: STORIES FROM THE BEDSIDE AND BEYOND Dorothy M. Smith Nursing Leadership Conference University of Florida College of Nursing February 4, 2016 Jeannie P. Cimiotti Associate Professor & Dorothy M. Smith Endowed Chair
The Pre Data Years: 40.9147 N, 74.1628 W Case Study 1 Liver failure Case Study 2 Renal failure Case Study 3 Orthopedic emergency Case Study 4 Dialysis emergency
The Pre Data Years: 40.8417 N, 73.9375 W Case Study 1 Anaphylaxis Case Study 2 Blood bank Case Study 3 Man made outbreak Case Study 4... and in the end
Where s the Data: 40.8417 N, 73.9375 W First partnership Nurse and physician Hospital epidemiologist and ID attending Data collection on device utilization in the ICU Urinary catheters Hospital acquired infections Device utilization associated with infection Presentation to medical staff
Data Collection: 40.8417 N, 73.9375 W Partnership in Research on HAIs (1RO1 NR05197 E. Larson) Nurses, physicians, epidemiologists, pharmacists, microbiologists, statisticians, hospital administration Subjects were nurses and infants 119 FT nurses and 2,926 infants Direct and indirect observational data (2 years) Hand hygiene and skin integrity, cultures of infants and nurses, nurse staffing, nurse diary, demographic characteristics of nurses and patients
Findings: 40.8417 N, 73.9375 W Demographic characteristics associated with infection Hand hygiene was suboptimal Infants were touched 78 (mean) times per shift 22.8% with cleaned hands New Finding: New nurse graduates acquired methicillin resistance organisms within 4 12 weeks
Nurse Workload and Infection Nurse staffing is a risk factor for infection in infants Increased workload associated with a 53% increase in risk of bloodstream infection Hypotheses: Inadequate nurse staffing results in Poor hand hygiene compliance Breaks in aseptic technique Compromises in practice
Moving Forward: 39.9500 N, 75.1667 W Partnership in Organization and Delivery of Nursing Care (R01 NR004513 L. Aiken) Nurses, physicians, sociologists, demographers, statisticians Subjects were nurses and adult patients (CA, FL, NJ, PA) 225,000 nurses and 6 million patients Primary and secondary data Nurse survey Inpatient claims data All adult patients discharged from acute care hospital
The Nurse Survey Practice Environment Scale of the Nursing Work Index (PES NWI). A reliable and valid measure of the nurse work environment Adopted by the National Quality Forum The Maslach Burnout Inventory Human Services Survey (MBI HHS) A reliable and valid measure of job related burnout. A version of the MBI designed specifically for use in healthcare providers And more.
Nurse Work Environment Percent of nurses agreeing the following were present in their job Reasonable workload California 73% New Jersey 59% Pennsylvania 61% Adequate support services allow me to spend time with patients California 66% New Jersey 53% Pennsylvania 55%
Nurse Work Environment Enough registered nurses in staff to provide quality patient care California 58% New Jersey 41% Pennsylvania 44% Enough staff to get the work done California 56% New Jersey 40% Pennsylvania 44%
Effects of Increased workloads Complaints from patients or families (OR =1.2) Verbal abuse by patients (OR = 1.3) Verbal abuse by staff (OR = 1.3) Job Related Burnout (OR = 1.5) Job dissatisfaction (OR = 1.5) Quality of care fair/poor (OR = 1.8) Workload causes me to miss changes in patient condition (OR = 1.5) Workload causes me to look for a new position (OR = 1.6)
Inpatient Mortality & Failure to Rescue Adding one additional patient to a nurse workload (death) California (OR = 1.13) New Jersey (OR = 1.10) Pennsylvania (1.06) Adding one additional patient to a nurse workload (FTR) California (OR = 1.15) New Jersey (OR = 1.10) Pennsylvania (OR = 1.06)
Nurse Burnout: Practice Setting
Nurse Burnout: The Work Environment
Nurse Burnout and Infection (PA) Catheter Associated Urinary Tract Infection (CAUTI) Nurse burnout was associated with a.82 unit increase in the rate of urinary tract infection Surgical Site Infection (SSI) Nurse burnout was associated with a 1.56 unit increase in the rate of surgical site infection 10% increase in a hospitals composition of high burnout nurses associated with an increase in 1 CAUTI and 2 SSIs per 1,000 patients
Cost of Burnout: PA Hospitals Average attributable per patient cost of infection $749 to $832 for CAUTI $11,087 to $29,443 for SSI Hospitals where nurse burnout is reduced by 30% Decrease CAUTI by 4,006 Decrease SSI by 2,233 $28 million to $68 million saved annually Reduction hospitals burned out nurses from 30% to 10% 4,160 infection prevented $41 million saved annually
Nurse Burnout & Patient Satisfaction
RN4CAST: 50.8500 N, 4.3500 E Global Partnership International study of nurse workforce and quality of patient care Belgium, Botswana, China, Finland, Germany, Greece, Ireland, The Netherlands, Norway, Poland, South Africa, Spain, Sweden, Switzerland, United Arab Emirates, United Kingdom, United States
Shanghai, China High levels of job related burnout (46%) Dissatisfied with the job (56%) Environment on their ward as fair/poor (61%) Quality of care on their ward as fair/poor (28%) Not confident patients can manage care when discharged (51%) Add one additional patient to a nurses workload 14% increase in odds of nurses reporting quality of care as fair/poor
Ongoing Work: RN4CAST 2016 (USA) Partnership Organization of Nursing Care (2015 2016) Nurses, physicians, sociologists, demographers, statisticians Subjects were nurses and adult patients (CA, FL, NJ, PA) 225,000 nurses and 2.6 million patients Primary and secondary data Nurse survey Inpatient claims data All adult patients discharged from acute care hospital
Future Work: Under Review AHRQ Examine cross sectional data to determine the extent to which nursing resources are associated with HAIs Staffing, skill mix, nurse education, use of temporary nurses, quality of the work environment Determine the effects of changes in nursing by hospitals over time on rates of common HAIs CLABSI, MRSA bacteremia, CAUTI, SSI, C. difficile, VAP, and non device related infections and infection related outcomes Determine the extent to which financial investments in nursing offset annual direct costs associated with the treatment of HAI
Pay it Forward: Training Centers & Grants Partnership in Training the Next Generation Advanced Training in Nursing Outcomes Research (T32 NR07104) Pediatric Hospital Epidemiology and Outcomes research Training (T32 HD060550) Impact of Health Information Technology on Delivery and Quality of Patient Care (R36 HS021988 01)