Case for hospital nurse-to-patient ratio legislation in Queensland, Australia, hospitals: an observational study
Objectives To determine whether there was variation in nurse staffing across hospitals in Queensland prior to implementation of nurse-to-patient ratio legislation targeting medical-surgical wards, and if so, the extent to which nurse staffing variation was associated with poor outcomes for patients...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2020-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/9/e036264.full |
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| author | Carol Windsor Patsy Yates Linda H Aiken Clint Douglas Matthew D McHugh |
| author_facet | Carol Windsor Patsy Yates Linda H Aiken Clint Douglas Matthew D McHugh |
| author_sort | Carol Windsor |
| collection | DOAJ |
| description | Objectives To determine whether there was variation in nurse staffing across hospitals in Queensland prior to implementation of nurse-to-patient ratio legislation targeting medical-surgical wards, and if so, the extent to which nurse staffing variation was associated with poor outcomes for patients and nurses.Design Analysis of cross-sectional data derived from nurse surveys linked with admitted patient outcomes data.Setting Public hospitals in Queensland.Participants 4372 medical-surgical nurses and 146 456 patients in 68 public hospitals.Main outcome measures 30-day mortality, quality and safety indicators, nurse outcomes including emotional exhaustion and job dissatisfaction.Results Medical-surgical nurse-to-patient ratios before implementation of ratio legislation varied significantly across hospitals (mean 5.52 patients per nurse; SD=2.03). After accounting for patient characteristics and hospital size, each additional patient per nurse was associated with 12% higher odds of 30-day mortality (OR=1.12; 95% CI 1.01 to 1.26). Each additional patient per nurse was associated with poorer outcomes for nurses including 15% higher odds of emotional exhaustion (OR=1.15; 95% CI 1.07 to 1.23) and 14% higher odds of job dissatisfaction (OR=1.14; 95% CI 1.02 to 1.28), as well as higher odds of concerns about quality of care (OR=1.12; 95% CI 1.01 to 1.25) and patient safety (OR=1.32; 95% CI 1.11 to 1.57).Conclusions Before ratios were implemented, nurse staffing varied considerably across Queensland hospital medical-surgical wards and higher nurse workloads were associated with patient mortality, low quality of care, nurse emotional exhaustion and job dissatisfaction. The considerable variation across hospitals and the link with outcomes suggests that taking action to improve staffing levels was prudent. |
| format | Article |
| id | doaj-art-d9380d1e3a3a4bdb8c615de46f01b0df |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-d9380d1e3a3a4bdb8c615de46f01b0df2025-01-09T05:15:10ZengBMJ Publishing GroupBMJ Open2044-60552020-09-0110910.1136/bmjopen-2019-036264Case for hospital nurse-to-patient ratio legislation in Queensland, Australia, hospitals: an observational studyCarol Windsor0Patsy Yates1Linda H Aiken2Clint Douglas3Matthew D McHugh4School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia2 Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, AustraliaCenter for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USASchool of Nursing, Queensland University of Technology, Brisbane, Queensland, AustraliaCenter for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USAObjectives To determine whether there was variation in nurse staffing across hospitals in Queensland prior to implementation of nurse-to-patient ratio legislation targeting medical-surgical wards, and if so, the extent to which nurse staffing variation was associated with poor outcomes for patients and nurses.Design Analysis of cross-sectional data derived from nurse surveys linked with admitted patient outcomes data.Setting Public hospitals in Queensland.Participants 4372 medical-surgical nurses and 146 456 patients in 68 public hospitals.Main outcome measures 30-day mortality, quality and safety indicators, nurse outcomes including emotional exhaustion and job dissatisfaction.Results Medical-surgical nurse-to-patient ratios before implementation of ratio legislation varied significantly across hospitals (mean 5.52 patients per nurse; SD=2.03). After accounting for patient characteristics and hospital size, each additional patient per nurse was associated with 12% higher odds of 30-day mortality (OR=1.12; 95% CI 1.01 to 1.26). Each additional patient per nurse was associated with poorer outcomes for nurses including 15% higher odds of emotional exhaustion (OR=1.15; 95% CI 1.07 to 1.23) and 14% higher odds of job dissatisfaction (OR=1.14; 95% CI 1.02 to 1.28), as well as higher odds of concerns about quality of care (OR=1.12; 95% CI 1.01 to 1.25) and patient safety (OR=1.32; 95% CI 1.11 to 1.57).Conclusions Before ratios were implemented, nurse staffing varied considerably across Queensland hospital medical-surgical wards and higher nurse workloads were associated with patient mortality, low quality of care, nurse emotional exhaustion and job dissatisfaction. The considerable variation across hospitals and the link with outcomes suggests that taking action to improve staffing levels was prudent.https://bmjopen.bmj.com/content/10/9/e036264.full |
| spellingShingle | Carol Windsor Patsy Yates Linda H Aiken Clint Douglas Matthew D McHugh Case for hospital nurse-to-patient ratio legislation in Queensland, Australia, hospitals: an observational study BMJ Open |
| title | Case for hospital nurse-to-patient ratio legislation in Queensland, Australia, hospitals: an observational study |
| title_full | Case for hospital nurse-to-patient ratio legislation in Queensland, Australia, hospitals: an observational study |
| title_fullStr | Case for hospital nurse-to-patient ratio legislation in Queensland, Australia, hospitals: an observational study |
| title_full_unstemmed | Case for hospital nurse-to-patient ratio legislation in Queensland, Australia, hospitals: an observational study |
| title_short | Case for hospital nurse-to-patient ratio legislation in Queensland, Australia, hospitals: an observational study |
| title_sort | case for hospital nurse to patient ratio legislation in queensland australia hospitals an observational study |
| url | https://bmjopen.bmj.com/content/10/9/e036264.full |
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