Primary Care Companion

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Psychiatric Briefs

Primary Care Companion J Clin Psychiatry 2002;4:252-256

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Background: With a growing shortage of hospital nurses and recent legislation in California requiring minimum ratios of hospital patients to nurses comes a need to understand the ways that nurse staffing levels affect patient outcomes and nurse retention in hospital practice. This study was conducted to determine the relationship of patient-to-nurse ratio to patient mortality, failure-to-rescue (deaths following complications) among surgical patients, and aspects of nurse retention. Method: Cross-sectional analyses were conducted of linked data from 10,184 staff nurses who were surveyed; 232,342 general, orthopedic, and vascular surgery patients discharged from the hospital between April 1, 1998, and November 30, 1999; and 168 nonfederal adult general hospitals in Pennsylvania. The chief outcome measures were risk-adjusted patient mortality and failure-to-rescue within 30 days of admission as well as job dissatisfaction and job-related burnout as reported by nurses. Results: After adjustments were made for patient and hospital characteristics (the latter included size, teaching status, and technology), each additional patient per nurse was associated with a 7% increase in the likelihood of dying within 30 days of admission (odds ratio [OR] = 1.07, 95% CI = 1.03 to 1.12) and a 7% increase in the odds of failure-to-rescue (OR = 1.07, 95% CI = 1.02 to 1.11). After adjustments were made for nurse and hospital characteristics, each additional patient per nurse was associated with a 23% increase in the odds of burnout (OR = 1.23, 95% CI = 1.13 to 1.34) and a 15% increase in the odds of job dissatisfaction (OR = 1.15, 95% CI = 1.07 to 1.25). Conclusions: Surgical patients in hospitals with high patientto- nurse ratios have higher risk-adjusted 30-day mortality and failure-to-rescue rates; nurses in such hospitals are more likely to experience job dissatisfaction and burnout.