The Impact of Nursing Workforce Organization on Outcomes of Hospitalized Children

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DESCRIPTION (provided by applicant): Hospital variation in quality outcomes for children exists, though it is not well understood. Certain characteristics of hospital nursing workforce organization - nurse workload, nurse education, and the nurse practice environment - are associated with better outcomes for hospitalized adults. It is not known whether these relationships hold in pediatrics. Additionally, it is unknown whether differences in pediatric outcomes between children's and general hospitals can be partially explained by nursing workforce organization. This cross-sectional, observational study will: 1) determine the extent to which nursing workforce organization is associated with outcomes for children hospitalized with common medical and surgical conditions after controlling for patient and hospital characteristics; and 2) compare outcomes for children treated in general hospitals and children's hospitals and, where differences exist, to determine the extent to which nursing Workforce organization accounts for these differences. Hospital administrative data, state-level patient discharge data, and previously collected nurse survey data from Registered Nurses in California, Florida, New Jersey, and Pennsylvania will be merged together to form an analytic dataset for secondary analysis. There are an estimated 259 hospitals, 32,000 nurses, and 96,000 pediatric patients in the sample. The outcomes of interest - prolonged length of stay (PLOS), conditional length of stay (CLOS), and readmission - will be examined using logistic and linear regression with the hospital as the unit of observation. The findings of the study have the impact to improve the quality of inpatient care delivered to children, an AHRQ priority population. It is a major public health problem that there is variation in the quality and patient safety of inpatient pediatric services in hospitals. It is anticipated that the proposed study will provide important information about relationships between nursing care and pediatric patient outcomes, enhancing the provision of safe hospital care for this vulnerable patient population.