Impact of Medical Surgical Acute Care Microsystem Nurse Characteristics and Practices on Patient Outcomes

Research briefs from the Robert Wood Johnson Foundation (RWJF) Nursing Research Network identify specific ways nurses affect patient care quality and outcomes. Since 2005, the Interdisciplinary Nursing Quality Research Initiative (INQRI) program has supported interdisciplinary teams that involved nursing scholars and scholars from other disciplines in research projects—from the conceptual study design to the adoption in practice of new measures of standards of care.

Prior to this study, little was known about how unit level variations in characteristics of the nurse workforce, workload, and specific practices interact to predict outcomes in acute care. This research brief develops a model to understand the effects of nurse workload, staff nurse characteristics, and selected nursing risk assessment and processes of care on patient outcomes.

Key Findings

  • Patient falls and injury falls were predicted by patient characteristics and clinical process variables, not by RN expertise. Units with zero injury falls had a higher percentage of unlicensed hours of care. No other staffing variables predicted falls or injury falls.

  • Hospital acquired pressure ulcer prevalence was predicted by a combination of all elements in the model: unit/patient characteristics, nursing workload, RN expertise, and clinical processes.

  • Restraint use was predicted by a combination of all elements: unit/patient characteristics, nursing workload, RN expertise, and clinical processes. Patient characteristics had the greatest impact on restraint use.

  • Medication administration accuracy: unit/patient characteristics combined with workload predicted medication administration practice errors; workload combined with safe practice deviations predicted outcome errors.

  • Increasing RN hours without changing adherence to safe practices, resulted in less change in medication administration errors. If safe practice deviations were eliminated, most outcome errors would be eliminated.

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To support interdisciplinary studies that address critical knowledge gaps regarding causal linkages between nursing and health care quality and to synthesize, translate, and disseminate major findings to key stakeholders.

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