Instability in patient and nurse characteristics, unit complexity and patient and system outcomes

Duffield, CM; Roche, MA; Dimitrelis, S; Homer, C; Buchan, J

Instability in patient and nurse characteristics, unit complexity and patient and system outcomes

Duffield, CM

Roche, MA

Dimitrelis, S Homer, C

Buchan, J

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Publication Type:: Journal Article
Citation:: Journal of Advanced Nursing, 2015, 71 (6), pp. 1288 - 1298
Issue Date:: 2015-01-01

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Field	Value	Language
dc.contributor.author	Duffield, CM https://orcid.org/0000-0001-6534-8743	en_US
dc.contributor.author	Roche, MA https://orcid.org/0000-0002-3831-537X	en_US
dc.contributor.author	Dimitrelis, S	en_US
dc.contributor.author	Homer, C https://orcid.org/0000-0002-7454-3011	en_US
dc.contributor.author	Buchan, J	en_US
dc.date.available	2020-05-25T19:27:00Z
dc.date.issued	2015-01-01	en_US
dc.identifier.citation	Journal of Advanced Nursing, 2015, 71 (6), pp. 1288 - 1298	en_US
dc.identifier.issn	0309-2402	en_US
dc.identifier.uri	http://hdl.handle.net/10453/35230
dc.description.abstract	© 2014 John Wiley & Sons Ltd. Aims: To explore key factors related to nursing unit instability, complexity and patient and system outcomes. Background: The relationship between nurse staffing and quality of patient outcomes is well known. The nursing unit is an important but different aspect that links to complexity and to system and patient outcomes. The relationship between the instability, complexity and outcomes needs further exploration. Design: Descriptive. Methods: Data were collected via a nurse survey, unit profile and review of patient records on 62 nursing units (wards) across three states of Australia between 2008-2010. Two units with contrasting levels of patient and nurse instability and negative system and patient outcomes, were profiled in detail from the larger sample. Results: Ward A presented with greater patient stability (low occupancy, high planned admissions, few ICU transfers, fewer changes to patient acuity/work re-sequencing) and greater nurse instability (nurses changing units, fewer full-time staff, more temporary/casual staff) impacting system outcomes negatively (high staff turnover). In contrast, Ward B had greater patient instability, however, more nurse stability (greater experienced and permanent staff, fewer casuals), resulting in high rates for falls, medication errors and other adverse patient outcomes with lower rates for system outcomes (lower intention to leave). Conclusion: Instability in patient and nurse factors can contribute to ward complexity with potentially negative patient outcomes. The findings highlight the variation of many aspects of the system where nurses work and the importance of nursing unit managers and senior nurse executives in managing ward complexity.	en_US
dc.relation	http://purl.org/au-research/grants/arc/LP0774836R1
dc.relation.ispartof	Journal of Advanced Nursing	en_US
dc.relation.isbasedon	10.1111/jan.12597	en_US
dc.subject.classification	Nursing	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Nurse-Patient Relations	en_US
dc.subject.mesh	Nursing Staff	en_US
dc.subject.mesh	Outcome Assessment (Health Care)	en_US
dc.subject.mesh	Outcome Assessment, Health Care	en_US
dc.title	Instability in patient and nurse characteristics, unit complexity and patient and system outcomes	en_US
dc.type	Journal Article
utslib.citation.volume	6	en_US
utslib.citation.volume	71	en_US
utslib.for	1110 Nursing	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Nursing
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
pubs.organisational-group	/University of Technology Sydney/Strength - WHO CC
utslib.copyright.status	open_access
pubs.issue	6	en_US
pubs.publication-status	Published	en_US
pubs.volume	71	en_US

Abstract:

© 2014 John Wiley & Sons Ltd. Aims: To explore key factors related to nursing unit instability, complexity and patient and system outcomes. Background: The relationship between nurse staffing and quality of patient outcomes is well known. The nursing unit is an important but different aspect that links to complexity and to system and patient outcomes. The relationship between the instability, complexity and outcomes needs further exploration. Design: Descriptive. Methods: Data were collected via a nurse survey, unit profile and review of patient records on 62 nursing units (wards) across three states of Australia between 2008-2010. Two units with contrasting levels of patient and nurse instability and negative system and patient outcomes, were profiled in detail from the larger sample. Results: Ward A presented with greater patient stability (low occupancy, high planned admissions, few ICU transfers, fewer changes to patient acuity/work re-sequencing) and greater nurse instability (nurses changing units, fewer full-time staff, more temporary/casual staff) impacting system outcomes negatively (high staff turnover). In contrast, Ward B had greater patient instability, however, more nurse stability (greater experienced and permanent staff, fewer casuals), resulting in high rates for falls, medication errors and other adverse patient outcomes with lower rates for system outcomes (lower intention to leave). Conclusion: Instability in patient and nurse factors can contribute to ward complexity with potentially negative patient outcomes. The findings highlight the variation of many aspects of the system where nurses work and the importance of nursing unit managers and senior nurse executives in managing ward complexity.

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http://hdl.handle.net/10453/35230