Hospital nurse-staffing models and patient- and staff-related outcomes

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dc.contributor.author Butler, Michelle
dc.contributor.author Schultz, Timothy J.
dc.contributor.author Halligan, Phil
dc.contributor.author Sheridan, Ann
dc.contributor.author Kinsman, Leigh
dc.contributor.author Rotter, Thomas
dc.contributor.author Beaumier, Jonathan
dc.contributor.author Kelly, Robyn Gail
dc.contributor.author Drennan, Jonathan
dc.date.accessioned 2019-05-21T15:54:56Z
dc.date.available 2019-05-21T15:54:56Z
dc.date.issued 2019-04-23
dc.identifier.citation Butler, M., Schultz, T. J., Halligan, P., Sheridan, A., Kinsman, L., Rotter, T., Beaumier, J., Kelly, R. G. and Drennan, J.(2019) 'Hospital nurse-staffing models and patient- and staff-related outcomes', Cochrane Database of Systematic Reviews, 4, CD007019 (94pp). doi: 10.1002/14651858.CD007019.pub3 en
dc.identifier.issued 4 en
dc.identifier.startpage 1 en
dc.identifier.endpage 94 en
dc.identifier.issn 1465-1858
dc.identifier.uri http://hdl.handle.net/10468/7957
dc.identifier.doi 10.1002/14651858.CD007019.pub3 en
dc.description.abstract Background: Nurses comprise the largest component of the health workforce worldwide and numerous models of workforce allocation and profile have been implemented. These include changes in skill mix, grade mix or qualification mix, staff‐allocation models, staffing levels, nursing shifts, or nurses’ work patterns. This is the first update of our review published in 2011. Objectives: The purpose of this review was to explore the effect of hospital nurse‐staffing models on patient and staff‐related outcomes in the hospital setting, specifically to identify which staffing model(s) are associated with: 1) better outcomes for patients, 2) better staff‐related outcomes, and, 3) the impact of staffing model(s) on cost outcomes. Search methods: CENTRAL, MEDLINE, Embase, two other databases and two trials registers were searched on 22 March 2018 together with reference checking, citation searching and contact with study authors to identify additional studies. Selection criteria: We included randomised trials, non‐randomised trials, controlled before‐after studies and interrupted‐time‐series or repeated‐measures studies of interventions relating to hospital nurse‐staffing models. Participants were patients and nursing staff working in hospital settings. We included any objective reported measure of patient‐, staff‐related, or economic outcome. The most important outcomes included in this review were: nursing‐staff turnover, patient mortality, patient readmissions, patient attendances at the emergency department (ED), length of stay, patients with pressure ulcers, and costs. Data collection and analysis: We worked independently in pairs to extract data from each potentially relevant study and to assess risk of bias and the certainty of the evidence. Main results: We included 19 studies, 17 of which were included in the analysis and eight of which we identified for this update. We identified four types of interventions relating to hospital nurse‐staffing models: introduction of advanced or specialist nurses to the nursing workforce; introduction of nursing assistive personnel to the hospital workforce; primary nursing; and staffing models. The studies were conducted in the USA, the Netherlands, UK, Australia, and Canada and included patients with cancer, asthma, diabetes and chronic illness, on medical, acute care, intensive care and long‐stay psychiatric units. The risk of bias across studies was high, with limitations mainly related to blinding of patients and personnel, allocation concealment, sequence generation, and blinding of outcome assessment. The addition of advanced or specialist nurses to hospital nurse staffing may lead to little or no difference in patient mortality (3 studies, 1358 participants). It is uncertain whether this intervention reduces patient readmissions (7 studies, 2995 participants), patient attendances at the ED (6 studies, 2274 participants), length of stay (3 studies, 907 participants), number of patients with pressure ulcers (1 study, 753 participants), or costs (3 studies, 617 participants), as we assessed the evidence for these outcomes as being of very low certainty. It is uncertain whether adding nursing assistive personnel to the hospital workforce reduces costs (1 study, 6769 participants), as we assessed the evidence for this outcome to be of very low certainty. It is uncertain whether primary nursing (3 studies, > 464 participants) or staffing models (1 study, 647 participants) reduces nursing‐staff turnover, or if primary nursing (2 studies, > 138 participants) reduces costs, as we assessed the evidence for these outcomes to be of very low certainty. Authors' conclusions: The findings of this review should be treated with caution due to the limited amount and quality of the published research that was included. We have most confidence in our finding that the introduction of advanced or specialist nurses may lead to little or no difference in one patient outcome (i.e. mortality) with greater uncertainty about other patient outcomes (i.e. readmissions, ED attendance, length of stay and pressure ulcer rates). The evidence is of insufficient certainty to draw conclusions about the effectiveness of other types of interventions, including new nurse‐staffing models and introduction of nursing assistive personnel, on patient, staff and cost outcomes. Although it has been seven years since the original review was published, the certainty of the evidence about hospital nurse staffing still remains very low. en
dc.description.sponsorship National Institute for Health Research (Cochrane Infrastructure funding to the Effective Practice and Organisation of Care (EPOC) Group); Health Research Board (Cochrane Fellowship) en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher Cochrane Collaboration en
dc.relation.uri https://doi.org//10.1002/14651858.CD007019.pub3
dc.rights © 2019, the Cochrane Collaboration. Published by John Wiley & Sons, Ltd. All rights reserved. en
dc.subject Readmissions en
dc.subject ED attendance en
dc.subject Length of stay en
dc.subject Pressure ulcer en
dc.subject Mortality en
dc.subject Specialist nurse en
dc.subject Nurse-staffing model en
dc.subject Models en
dc.subject Nursing en
dc.subject Clinical trials en
dc.subject Humans en
dc.subject Midwifery en
dc.subject Nursing staff en
dc.subject Hospital en
dc.subject Outcome assessment en
dc.subject Health care en
dc.subject Personnel en
dc.subject Staffing en
dc.subject Scheduling en
dc.subject Specialties en
dc.title Hospital nurse-staffing models and patient- and staff-related outcomes en
dc.type Review en
dc.internal.authorcontactother Jonathan Drennan, Nursing & Midwifery, University College Cork, Cork, Ireland. +353-21-490-3000 Email: jonathan.drennan@ucc.ie en
dc.internal.availability Full text available en
dc.check.info Access to this article is restricted until 12 months after publication by request of the publisher. en
dc.check.date 2020-04-23
dc.date.updated 2019-05-21T15:44:35Z
dc.description.version Published Version en
dc.internal.rssid 486046612
dc.contributor.funder National Institute for Health Research en
dc.contributor.funder Health Research Board
dc.description.status Peer reviewed en
dc.identifier.journaltitle Cochrane Database of Systematic Reviews en
dc.internal.copyrightchecked Yes
dc.internal.licenseacceptance Yes en
dc.internal.IRISemailaddress jonathan.drennan@ucc.ie en
dc.identifier.articleid CD007019 en
dc.identifier.eissn 1469-493X


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