| There is a need to study the process which links structure with positive patient outcomes. Nursing research has concentrated on staffing predictors of skill mix, nurses' participation in decision-making, and identifying patient outcomes attributable to quality of nursing care. Few research papers have examined the process link between nurse staffing practices (structure) and patient outcomes. The purpose of this evaluation research was to determine whether the judgments made by the “frontline” nurse caregivers could affect quality patient care—as evidenced by decreased incidences of adverse nurse-sensitive patient outcomes (medication errors, patient falls, nosocomial pressure ulcers)—when those decisions were utilized to determine patient acuities and to predict acuity-adjusted staffing needs.; The interrupted time-series design evaluated whether utilizing a nurse-determined patient classification and staffing system improved good patient outcomes. The setting was a small, rural, Western Pennsylvania hospital; the environment was one of organizational autonomy with decentralized control of decision-making regarding staffing patterns and patient care at the unit level. The focus of data collection was on incidences of nurse-sensitive outcomes—patient falls, medication errors, and nosocomial pressure ulcers. Structural indicators used to analyze the medical/surgical unit's stability over time were “average daily census,” “average nursing care hours per patient day,” “average reimbursement patient acuity index,” “average length of stay,” “percentage of female patients,” “percentage of Medicare patients,” “skill mix” (RNs, LPNs, NAs, and unit clerks), and “turnover rates of professional nursing staff.” The analyses involved archival data collected as a set of 36 time-ordered observations; 442 adverse events were evaluated.; “Ordinary least squares” regression analyses yielded insufficient statistical evidence to determine significant results. However, the new PCSS has been shown to have practical utility for nurses regarding decreased medication errors. Overall, nurses were less likely to make medication errors after the implementation of a patient classification system in which RNs providing direct patient care determined patients' acuity classifications. Nursing staff productivity, sex of patient, and time (shift, day of week, seasonal effects) were ruled out as plausible rival explanations for incidences or errors. |
