title: The impact of adding assistants in nursing to acute care hospital ward nurse staffing on adverse patient outcomes: An analysis of administrative health data.
abstract: OBJECTIVE
  The aim of this study was to assess the impact of adding assistants in nursing to acute care hospital ward nurse staffing on adverse patient outcomes using administrative health data.
  
  
  METHODS
  Logistic regression modelling was used with linked administrative health data to examine the association between seven adverse patient outcomes and use of assistants in nursing utilising a pre-test/post-test design. Outcomes included were in-hospital 30-day mortality, failure to rescue, urinary tract infection, pressure injury, pneumonia, sepsis and falls with injury.
  
  
  METHODS
  Eleven acute care metropolitan hospitals in Western Australia.
  
  
  METHODS
  Patients were retained in the dataset if they spent any time on a medical, surgical or rehabilitation ward during their admission and excluded if they only spent time on other ward types, as the outcomes used in this study are only validated for these patient populations. There were 256,302 patient records in the total sample with 125,762 in the pre-test period (2006-2007) and 130,540 in the post-test period (2009-2010).
  
  
  RESULTS
  The results showed three significant increases in observed to expected adverse outcomes on the assistant in nursing wards (failure to rescue, urinary tract infection, falls with injury), with one significant decrease (mortality). On the non-assistant in nursing wards there was one significant decrease (pneumonia) in the observed to expected adverse outcomes and one significant increase (falls with injury). Post-test analysis showed that spending time on assistant in nursing wards was a significant predictor for urinary tract infection and pneumonia. For every 10% of extra time patients spent on assistant in nursing wards they had a 1% increase in the odds of developing a urinary tract infection and a 2% increase in the odds of developing pneumonia.
  
  
  CONCLUSIONS
  The results suggest that the introduction of assistants in nursing into ward staffing in an additive role should be done under a protocol which clearly defines their role, scope of practice, and working relationship with registered nurses, and the impact on patient care should be monitored.
authors.affiliation: School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia; Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia. Electronic address: Christine.Duffield@uts.edu.au.
authors.forename: Diane E
authors.initials: DE
authors.lastname: Twigg
authors.affiliation: School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia. Electronic address: h.myers@ecu.edu.au.
authors.forename: Helen
authors.initials: H
authors.lastname: Myers
authors.affiliation: School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia; Centre for Health Services Management, University of Technology, Sydney, New South Wales, Australia. Electronic address: Christine.Duffield@uts.edu.au.
authors.forename: Christine
authors.initials: C
authors.lastname: Duffield
authors.affiliation: School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia; School of Health Professions Murdoch University, Murdoch, Western Australia, Australia. Electronic address: J.Pugh@murdoch.edu.au.
authors.forename: Judith D
authors.initials: JD
authors.lastname: Pugh
authors.affiliation: School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia. Electronic address: l.gelder@ecu.edu.au.
authors.forename: Lucy
authors.initials: L
authors.lastname: Gelder
authors.affiliation: Centre for Health Services Management, University of Technology, Sydney, New South Wales, Australia. Electronic address: michael.roche@uts.edu.au.
authors.forename: Michael
authors.initials: M
authors.lastname: Roche
mesh_terms: D000488:Allied Health Personnel / Q000706:statistics & numerical data*; D001315:Australia; D005260:Female; D006782:Hospitals, Special; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital; D017063:Outcome Assessment, Health Care; D063868:Patient Outcome Assessment; D010561:Personnel Staffing and Scheduling; D011014:Pneumonia / Q000401:mortality; D014552:Urinary Tract Infections / Q000451:nursing; D000078329:Workforce
keywords: Assistants in nursing; Nursing; Nursing sensitive outcomes; Nursing workforce; Patient outcomes