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Cases & Commentaries
- Web M&M
Donna L. Washington, MD, MPH; January 2004
A triage nurse instructed by a physician to immediately bring a febrile child, who was possibly dehydrated, to the treatment area is stopped by the charge nurse, citing overcrowding. The parents seek treatment elsewhere; upon arrival, the child is in full arrest.
Perspectives on Safety > Interview
Nurse Staffing and Patient Safety, September 2012
Prof. Needleman has performed some of the key studies on how the nursing workforce influences health outcomes, including seminal articles published in the New England Journal of Medicine in 2002 and 2011.
Legislation/Regulation > Legislation/Case Law
Enacting the Washington state patient safety act requiring hospital staffing plans for nursing services and establishing recordkeeping and reporting requirements.
Washington State Legislature. HB 1602 (2003).
This addition to the Washington Patient Safety Act requires hospitals to develop and implement a staffing plan for nursing services. The plan addresses personnel issues for each patient care unit, requires hospitals to maintain records regarding patients and nursing care personnel, and authorizes the Department of Health to investigate complaints of staffing plan requirement violations and to conduct audits.
Princeton, NJ: Robert Wood Johnson Foundation; November 2010.
Part I of this three-part series examines the quality improvement experience of four health care organizations and one state government. Part II examines how nursing intersects with health information technology implementation efforts. Part III examines how the design of the care environment affects patient outcomes.
Journal Article > Study
Needleman J, Buerhaus P, Pankratz VS, Leibson CL, Stevens SR, Harris M. N Engl J Med. 2011;364:1037-1045.
Several studies have pointed to a relationship between nurse staffing ratios (particularly staffing by RNs) and patient safety. Such studies have influenced public policy. For example, the state of California mandates certain minimum nurse-to-patient ratios in intensive care units and medical–surgical units. However, methodological limitations have led some to question the strength of this association. This study, the most methodologically robust to date, identified a statistically significant relationship between higher RN staffing and lower patient mortality. High patient turnover was also associated with excess mortality. The study is likely to increase the pressure on hospitals to ensure adequate levels of nurse staffing.
Simmons-Ritchie D. Penn Live. November 15, 2018.
Nursing home patients are vulnerable to preventable harm due to poor safety culture, insufficient staffing levels, lack of regulation enforcement, and misaligned financial incentives. This news investigation reports on how poor practices resulted in resident harm in Pennsylvania nursing homes and discusses strategies for improvement, such as enhancing investigation processes.
Journal Article > Study
Law AC, Stevens JP, Hohmann S, Walkey AJ. Crit Care Med. 2018;46:1563-1569.
Inadequate nurse staffing in hospitals leads to increased morbidity and mortality. Two proposed explanations are that nurses provide surveillance and reassessment, which are particularly important for seriously ill patients, and that inadequate staffing leads to missed nursing care. This retrospective cohort study assessed the impact of a 2016 Massachusetts law that mandated minimum nursing ratios in intensive care units. Mortality and complication rates did not change after the law's passage, nor did they differ from states without staffing ratio mandates. Nurse staffing was not substantially higher in Massachusetts after the mandate when compared with other states. Two accompanying editorials highlight the challenges of measuring and promoting appropriate nursing care, which authors argue cannot be simply defined with a staffing ratio. A PSNet perspective and a WebM&M commentary further explore the safety risks of missed nursing care.
Journal Article > Study
Griffiths P, Maruotti A, Recio Saucedo A, et al; Missed Care Study Group. BMJ Qual Saf. 2019;28:609-617.
There is a clear link between nurse staffing ratios and patient safety. This study corroborates the finding that lower registered nurse staffing and higher numbers of patients admitted per nurse are associated with increased rates of in-hospital mortality. The results underscore the importance of adequate nursing to ensure safe acute care.