title: Association of Temporal Variations in Staffing With Hospital-Acquired Pressure Injury in Military Hospitals.
abstract: To more precisely evaluate the effects of nurse staffing on hospital-acquired pressure injury (HAPI) development, data on nursing care hours per patient day (NCHPPD), nursing skill mix, patient turnover (i.e., admissions, transfers, and discharges), and patient acuity were merged with patient information from pressure injury prevalence surveys that were collected annually for the Military Nursing Outcomes Database (MilNOD) project. The MilNOD included staffing and adverse events from 56 medical-surgical, stepdown, and critical care units in 13 military hospitals over a 4-year-period. Data on 1,643 patients were analyzed with Cox proportional hazards models and generalized estimating equations. Staffing was not associated with pressure injuries in stepdown or critical care patients. However, among the 1,104 medical-surgical patients, higher licensed practical nurse (LPN) nursing care hours per patient day (NCHPPD) 3 days and 1 week prior to the HAPI discovery date were associated with fewer HAPI (HR 0.27, p < .001), after controlling for patient age, Braden mobility score, and albumin level. Neither total staff number, nor RN NCHPPD, nor the proportion of staff who were RNs (RN skill mix) were associated with HAPI. These findings suggest that on military medical-surgical units, LPNs play a major role in HAPI prevention. Although the national trend in acute care is to staff hospital units with more RNs and patient care technicians, and fewer LPNs, hospitals should reconsider LPNs as valuable members of the nursing care team. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Donna Brown Banton Endowed Professor, School of Nursing, University of Alabama at Birmingham, NB 324 1720 Second Avenue South, Birmingham, AL, 35294-1210.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Patrician
authors.affiliation: Senior Nurse Scientist, Madigan Army Medical Center, Tacoma, WA.
authors.forename: Mary S
authors.initials: MS
authors.lastname: McCarthy
authors.affiliation: Lieutenant Colonel, US Army Nurse Corps, PhD Candidate, School of Nursing, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Pauline
authors.initials: P
authors.lastname: Swiger
authors.affiliation: Assistant Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Dheeraj
authors.initials: D
authors.lastname: Raju
authors.affiliation: Colonel, US Army Nurse Corps, Regional Nurse Executive, Europe Regional Medical Command, Landstuhl, Germany.
authors.forename: Sara
authors.initials: S
authors.lastname: Breckenridge-Sproat
authors.affiliation: Associate Professor, Department of Mathematical Sciences, University of Texas at El Paso, El Paso, TX.
authors.forename: Xiaogang
authors.initials: X
authors.lastname: Su
authors.affiliation: PhD student, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Kelly H
authors.initials: KH
authors.lastname: Randall
authors.affiliation: Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Loan
mesh_terms: D005260:Female; D006757:Hospital Units; D006772:Hospitals, Military / Q000458:organization & administration*; D006801:Humans; D065102:Licensed Practical Nurses / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000600:supply & distribution*; D010561:Personnel Staffing and Scheduling; D010563:Personnel Turnover; D003668:Pressure Ulcer / Q000517:prevention & control*
keywords: HAPI; licensed practical nurses; military hospitals; nurse staffing; pressure injury; pressure ulcer