The impact of California's staffing mandate and the economic recession on registered nurse staffing levels: A longitudinal analysis

Author(s):  
Andrew Dierkes ◽  
Duy Do ◽  
Haley Morin ◽  
Monica Rochman ◽  
Douglas Sloane ◽  
...  
Genealogy ◽  
2020 ◽  
Vol 4 (1) ◽  
pp. 19
Author(s):  
Josep M. Oller ◽  
Albert Satorra ◽  
Adolf Tobeña

During the last decade, the Catalonian secessionist challenge induced a chronic crisis within Spain’s politics that does not offer hints of a viable arrangement. The rapidly escalating demands for secession ran almost in parallel with the accentuation of the economic recession that followed the disruption of the world financial system in 2008–2010. Such secession claims reached maximums during 2012–2014, attaining support levels of nearly 50% of citizenry in favour of independence. These figures subsequently diminished a bit but remained close to that level until today. Despite the coincident course, previous studies had shown that the impact of economic hardships was not a major factor in explaining the segregation urgencies, connecting them instead to triggers related to internecine political struggles in the region: Harsh litigations that resulted in an abrupt polarization along nationalistic features in wide segments of the population. In this longitudinal analysis based on the responses of 88,538 individuals through a regular series of 45 official surveys, in the period 2006–2019, we show that economic factors did play a role in the secessionist wave. Our findings showed that the main idiomatic segmentation (Catalan vs. Spanish, as family language) interacted with economic segmentations in inducing variations on national identity feelings that resulted in erosions of the dual CatSpanish identity. Moreover, our findings also showed that the more privileged segments of Catalonian citizenry where those that mostly supported secession, whereas poorer and unprotected citizenry was clearly against it. All the data points to the conclusion that the secessionist challenge was, in fact, a rebellion of the wealthier and well-situated people.


2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Filip Haegdorens ◽  
Peter Van Bogaert ◽  
Koen De Meester ◽  
Koenraad G. Monsieurs

Abstract Background Growing evidence indicates that improved nurse staffing in acute hospitals is associated with lower hospital mortality. Current research is limited to studies using hospital level data or without proper adjustment for confounders which makes the translation to practice difficult. Method In this observational study we analysed retrospectively the control group of a stepped wedge randomised controlled trial concerning 14 medical and 14 surgical wards in seven Belgian hospitals. All patients admitted to these wards during the control period were included in this study. Pregnant patients or children below 17 years of age were excluded. In all patients, we collected age, crude ward mortality, unexpected death, cardiac arrest with Cardiopulmonary Resuscitation (CPR), and unplanned admission to the Intensive Care Unit (ICU). A composite mortality measure was constructed including unexpected death and death up to 72 h after cardiac arrest with CPR or unplanned ICU admission. Every 4 months we obtained, from 30 consecutive patient admissions across all wards, the Charlson comorbidity index. The amount of nursing hours per patient days (NHPPD) were calculated every day for 15 days, once every 4 months. Data were aggregated to the ward level resulting in 68 estimates across wards and time. Linear mixed models were used since they are most appropriate in case of clustered and repeated measures data. Results The unexpected death rate was 1.80 per 1000 patients. Up to 0.76 per 1000 patients died after CPR and 0.62 per 1000 patients died after unplanned admission to the ICU. The mean composite mortality was 3.18 per 1000 patients. The mean NHPPD and proportion of nurse Bachelor hours were respectively 2.48 and 0.59. We found a negative association between the nursing hours per patient day and the composite mortality rate adjusted for possible confounders (B = − 2.771, p = 0.002). The proportion of nurse Bachelor hours was negatively correlated with the composite mortality rate in the same analysis (B = − 8.845, p = 0.023). Using the regression equation, we calculated theoretically optimal NHPPDs. Conclusions This study confirms the association between higher nurse staffing levels and lower patient mortality controlled for relevant confounders.


Medical Care ◽  
2007 ◽  
Vol 45 (12) ◽  
pp. 1195-1204 ◽  
Author(s):  
Robert L. Kane ◽  
Tatyana A. Shamliyan ◽  
Christine Mueller ◽  
Sue Duval ◽  
Timothy J. Wilt

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e051133
Author(s):  
Vera Winter ◽  
Karina Dietermann ◽  
Udo Schneider ◽  
Jonas Schreyögg

ObjectiveTo examine the impact of nurse staffing on patient-perceived quality of nursing care. We differentiate nurse staffing levels and nursing skill mix as two facets of nurse staffing and use a multidimensional instrument for patient-perceived quality of nursing care. We investigate non-linear and interaction effects.SettingThe study setting was 3458 hospital units in 1017 hospitals in Germany.ParticipantsWe contacted 212 554 patients discharged from non-paediatric, non-intensive and non-psychiatric hospital units who stayed at least two nights in the hospital between January and October 2019. Of those, 30 174 responded, yielding a response rate of 14.2%. Our sample included only those patients. After excluding extreme values for our nurse staffing variables and removing observations with missing values, our final sample comprised 28 136 patients ranging from 18 to 97 years of age (average: 61.12 years) who had been discharged from 3458 distinct hospital units in 1017 hospitals.Primary and secondary outcome measuresPatient-perceived quality of nursing care (general nursing care, guidance provided by nurses, and patient loyalty to the hospital).ResultsFor all three dimensions of patient-perceived quality of nursing care, we found that they significantly decreased as (1) nurse staffing levels decreased (with decreasing marginal effects) and (2) the proportion of assistant nurses in a hospital unit increased. The association between nurse staffing levels and quality of nursing care was more pronounced among patients who were less clinically complex, were admitted to smaller hospitals or were admitted to medical units.ConclusionsOur results indicate that, in addition to nurse staffing levels, nursing skill mix is crucial for providing the best possible quality of nursing care from the patient perspective and both should be considered when designing policies such as minimum staffing regulations to improve the quality of nursing care in hospitals.


2015 ◽  
Vol 73 (1) ◽  
pp. 41-61 ◽  
Author(s):  
Seung Chun Paek ◽  
Ning J. Zhang ◽  
Thomas T. H. Wan ◽  
Lynn Y. Unruh ◽  
Natthani Meemon

Author(s):  
Karina Dietermann ◽  
Vera Winter ◽  
Udo Schneider ◽  
Jonas Schreyögg

AbstractThe goal of this study is to provide empirical evidence of the impact of nurse staffing levels on seven nursing-sensitive patient outcomes (NSPOs) at the hospital unit level. Combining a very large set of claims data from a German health insurer with mandatory quality reports published by every hospital in Germany, our data set comprises approximately 3.2 million hospital stays in more than 900 hospitals over a period of 5 years. Accounting for the grouping structure of our data (i.e., patients grouped in unit types), we estimate cross-sectional, two-level generalized linear mixed models (GLMMs) with inpatient cases at level 1 and units types (e.g., internal medicine, geriatrics) at level 2. Our regressions yield 32 significant results in the expected direction. We find that differentiating between unit types using a multilevel regression approach and including postdischarge NSPOs adds important insights to our understanding of the relationship between nurse staffing levels and NSPOs. Extending our main model by categorizing inpatient cases according to their clinical complexity, we are able to rule out hidden effects beyond the level of unit types.


2019 ◽  
Author(s):  
Filip Haegdorens ◽  
Peter Van Bogaert ◽  
Koen De Meester ◽  
Koen Monsieurs

Abstract BACKGROUND Growing evidence indicates that improved nurse staffing in acute hospitals is associated with lower hospital mortality. Current research is limited to studies using hospital level data or without proper adjustment for confounders which makes the translation to practice difficult. METHOD In this observational study we analysed retrospectively the control group of a stepped wedge randomised controlled trial concerning 14 medical and 14 surgical wards in seven Belgian hospitals. All patients admitted to these wards during the control period were included in this study. Pregnant patients or children below 17 years of age were excluded. In all patients, we collected age, crude ward mortality, unexpected death, cardiac arrest with Cardiopulmonary Resuscitation (CPR), and unplanned admission to the Intensive Care Unit (ICU). A composite mortality measure was constructed including unexpected death and death up to 72 hours after cardiac arrest with CPR or unplanned ICU admission. Every four months we obtained, from 30 consecutive patient admissions across all wards, the Charlson comorbidity index. The amount of nursing hours per patient days (NHPPD) were calculated every day for 15 days, once every four months. Data were aggregated to the ward level resulting in 68 estimates across wards and time. Linear mixed models were used since they are most appropriate in case of clustered and repeated measures data. RESULTS The unexpected death rate was 1.80 per 1000 patients. Up to 0.76 per 1000 patients died after CPR and 0.62 per 1000 patients died after unplanned admission to the ICU. The mean composite mortality was 3.18 per 1000 patients. The mean NHPPD and proportion of nurse Bachelor hours were respectively 2.48 and 0.59. We found a negative association between the nursing hours per patient day and the composite mortality rate adjusted for possible confounders (B= -2.771, p=0.002). The proportion of nurse Bachelor hours was negatively correlated with the composite mortality rate in the same analysis (B= -8.845, p=0.023). Using the regression equation, we calculated theoretically optimal NHPPDs. CONCLUSIONS This study confirms the association between higher nurse staffing levels and lower patient mortality controlled for relevant confounders.


2009 ◽  
Vol 17 (8) ◽  
pp. 986-993 ◽  
Author(s):  
TARJA TERVO-HEIKKINEN ◽  
VESA KIVINIEMI ◽  
PIRJO PARTANEN ◽  
KATRI VEHVILÄINEN-JULKUNEN

2018 ◽  
Vol 35 (5) ◽  
pp. 468-471 ◽  
Author(s):  
Blair Wendlandt ◽  
Thomas Bice ◽  
Shannon Carson ◽  
Lydia Chang

Purpose: Intermediate care units (IMCUs) represent an alternative care setting with nurse staffing levels between those of the general ward and the intensive care unit (ICU). Despite rising prevalence, little is known about IMCU practices across US hospitals. The purpose of this study is to characterize utilization patterns and assess for variation. Materials and Methods: A 14-item survey was distributed to a random nationwide sample of pulmonary and critical care physicians between January and April 2017. Results: A total of 51 physicians from 24 different states completed the survey. Each response represented a unique institution, the majority of which were public (59%), academic (73%), and contained at least 1 IMCU (65%). Of the IMCUs surveyed, 58% operated as 1 mixed unit that admitted medical, cardiac, and surgical patients as opposed to having separate subspecialty units. Ninety-one percent of units admitted step-down patients from the ICU, but 39% of units accepted a mix of step-up patients, step-down patients, postoperative patients, and patients from the emergency department. Intensivists managed care in 21% of units whereas 36% had no intensivist involvement. Conclusion: Organization practices vary considerably between IMCUs across institutions. The impact of different organization practices on patient outcomes should be assessed.


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