Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction
Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction
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DOI：
10.1001/jama.288.16.1987
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发表时间：
2002-10-23
影响因子：
120.7
通讯作者：
Silber, JH
中科院分区：
文献类型：
--
作者：
Aiken, LH;Clarke, SP;Silber, JH
背景医院护士短缺的加剧和最近加州立法规定的最低医院病人与护士的比例要求了解护士配备水平如何影响病人的结果和护士保留在医院的做法。目的确定病人与护士的比例与病人死亡率，抢救失败，（并发症后死亡）的外科病人，以及与护士保留相关的因素。设计，设置，和参与者的横断面分析的链接数据从10184名护士调查，232342例普通外科、整形外科和血管外科患者在1998年4月1日至1999年11月30日期间出院，管理数据来自宾夕法尼亚州168家非联邦成人综合医院。结果调整患者和医院特征后，护士对工作不满意和职业倦怠的发生率分别为95.3%和95.3%（规模、教学状况和技术），每名护士每增加一名患者与7%（比值比[OR]，1.07; 95%置信区间[CI]，1.03-1.12）入院后30天内死亡的可能性增加，抢救失败的几率增加7%（OR，1.07; 95% CI，1.02-1.11）。在调整护士和医院特征后，每名护士每增加一名病人，（OR，1.23; 95% CI，1.13-1.34）倦怠的几率增加，15%的（OR，1.15; 95%CI，1.07-1.25）工作不满意的几率增加。结论在病人与护士比率高的医院，外科病人经历了更高的风险调整后的30天死亡率和抢救失败率，护士更有可能经历倦怠和工作不满。
Context The worsening hospital nurse shortage and recent California legislation mandating minimum hospital patient-to-nurse ratios demand an understanding of how nurse staffing levels affect patient outcomes and nurse retention in hospital practice.Objective To determine the association between the patient-to-nurse ratio and patient mortality, failure-to-rescue (deaths following complications) among surgical patients, and factors related to nurse retention.Design, Setting, and Participants Cross-sectional analyses of linked data from 10184 staff nurses surveyed, 232342 general, orthopedic, and vascular surgery patients discharged from the hospital between April 1, 1998, and November 30, 1999 and administrative data from 168 nonfederal adult general hospitals in Pennsylvania.Main Outcome Measures Risk-adjusted patient mortality and failure-to-rescue within 30 days of admission, and nurse-reported job dissatisfaction and job-related burnout.Results After adjusting for patient and hospital characteristics (size, teaching status, and technology), each additional patient per nurse was associated with a 7% (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.03-1.12) increase in the likelihood of dying within 30 days of admission and a 7% (OR, 1.07; 95% CI, 1.02-1.11) increase in the odds of failure-to-rescue. After adjusting for nurse and hospital characteristics, each additional patient per nurse was associated with a 23% (OR, 1.23; 95% CI, 1.13-1.34) increase in the odds of burnout and a 15% (OR, 1.15; 95% CI, 1.07-1.25) increase in the odds of job dissatisfaction.Conclusions In hospitals with high patient-to-nurse ratios, surgical patients experience higher risk-adjusted 30-day mortality and failure-to-rescue rates, and nurses, are more likely to experience burnout and job dissatisfaction.