Competence and certification of registered nurses and safety of patients in intensive care units.
BACKGROUND
Adverse events that place patients at risk for harm are common in intensive care units. Clinicians' level of knowledge and judgment appear to play a role in the prevention, mitigation, and creation of adverse advents. Research suggests a possible association between nurses' specialty certification and clinical expertise. The relationship between specialty certification and clinical competence of registered nurses and safety of patients is a relatively new area of inquiry in nursing.


OBJECTIVE
To explore the relationship between the proportion of certified staff nurses in a unit and risk of harm to patients.


METHODS
Hierarchical linear modeling was used in a secondary data analysis of 48 intensive care units from a random sample of 29 hospitals to examine the relationships between unit certification rates, organizational nursing characteristics (magnet status, staffing, education, and experience), and rates of medication administration errors, falls, skin breakdown, and 3 types of nosocomial infections. Medicare case mix index was used to adjust for patient risk.


RESULTS
Unit proportion of certified staff registered nurses was inversely related to rate of falls, and total hours of nursing care was positively related to medication administration errors. The mean number of years of experience of registered nurses in the unit was inversely related to frequency of urinary tract infections; however, the small sample size requires that caution be exercised when interpreting results.


CONCLUSIONS
Specialty certification and competence of registered nurses are related to patients' safety. Further research on this relationship is needed.
Kendall-Gallagher
Deborah
D
Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA 19104-6096, USA. debk@nursing.upenn.edu
Blegen
Mary A
MA
D000058:Accidental Falls / Q000706:statistics & numerical data; D002568:Certification / Q000706:statistics & numerical data*; D002983:Clinical Competence; D003428:Cross Infection / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000706:statistics & numerical data*; D016014:Linear Models; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D009726:Nurses / Q000458:organization & administration* / Q000706:statistics & numerical data*; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D017751:Safety Management / Q000458:organization & administration