2.50
Hdl Handle:
http://hdl.handle.net/10755/157917
Type:
Presentation
Title:
Ratios, Political Correctness and Methodological Precision
Abstract:
Ratios, Political Correctness and Methodological Precision
Conference Sponsor:Western Institute of Nursing
Conference Year:2009
Author:Bolton, Linda Burnes, DrPH, RN, FAAN
P.I. Institution Name:Cedars-Sinai Medical Center
Title:VP and Chief Nursing Officer
Contact Address:8700 Beverly Blvd, Los Angeles, CA, 90048, USA
Contact Telephone:(310) 855-3694
Co-Authors:Diane Brown, PhD, FNAHQ, FAAN, CalNOC Co-Principal Investigator, Kaiser Permanente Northern California Region Accreditation Clinical Practice Leader; Nancy Donaldson, RN, DNSc, FAAN, Director, Center for Nursing Research & Innovation; Moshe Fridman, PhD,
Introduction: In October 1999, California became the first state to adopt legislation mandating unit-based minimum licensed nurse-to-patient ratios in acute care hospitals. Witness to a natural experiment, CalNOC has published 2 papers examining the impacts of the resulting regulatory changes in nurse staffing on patient outcomes at the unit level. Findings pre- and post-regulation reveal expected changes in nurse staffing, but no significant changes in the quality measures studied, and no consistent trends in the relationship between staffing and patient outcomes. Confounding conventional wisdom and findings reported by other investigators using myriad data sources, this paper examines the methodological issues and challenges confronting investigators whose public policy stakeholders seek robust answers to lingering questions and validation of existing regulatory interventions intended to ensure patient safety. Methods: CalNOC preliminary ratios evaluation analyses use a matched sample of units with staffing and falls data and at least one prevalence study available for the first two quarters of each year: 2002 (pre-regulation), 2006 (post regulation), and 2007 (recent unpublished data). The analysis used repeated measures ANOVA with adjustment for multiplicity of testing and was conducted in two steps to first understand the impact of the ratio mandate, and second to explore relationships between nurse staffing and patient outcomes. All analyses were performed for medical-surgical and step-down units separately because of inherent differences in patient populations and resulting differences in nurse staffing ratios. Results: Analyses of staffing for medical-surgical units showed that total RN hours of care per patient day increased from 4.78 in 2002 to 6.59 in 2007. The increase from 2006 (6.31) to 2007 (6.59) was also significant. Corresponding changes were seen in percent of care by RNs. Step down units showed similar changes from 2002-2007. From 2006-2007 in step down units, however, only the percent of care by unlicensed staff continued to change, from 23% in 2006 to 20% in 2007. Noting significant staffing changes, no significant changes in target patient outcomes (falls and injury falls per 1,000 patient days, pressure ulcer prevalence, and restraint use) were found. Methodological differences between this approach and other recent reports will be highlighted. Conclusions and Implications for Practice: Although mandated nurse staffing ratios changed the configuration of the direct care workforce, these analyses did not reveal consistent trends in the relationship between staffing and outcomes. Analytical precision (matched unit level data and repeated measures) may explain why CalNOC findings vary from those of other investigators in the field and confound conventional wisdom. We posit that multiple factors, not limited to characteristics of the nursing workforce and the amount of time nurses spend in direct patient care, ultimately determine patient outcomes and that this is the new frontier of nursing quality research.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleRatios, Political Correctness and Methodological Precisionen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157917-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Ratios, Political Correctness and Methodological Precision</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Bolton, Linda Burnes, DrPH, RN, FAAN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Cedars-Sinai Medical Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">VP and Chief Nursing Officer</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">8700 Beverly Blvd, Los Angeles, CA, 90048, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(310) 855-3694</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">bolton@cshs.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Diane Brown, PhD, FNAHQ, FAAN, CalNOC Co-Principal Investigator, Kaiser Permanente Northern California Region Accreditation Clinical Practice Leader; Nancy Donaldson, RN, DNSc, FAAN, Director, Center for Nursing Research &amp; Innovation; Moshe Fridman, PhD,</td></tr><tr><td colspan="2" class="item-abstract">Introduction: In October 1999, California became the first state to adopt legislation mandating unit-based minimum licensed nurse-to-patient ratios in acute care hospitals. Witness to a natural experiment, CalNOC has published 2 papers examining the impacts of the resulting regulatory changes in nurse staffing on patient outcomes at the unit level. Findings pre- and post-regulation reveal expected changes in nurse staffing, but no significant changes in the quality measures studied, and no consistent trends in the relationship between staffing and patient outcomes. Confounding conventional wisdom and findings reported by other investigators using myriad data sources, this paper examines the methodological issues and challenges confronting investigators whose public policy stakeholders seek robust answers to lingering questions and validation of existing regulatory interventions intended to ensure patient safety. Methods: CalNOC preliminary ratios evaluation analyses use a matched sample of units with staffing and falls data and at least one prevalence study available for the first two quarters of each year: 2002 (pre-regulation), 2006 (post regulation), and 2007 (recent unpublished data). The analysis used repeated measures ANOVA with adjustment for multiplicity of testing and was conducted in two steps to first understand the impact of the ratio mandate, and second to explore relationships between nurse staffing and patient outcomes. All analyses were performed for medical-surgical and step-down units separately because of inherent differences in patient populations and resulting differences in nurse staffing ratios. Results: Analyses of staffing for medical-surgical units showed that total RN hours of care per patient day increased from 4.78 in 2002 to 6.59 in 2007. The increase from 2006 (6.31) to 2007 (6.59) was also significant. Corresponding changes were seen in percent of care by RNs. Step down units showed similar changes from 2002-2007. From 2006-2007 in step down units, however, only the percent of care by unlicensed staff continued to change, from 23% in 2006 to 20% in 2007. Noting significant staffing changes, no significant changes in target patient outcomes (falls and injury falls per 1,000 patient days, pressure ulcer prevalence, and restraint use) were found. Methodological differences between this approach and other recent reports will be highlighted. Conclusions and Implications for Practice: Although mandated nurse staffing ratios changed the configuration of the direct care workforce, these analyses did not reveal consistent trends in the relationship between staffing and outcomes. Analytical precision (matched unit level data and repeated measures) may explain why CalNOC findings vary from those of other investigators in the field and confound conventional wisdom. We posit that multiple factors, not limited to characteristics of the nursing workforce and the amount of time nurses spend in direct patient care, ultimately determine patient outcomes and that this is the new frontier of nursing quality research.</td></tr></table>en_GB
dc.date.available2011-10-26T20:19:46Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:19:46Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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