title: The impact of nursing grade on the quality and outcome of nursing care.
abstract: The large industry which has grown up around the estimation of nursing requirements for a ward or for a hospital takes little account of variations in nursing skill; meanwhile nursing researchers tend to concentrate on the appropriate organisation of the nursing process to deliver best quality care. This paper, drawing on a Department of Health funded study, analyses the relation between skill mix of a group of nurses and the quality of care provided. Detailed data was collected on 15 wards at 7 sites on both the quality and outcome of care delivered by nurses of different grades, which allowed for analysis at several levels from a specific nurse-patient interaction to the shift sessions. The analysis shows a strong grade effect at the lowest level which is 'diluted' at each succeeding level of aggregation; there is also a strong ward effect at each of the lower levels of aggregation. The conclusion is simple; you pay for quality care.
authors.affiliation: Centre for Health Economics, University of York, UK.
authors.forename: R A
authors.initials: RA
authors.lastname: Carr-Hill
authors.forename: P
authors.initials: P
authors.lastname: Dixon
authors.forename: M
authors.initials: M
authors.lastname: Griffiths
authors.forename: M
authors.initials: M
authors.lastname: Higgins
authors.forename: D
authors.initials: D
authors.lastname: McCaughan
authors.forename: N
authors.initials: N
authors.lastname: Rice
authors.forename: K
authors.initials: K
authors.lastname: Wright
mesh_terms: D000704:Analysis of Variance; D002983:Clinical Competence / Q000592:standards*; D006801:Humans; D007587:Job Description; D015233:Models, Statistical; D009723:Nurse-Patient Relations; D015403:Nursing Evaluation Research / Q000379:methods; D009738:Nursing Service, Hospital / Q000592:standards*; D009741:Nursing Staff, Hospital / Q000145:classification / Q000523:psychology / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D006113:United Kingdom