title: Nurse staffing and patient outcomes in Belgian acute hospitals: cross-sectional analysis of administrative data.
abstract: BACKGROUND
  Studies have linked nurse staffing levels (number and skill mix) to several nurse-sensitive patient outcomes. However, evidence from European countries has been limited.
  
  
  OBJECTIVE
  This study examines the association between nurse staffing levels (i.e. acuity-adjusted Nursing Hours per Patient Day, the proportion of registered nurses with a Bachelor's degree) and 10 different patient outcomes potentially sensitive to nursing care. DESIGN-SETTING-PARTICIPANTS: Cross-sectional analyses of linked data from the Belgian Nursing Minimum Dataset (general acute care and intensive care nursing units: n=1403) and Belgian Hospital Discharge Dataset (general, orthopedic and vascular surgery patients: n=260,923) of the year 2003 from all acute hospitals (n=115).
  
  
  METHODS
  Logistic regression analyses, estimated by using a Generalized Estimation Equation Model, were used to study the association between nurse staffing and patient outcomes.
  
  
  RESULTS
  The mean acuity-adjusted Nursing Hours per Patient Day in Belgian hospitals was 2.62 (S.D.=0.29). The variability in patient outcome rates between hospitals is considerable. The inter-quartile ranges for the 10 patient outcomes go from 0.35 for Deep Venous Thrombosis to 3.77 for failure-to-rescue. No significant association was found between the acuity-adjusted Nursing Hours per Patient Day, proportion of registered nurses with a Bachelor's degree and the selected patient outcomes.
  
  
  CONCLUSIONS
  The absence of associations between hospital-level nurse staffing measures and patient outcomes should not be inferred as implying that nurse staffing does not have an impact on patient outcomes in Belgian hospitals. To better understand the dynamics of the nurse staffing and patient outcomes relationship in acute hospitals, further analyses (i.e. nursing unit level analyses) of these and other outcomes are recommended, in addition to inclusion of other study variables, including data about nursing practice environments in hospitals.
authors.affiliation: Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Kapucijnenvoer 35/4, Leuven B-3000, Belgium. koen.vandenheede@med.kuleuven.be
authors.forename: Koen
authors.initials: K
authors.lastname: Van den Heede
authors.forename: Walter
authors.initials: W
authors.lastname: Sermeus
authors.forename: Luwis
authors.initials: L
authors.lastname: Diya
authors.forename: Sean P
authors.initials: SP
authors.lastname: Clarke
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Lesaffre
authors.forename: Arthur
authors.initials: A
authors.lastname: Vleugels
authors.forename: Linda H
authors.initials: LH
authors.lastname: Aiken
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D003430:Cross-Sectional Studies; D006761:Hospitals; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010561:Personnel Staffing and Scheduling