The relationship of nurse staffing to adherence to practice guidelines, and patient outcomes in the treatment of hypoglycemia

A growing body of literature has demonstrated an empirical relationship between RN staffing in acute care settings and patient outcomes. The causal mechanisms that mediate that relationship are unknown. The purpose of this study was to determine if a relationship existed between nurse staffing and adherence to hypoglycemia practice guidelines by nurses. The four specific aims for this study were to: (a) examine the relationship of nurse staffing to RNs' adherence to practice guidelines in the treatment of hypoglycemia, (b) examine the relationship of nurse staffing to patient outcomes in the detection and treatment of hypoglycemia, (c) examine the relationship of adherence to practice guidelines by RNs and patient outcomes in the treatment of hypoglycemia, and (d) describe current practice patterns used by RNs in the treatment of hypoglycemia.;The study took place at two Midwestern hospitals. Nurse staffing was measured as: (a) the ratio of total nursing staff hours to patient days; (b) the proportion of those hours provided by RNs (skill mix); and (c) patient-to-RN hours ratio. A total of 105 patient records were examined at each hospital. Practice guidelines were poorly adhered to at both sites, with no instance of adherence to all five steps. Nurse staffing was not found to be related to nurses' adherence to the hypoglycemia practice guidelines at either study hospital.;With one exception, nurse staffing was not found to be related to patient outcomes. There was a positive relationship between skill mix and total number of episodes of hypoglycemia at Hospital B r(103) = .27, p = .006. The inability to control for patient acuity is a possible explanation for this unexpected finding.;The results of this study have important implications for nursing practice and education. Barriers to evidence-based practice must be reduced and sufficient time, education, and resources must be made available to clinical nurses in order to change the culture of clinical nursing practice to one that recognizes and embraces the importance of research to providing safe, appropriate nursing care.