on interventions that promote positive outcomes, and focus on equity and the wellbeing of RNs.

Individual nurse empowerment: A concept analysis.

AIM: This concept analysis aims to distinguish the concept of nurse empowerment as an individual professional process rather than a job-related process and to identify ways in which a clarified understanding of individual empowerment can impact the discipline. BACKGROUND: The history of nursing as a gendered role has led to oppression in the profession as evidenced by lateral violence and attrition. Empowerment initiatives that focus on a nurse within an organization often provide false power. DESIGN: Walker and Avant's method was used for this concept analysis. DATA SOURCE: Published literature from 1990 to 2019 was identified from electronic health profession-related databases, and current definitions and uses of empowerment were pulled from empirical works and electronic databases. REVIEW METHODS: A review of abstracts and full text from articles relating to nurse empowerment was performed, and empirical studies used to provide an understanding of the concept as used today. RESULTS: True empowerment entails a nurse controlling her practice and career. Elements of individual empowerment can be pulled from existing work on structural and psychological empowerment. CONCLUSIONS: Analyzing nurse empowerment from an individual perspective allows us to move beyond the oppressive history of nursing and move the profession forward to impact our communities.