Unit Level Nurse Workload Impacts on Patient Safety

说明(申请摘要)：建议的两年制的目标 描述性相关性研究建立在已建立的完整性和 加州急诊医院自愿使用ANA护理质量 用于报告标准化护士人员配置、患者安全和 协作研究、知识库开发中的质量指标 标杆项目。就本研究而言，假设 每日单位级别的护士人员配置和工作量可能会有所缓冲 患者因差错而造成的伤害或损害患者 当这些因素的差异超过工作人员的适应能力时的安全性 突破了单位级别的安全边际。这项研究的目的是切合实际的。 因为我们知道人类有可能危及病人的安全 护理实践和医疗护理中的错误是固有的(IOM，1999；Quic，2000； 原因，1990)。 来自77家医院的内外科急救病房样本，这项研究将 在跟踪日常单位级直接护理护士人员配置方面取得了新的进展 在两个月的时间里，100个患者护理单元，以检查关联 医院护士编制结构与权威指标的关系 急诊护理医院通常跟踪的患者结局和安全性，如 克制盛行和重大临床事件。人员配备措施，以 护理者，联系或机构工作人员的百分比，需要与实际的比率 小时的护理，以及多年的执照颁发后的注册经验。本研究 护士人员配置工作量，并将其整合到多元回归分析中 检查护士人员配置和结果之间的关系。平等的 重要的是，这项研究将通过跟踪和 分析人员配备变化和患者离职的影响，探索

DESCRIPTION (APPLICATION ABSTRACT): The aims of this proposed two-year descriptive correlational study build on the established integrity and capacity of the California Nursing Outcomes Coalition (CalNOC) to engage California acute care hospitals in voluntarily using ANA nursing quality indicators for reporting standardized nurse staffing, patient safety, and quality indicators in a collaborative research, repository development, and benchmarking project. For the purposes of this study, it is posited that the daily unit-level configuration of nurse staffing and workload may buffer patients from the effects of error and resulting injury or compromise patient safety when variance in these factors exceeds a staff's adaptive capacity and breaches a unit-level margin of safety. The aims of this study are grounded in the knowledge that the potential to compromise patient safety through human error is inherent in nursing practice and medical care (IOM, 1999; QUIC, 2000; Reason, 1990). In collaboration with CalNOC's Statewide voluntary-convenience sample of medical-surgical acute care units from 77 hospitals, this study will break new ground in tracing daily unit-level direct care nurse staffing, in 100 patient care units over a two-month period, to examine associations between the structure of hospital nurse staffing and authoritative indicators of patient outcomes and safety commonly tracked by acute care hospitals, as well as regulatory and accreditation agencies--falls, pressure ulcers, restraint prevalence, and significant clinical events. Staffing measures to be studied include hours of direct care per patient day, skill mix of nurse caregivers, percent of contacted or agency staff, ratio of required to actual hours of care, and RN years of post-licensure experience. This study recognizes and quantifies the impact of patient turnover, a key factor in nurse staffing workload, and integrates it into multiple regression analyses examining associations between nurse staffing and outcomes. Of equal importance, this study will advance staffing measurement by tracing and analyzing the impact of variation in staffing and patient turnover, exploring the impact of variance on patient safety and outcomes.