Patient Safety and Quality

Researchers compare two widely used data sources to examine hospital nurse staffing

With increasing concerns on about the adequacy of hospital nurse staffing and the implications for patient safety, it is important to examine the consistency of nurse staffing measures from different data sets. Specifically, to what extent does nurse staffing appear differently as measured by different data sources? Do the nurse staffing measures derived from different data sources show similar relationships with patient outcomes? To answer these questions, researchers at the Agency for Healthcare Research and Quality compared the American Hospital Association (AHA) annual survey with the California Office for Statewide Health Planning and Development (OSHPD) data on nurse staffing for 372 non-Federal, acute care hospitals in California. The OSHPD data appeared to be more complete, to include data on unlicensed nursing staff such as nurse aides (which comprised an average of 26 percent of nursing personnel), and to be more closely associated with patient outcomes.

Both databases showed that hospitals with higher registered nurse (RN) hours per adjusted patient day had significantly lower risk-adjusted rates for decubitus ulcers (bed sores) and mortality. However, the RN measures derived from OSHPD had greater effects on these outcomes than did the measures based on the AHA survey. No significant relationship was found between RN hours and rates of failure-to-rescue (patients who die after a complication). The data from both sources matched closely on overall average licensed nurse staffing level (total RNs and licensed practical nurses) and skill mix. Yet, staffing level data varied substantially by hospital characteristics. The AHA data more closely matched the OSHPD data for teaching, urban, large, or nonprofit hospitals (average relative difference ranged from less than 1 percent to 15 percent). However, AHA data showed an average of 16 to 49 percent higher staffing level than the OSHPD data for rural or small hospitals, whose resources might be too constrained to report annual data to the AHA.

The findings suggest that refining the AHA annual survey as a national database for nurse staffing could significantly enhance the capacity to monitor the nurse workforce and its effect on quality of care. Particularly, improvements are needed in data on unlicensed staff such as nurse aides, measuring nurse staff by nursing unit, type of nursing activity (for example, direct care vs. management), educational level, national origin, and productive hours (absent hours for vacation, sick leave, etc.).

See "Disparities between two common data sources on hospital nurse staffing," by H. Joanna Jiang, Ph.D., Carol Stocks, R.N., M.H.S.A., and Cindy J. Wong, M.S., M.A., in the Journal of Nursing Scholarship 38(2), pp. 187-193, 2006. Reprints (AHRQ Publication No. 06-R055) are available from the AHRQ Publication Clearinghouse.

Return to Contents
Proceed to Next Article