Associations between rates of unassisted inpatient falls and levels of registered and non-registered nurse staffing.
OBJECTIVE
To enhance understanding of how nurse staffing relates to unassisted falls by exploring non-linear associations between unassisted fall rates and levels of registered nurse (RN) and non-RN staffing on 5 nursing unit types, thereby enabling managers to improve patient safety by making better-informed decisions about staffing.


METHODS
Cross-sectional analysis of routinely collected data using hierarchical negative binomial regression.


METHODS
8069 nursing units in 1361 U.S. hospitals participating in the National Database of Nursing Quality Indicators(®). Main outcome measure Rate of unassisted falls per inpatient day.


RESULTS
Associations between unassisted fall rates and nurse staffing varied by unit type. For medical-surgical units, higher RN staffing was weakly associated with lower fall rates. On step-down and medical units, the association between RN staffing and fall rates depended on the level of staffing: At lower staffing levels, the fall rate increased as staffing increased, but at moderate and high staffing levels, the fall rate decreased as staffing increased. Higher levels of non-RN staffing were generally associated with higher fall rates..


CONCLUSIONS
Increasing non-RN staffing seems ineffective at preventing unassisted falls. Increasing RN staffing may be effective, depending on the unit type and the current level of staffing.
Department of Biostatistics, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 3060, Kansas City, KS 66160, USA. vstaggs@kumc.edu.
Vincent S
VS
Staggs
Nancy
N
Dunton
D000058:Accidental Falls / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D009741:Nursing Staff, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D000078329:Workforce
accidental falls; nursing personnel; patient safety; personnel staffing and scheduling