Researchers at the Columbia University School of Nursing found an association between inadequate nurse staffing and an increase in healthcare–associated infection in a study published in the Journal of Nursing Administration.
The study examined nursing unit–level data from 2007 to 2012 for 100,000 patients at a large urban hospital system. It found the infection risk was 15% higher for patients who were treated on units that were understaffed for both the day and night shift. For units that were understaffed for only one shift, there was not a significantly higher risk of infection. It defined understaffing as registered-nurse staffing levels that were less than 80% of the median level.
"The novel finding is that a patient who stays in a unit that is continuously understaffed for the day and night shift is more likely to develop an infection," said Jingjing Shang, the study's lead author and an associate professor at Columbia Nursing.
Shang said the analysis differed from previous studies in that the researchers had access to payroll data to look at staffing at the unit-level rather than as an average across an entire hospital. This allowed the authors to compare staffing across similar units within the health system—ICUs with ICUs, for example.
Patients acquire healthcare–associated infections in about 4% of hospital stays nationwide. The analysis looked at the rates of urinary tract infections, bloodstream infections and cases of pneumonia.
"Hospitals should establish sufficient staffing to ensure the high quality of patient care," Shang said.
Nurse staffing played a major role in recent negotiations between the NYC Hospital Alliance and the New York State Nurses Association. The hospitals involved in the negotiations—Montefiore, Mount Sinai and New York–Presbyterian health systems—agreed to contractual nurse-to-patient ratios and to spend $100 million to hire about 1,450 new nurses.