Evidence of association between the four key complications and nursing work environments
| Study | Sample | Location and data time frame | Characteristics of nursing work environments (independent variable) | Patient complication (dependent variable) |
|---|---|---|---|---|
| Cimiotti22 | 161 hospitals 1 571 068 patients 7076 nurses | USA 2006 | Lower levels of burnt out (a) nurses | Lower rates of urinary tract infection |
| Needleman et al18 | 799 hospitals 6 million+ patients | USA 1997 | Higher levels of total nurse staffing | Lower rates of urinary tract infection |
| Cho et al23 | 232 hospitals 124 204 patients | USA 1997 | Higher proportions of RNs (b) | Lower rates of pneumonia |
| Kovner et al24 | 187 hospitals | USA 1990–1996 | Higher RN hours per patient day | Lower rates of pneumonia |
| Pappas et al25 | 2 hospitals 3200 patients | USA 2007 | Higher RN hours per patient day | Lower rates of pneumonia |
| Kane et al11 | Systematic review 96 studies | USA 2006 | Higher proportions of RN per patient day | Decreased OR of hospital-acquired pneumonia |
| Twigg et al26 | 3 hospitals 236 454 patients 150 925 nurses | Australia 2000–2004 | Refined staffing model (c) | Lower rates of pneumonia Lower rates of delirium |
| Schubert et al27 | 8 hospitals 779 patients 1338 nurses | Switzerland 2003–2004 | Implicit care rationing (d) | Predicted higher levels of pressure ulcers |
| Horn et al28 | 82 RACF 1376 residents | USA 1996–1997 | Higher RN direct time per resident per day | Lower rates of pressure ulcers |
| Pekkarinen et al29 | 66 RACF 724 nurses | Finland 2002 | Increased time unit pressure (e) | Higher rates of pressure ulcers |
| Hickey et al30 | 35 RACF Patient assessment files Staffing data | USA 1998–1999 | Lower skill mix (less RNs) | Higher rates of pressure ulcers |
(a) Burnt out: where workers emotionally and cognitively detach from work as a way to cope with demands.
(b) RN: registered nurse—a graduate from a University or college nursing programme who has met national licensing conditions.
(c) Refined staffing model: which developed categories of nurse staffing based on patient complexity, intervention levels, high dependency beds, emergency/elective patient mix and patient turnover.
(d) Implicit care rationing: where nurses withhold or fail to carry out necessary nursing tasks due to inadequate time, staffing level and/or skill mix.
(e) Time unit pressure: as a measure of nursing working conditions.
RACF, residential aged care facility.