Hospital Nurses' Working Conditions and Patient Outcomes

描述(申请摘要)：护士和其他人声称低护士 人员配备，增加加班和按日支付机构护士的使用，以及其他 医院工作条件的变化使患者面临更大的风险 可避免的不良后果。这些担忧导致了罢工和呼吁 医院、认证机构、付款人和政府采取行动增加 人员配备和减少加班。研究发现两者之间的关系 不良后果和护理技能组合，在较小程度上，护理时间， 但为了回应现在提出的问题，理解 护士的工作条件与不良后果的关系需要 大大扩大了。为达致这个目标，我们会： 目标1：检查不良后果与加班使用之间的关系 和签约护士。 目标2：采用测量护士工作中其他条件的方法 在单位一级研究中影响人员配置和工作量的环境 医院层面的研究。这些包括：护理提供模式、工作 压力，以及受伤的风险。我们将研究这些因素的独立影响 影响患者预后的变量及其混杂效应的研究 人员配备水平和组合。 目标3：检查工作要素的因果路径 环境相互作用并影响患者的预后。为了实现这些目标， 我们将a)根据医院出院数据集构建结果，b)获取数据 关于护士的人员配备水平、组合、加班和国家合同时间 管理数据集，直接来自医院，并通过工会，c) 对结果与这些措施的关联进行分析，d)适应 衡量护士工作条件的方法，包括护理 组织、工作压力和受伤风险，到医院级别，以及e) 使用这套更广泛的衡量标准对结果进行分析。

DESCRIPTION (APPLICATION ABSTRACT): Nurses and others claim that low nurse staffing, increased use of overtime and per diem agency nurses, and other changes in hospital working conditions are putting patients at greater risk of avoidable adverse outcomes. These concerns have led to strikes and calls for hospitals, accrediting agencies, payers, and government to act to increase staffing and reduce overtime. Research has found a relationship between adverse outcomes and nursing skill mix and, to a lesser extent, nursing hours, but to respond to the issues now being raised, understanding of the relationship of nurses' working conditions to adverse outcomes needs to be substantially expanded. To achieve this, we will: Aim 1: Examine the relationship between adverse outcomes and use of overtime and contract nurses. Aim 2: Adapt methods used to measure other conditions in the nurses' work environment affecting staffing and workload in unit-level studies for use in hospital-level studies. These include: nursing care delivery models, job strain, and risk of injury. We will examine the independent effects of these variables on patient outcomes and their confounding effect in studies of staffing levels and mix. Aim 3: Examine the causal pathways through which elements of the work environment interact and influence patient outcomes. To address these aims, we will a) construct outcomes from hospital discharge datasets, b) obtain data on nurse staffing levels, mix, overtime, and contract hours from State administrative datasets, directly from hospitals, and through unions, c) conduct analyses of the association of outcomes with these measures, d) adapt methods of measuring nurses' working conditions, including nursing care organization, job strain, and risk of injury, to the hospital level, and e) conduct analyses of outcomes using this broader set of measures.