JMIR Publications

ABSTRACT

Background:

Nursing-sensitive events (NSEs) are common and have been found to occur in hospitalized patient up to 77%. NSEs (e.g., fall-related harm, pressure ulcers, and healthcare-associated infections) lead to suffering for patients. Additionally, they constitute an economic burden on hospitals for generating high medical costs through a prolonged length of stay and additional medical procedures. To reduce NSEs and to ensure high-quality nursing care, appropriate nurse staffing levels are needed. While the link between nurse staffing and NSEs have been described in many studies, appropriate nurse staffing levels are lacking. Existing studies describe constant staffing exposure at the unit or hospital level without assessing individual patient-level exposure to nurse staffing during the hospital stay. Only few studies have assessed nurse staffing and patient outcomes using single-centre longitudinal design with a limited generalizability. There is a need for multicentre longitudinal studies with improved potential for generalization of the association between individual nurse staffing levels and NSEs.

Objective:

The aims of the study are 1) to determine the prevalence, preventability, type, and severity of NSEs; 2) to describe individual patient-level nurse staffing exposure across hospitals; 3) to describe the effect of nurse staffing on NSEs in patients; and 4) to determine thresholds of safe nurse staffing levels and test them against nursing-sensitive events in hospitalized patients.

Methods:

This is an international multicentre study with a longitudinal and observational research design. Four countries (Switzerland, Sweden, Germany, and Iran) will participate in the study, which includes 14 hospitals and 61 medical, surgery and mixed units. The observation period covers 16 weeks. NSEs will be collected using systematic retrospective record reviews. For each of the included units, 60 randomly selected patient admissions will be reviewed (n=3680 patient admissions in total). To be included, patients need to be hospitalized least 48 hours. Nurse staffing data (number of nurses and education) for each day and each shift will be collected to assess the association between NSEs and individual nurse staffing levels. Hospital data (type, teaching status, ownership) and unit data (service line, number of beds) will also be collected.

Results:

As of January 2024, the verification process for the plausibility and comprehensibility of patients' and nurse staffing data is underway across all four countries.

Conclusions:

This study will provide rich information on NSEs including their prevalence, preventability, type, and severity across countries. Moreover, this study will provide a better understanding of the mechanisms of NSEs and how nurse staffing might affect those events. We will evaluate within- and between-hospital variability to identify productive and urgently needed strategies to ensure safe nurse staffing levels to reduce NSEs in hospitalized patients. The TAILR-study will focus on the optimization of scarce staffing resources.