Other Titles
Symposium: The Impact of Adding Nursing Support Workers on Patient, Nurse, and System Outcomes
Abstract
Session presented on Sunday, July 24, 2016:
Purpose: To determine the impact of the addition of nursing support workers to nursing units (wards) on patient mortality and morbidity.
Methods: Retrospective analysis of longitudinal morbidity and mortality data. Administrative data were collected for all patients admitted to a hospital in Western Australia for more than 24 hours over a 4-year period. 256,302 records in total. Data included records from 2 years before the introduction of AINs (2006-2007, 125,762 records) and 2 years after the introduction of AINs (2009-2010, 130,540 records). Data were further divided into nursing wards with and without AINs for the latter period. Nurse Sensitive Outcomes (NSOs) were identified in the data following established international methods, using algorithms with inclusion and exclusion criteria based on ICD-10 codes (Needleman et al., 2011; Duffield, Diers, et al., 2011; Roche, Duffield, Aisbett, Diers, & Stasa, 2012; Twigg et al., 2011). Two analyses were undertaken for each NSO: a pre/post analysis of the introduction of AINs and a post-only analysis of AIN/non-AIN wards. Logistic regression models were developed with adjustments for a range of factors including age, gender, length of stay, Charlson comorbidity index, DRG cost weight, skillmix and ward transfers. Ethics approval was obtained from two universities and three hospitals.
Results: Comparison of NSOs pre- and post-introduction of AINs found that the observed frequency of most NSOs was higher than the expected frequency across all wards. On wards where AINs had been added to staffing, higher that expected rates of urinary tract infections, falls and mortality were observed, with statistically significant differences relative to pre-introduction. In the post-only analysis, patients who spent longer periods on wards with low skillmix and on AIN wards were significantly more likely to experience an NSO.
Conclusion: When nursing support workers are added to the staffing complement on a ward, the impact on patient care should be monitored. Low skillmix has been identified in the literature as being associated with poorer patient outcomes, and the addition of less skilled workers such as AINs will potentially compound this effect. Therefore, careful consideration needs to be given to the environment into which AINs are introduced, particularly if they are introduced into wards that already have low skillmix.
Sigma Membership
Phi Gamma (Virtual)
Type
Presentation
Format Type
Text-based Document
Study Design/Type
N/A
Research Approach
N/A
Keywords:
Nursing Support Workers, Nurse Sensitive Outcomes, Skill Mix
Recommended Citation
Twigg, Diane Esma, "The impact of nursing support workers on patient outcomes" (2016). INRC (Congress). 250.
https://www.sigmarepository.org/inrc/2016/presentations_2016/250
Conference Name
27th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Cape Town, South Africa
Conference Year
2016
Rights Holder
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Acquisition
Proxy-submission
The impact of nursing support workers on patient outcomes
Cape Town, South Africa
Session presented on Sunday, July 24, 2016:
Purpose: To determine the impact of the addition of nursing support workers to nursing units (wards) on patient mortality and morbidity.
Methods: Retrospective analysis of longitudinal morbidity and mortality data. Administrative data were collected for all patients admitted to a hospital in Western Australia for more than 24 hours over a 4-year period. 256,302 records in total. Data included records from 2 years before the introduction of AINs (2006-2007, 125,762 records) and 2 years after the introduction of AINs (2009-2010, 130,540 records). Data were further divided into nursing wards with and without AINs for the latter period. Nurse Sensitive Outcomes (NSOs) were identified in the data following established international methods, using algorithms with inclusion and exclusion criteria based on ICD-10 codes (Needleman et al., 2011; Duffield, Diers, et al., 2011; Roche, Duffield, Aisbett, Diers, & Stasa, 2012; Twigg et al., 2011). Two analyses were undertaken for each NSO: a pre/post analysis of the introduction of AINs and a post-only analysis of AIN/non-AIN wards. Logistic regression models were developed with adjustments for a range of factors including age, gender, length of stay, Charlson comorbidity index, DRG cost weight, skillmix and ward transfers. Ethics approval was obtained from two universities and three hospitals.
Results: Comparison of NSOs pre- and post-introduction of AINs found that the observed frequency of most NSOs was higher than the expected frequency across all wards. On wards where AINs had been added to staffing, higher that expected rates of urinary tract infections, falls and mortality were observed, with statistically significant differences relative to pre-introduction. In the post-only analysis, patients who spent longer periods on wards with low skillmix and on AIN wards were significantly more likely to experience an NSO.
Conclusion: When nursing support workers are added to the staffing complement on a ward, the impact on patient care should be monitored. Low skillmix has been identified in the literature as being associated with poorer patient outcomes, and the addition of less skilled workers such as AINs will potentially compound this effect. Therefore, careful consideration needs to be given to the environment into which AINs are introduced, particularly if they are introduced into wards that already have low skillmix.
