The impact of three nursing staffing models on nursing outcomes.
OBJECTIVE
To examine the impact of application of different nursing staffing models on patient safety, quality of care and nursing costs.


BACKGROUND
One proposed means of addressing the staff shortage while decreasing nursing costs is the application of nursing staffing models. However, the optimal proportion of registered nurses to nurse aides remains unclear.


METHODS
A retrospective cohort study.


METHODS
To examine a total of 667 inpatients of a 20-bed respiratory care centre at a medical centre located in southern Taiwan. Three mixed models of nursing staffing, where the portion of nurses compared with nurse aides was 76% (n = 213), 100% (n = 209) and 92% (n = 245), were applied during three different periods between 2006 - 2010.


RESULTS
The 76% RNs group made fewer medication errors than the 100% RNs group; the 76% and 92% RNs groups had a higher rate of urinary tract infections; the 92% RNs group had a lower rate of bloodstream infections; the 76% RNs group had a lower rate of ventilator weaning; and the 76% and 92% RNs groups incurred higher nursing costs.


CONCLUSIONS
Use of different nursing staffing models that substitute nurse aides for RNs may negatively affect patient safety and quality of care and increase nursing costs. To avoid this risk, hospitals should employ and train their own nurse aides and develop a training system and education materials for RN and nurse aides.
Department of Nursing, Kaohsiung Medical University Hospital, Taiwan.
Pei-Hsuan
PH
Yang
School of Nursing, Kaohsiung Medical University, Taiwan.
Chich-Hsiu
CH
Hung
Taipei Veterans General Hospital, Taiwan.
Yu-Chin
YC
Chen
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D009740:Nursing Staff / Q000600:supply & distribution*; D017063:Outcome Assessment, Health Care; D010561:Personnel Staffing and Scheduling; D012189:Retrospective Studies; D013624:Taiwan; D055815:Young Adult
bloodstream infections; nurse aids; nurses; nursing costs; nursing outcomes; nursing staffing model; patient safety; respiratory care centre; urinary tract infections; ventilator weaning