Association between workload of the nursing staff and patient safety outcomes

To describe the workload of the nursing team and relate it with patient safety outcomes in clinical and surgical inpatient units of a university hospital.

METHOD

Cross-sectional study, carried out from October 2013 to September 2015. The factor under study was the workload, expressed as the ratio between the mean number of patients and the number of nursing professionals in 24 hours and in the day shifts.

RESULTS

The sample consisted of 157,481 patients, 502 nursing professionals and 264 observations of safety outcomes. The ratios of patients per nurse and per nursing technician in day shifts indicate a mean estimate of 14-15 and 5-6 patients per professional, respectively. There was a significant association between the workloads in the inpatient units and average length of stay, urinary infection related to invasive procedure and the satisfaction of patients with nursing care.

CONCLUSION

The increase in the workload of the nursing team had an impact on quality of care and safety for patients. An adequate staffing promotes a safer care environment.

Descriptors
Workload; Nursing; Team; Patient Safety; Nursing Staff; Hospital; Quality Indicators Health Care

Quality and Safety Indicators (n=264)	Mean	Standard Deviation	Median	P25 -	P75^* * 25 percentile; 75 percentile.
Workload of nursing staff
Patient/nurse in the 24h	4.96	1.08
Patient/nursing technician in the 24h	1.63	0.23
Patient/nurse in day shifts (M+A)	6.89	1.69
Patient/nursing technician in day shifts (M+A)	2.26	0.34
Patient safety outcomes related to care
Mean length of stay	8.18	2.52
Incidence of falls (IF)			1.53	0.73	-2.42
Incidence of Pressure Ulcer (PU)			0.00	0	-1.17
Urinary tract infection related to invasive procedures (UTI)			2.99	0	-8.13
Primary bloodstream infection (BSI)			0.00	0	-4.48
Patient safety outcomes related to management
Absenteeism			3.21	2.12	4.42
Turnover			0.00	0	0.88
Patients' level of satisfaction with the nursing team (%)	77.90	10.44

Quality and Safety Indicators	Patient/ Nurse 24h		Patient/ Nurse Day Shift		Patient/ Nursing Technician 24h		Patient/ Nursing Technician Day Shift
Quality and Safety Indicators	B^B† B† Generalized Estimating Equations describe the association between the factor under study and the outcomes. Associations were significant if P < 0.05.	P	B^B† B† Generalized Estimating Equations describe the association between the factor under study and the outcomes. Associations were significant if P < 0.05.	P	B^B† B† Generalized Estimating Equations describe the association between the factor under study and the outcomes. Associations were significant if P < 0.05.	P	B^B† B† Generalized Estimating Equations describe the association between the factor under study and the outcomes. Associations were significant if P < 0.05.	P
Care
Mean lenght of stay	0.65	0.00	0.34	0.00	3.44	0.00	2.28	0.00
Incidence of falls (IF)	0.00	0.96	0.02	0.71	0.12	0.67	0.19	0.32
Incidence of pressure ulcer (PU)	-0.08	0.39	-0.05	0.43	-0.34	0.44	-0.21	0.46
Urinary tract infection related to invasive procedures (UTI)	0.23	0.00	0.16	0.00	1.26	0.00	0.80	0.00
Primary bloodstream infection (BSI)	-0.08	0.52	-0.05	0.55	-0.61	0.39	-0.43	0.41
Management
Absenteeism	0.12	0.38	0.15	0.07	0.49	0.42	-.28	0.52
Turnover	0.20	0.04	0.13	0.06	0.61	0.24	0.39	0.24
Level of satisfaction with the nursing team	-2.61	0.00	-1.63	0.00	-8.84	0.00	-5.67	0.00

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Ana Maria Müller de Magalhães. Rua São Manoel, 963 - Rio Branco. CEP 90620-110 - Porto Alegre, Rio Grande do Sul, Brazil. amagalhaes@hcpa.edu.br