BACKGROUND
Nursing-sensitive events (NSEs) are common and have been found to occur in hospitalized patient up to 77%. NSEs (e.g., fall-related harm, pressure ulcers, and healthcare-associated infections) lead to suffering for patients. Additionally, they constitute an economic burden on hospitals for generating high medical costs through a prolonged length of stay and additional medical procedures. To reduce NSEs and to ensure high-quality nursing care, appropriate nurse staffing levels are needed. While the link between nurse staffing and NSEs have been described in many studies, appropriate nurse staffing levels are lacking. Existing studies describe constant staffing exposure at the unit or hospital level without assessing individual patient-level exposure to nurse staffing during the hospital stay. Only few studies have assessed nurse staffing and patient outcomes using single-center longitudinal design with a limited generalizability.
OBJECTIVE
The aims of the study are 1) to determine the prevalence, preventability, type, and severity of nursing-sensitive events; 2) to describe individual patient-level nurse staffing exposure across hospitals; 3) to describe the effect of nurse staffing on nursing-sensitive events in patients; and 4) to determine thresholds of safe nurse staffing levels and test them against nursing-sensitive events in hospitalized patients.
METHODS
This is an international multicentre study with a longitudinal and observational research design. Four countries (Switzerland, Sweden, Germany, and Iran) will participate in the study, which includes 14 hospitals and 61 units. The observation period covers 16 weeks. Nursing-sensitive events will be collected using systematic retrospective record reviews. For each of the included units, 60 randomly selected patient admissions will be reviewed (n=3680 patient admissions). Nurse staffing data for each day and each shift will be collected to assess the association between nursing-sensitive events and individual nurse staffing levels. Hospital and unit data will also be collected.
RESULTS
As of January 2024, the verification process for the plausibility and comprehensibility of patients' and nurse staffing data is underway across all four countries.
CONCLUSIONS
This study will provide evidence of nursing-sensitive events and their prevalence, preventability, type, and severity across countries. Moreover, this study will provide a better understanding of the mechanisms of nursing-sensitive events and how nurse staffing might affect those events. We will evaluate within- and between-hospital variability to identify productive and urgently needed strategies to ensure safe nurse staffing levels to reduce nursing-sensitive events in hospitalized patients.