Monday, 21 July 2014

Impact of nurse staffing on clinical outcomes

In preparing this post, I invited Mireia Subirana, nurse and Director of Care Department at Hospital de  Vic (Catalonia), to present the contents of her doctoral thesis. It’s not a common occurrence for any nurse to get a doctor degree (University of Leeds). She now has a PhD degree and is a Fellow of the European Academy of Nursing Science.

But Subirana has not only been invited to praise her professional and academic career, but because I think it's worth explaining at exactly what point her research is at, having raised a hypothesis that affirms that if nurses from the hospital wards are well educated and the plans are well sized, this may have an impact on clinical outcomes of hospitalised patients. 

In the last ten years, research has established and endorsed the relationship between nurse staffing characteristics and clinical outcomes of hospitalised patients and thus objectifies the contribution of nurses in the care process. It remains to be found how this relationship is established, and the mechanisms that articulate it. This work, with a realistic methodological approach, identifies key factors in the process of care (monitoring, clinical trial, the level of training, experience and the tasks that they have not been able to do) along with the characteristics that define magnetic hospitals are articulated as possible mechanisms that could explain the impact of nurse staffing on patient outcomes.

What is a magnetic hospital?

The magnetic hospital term originates from the early 80’s to designate hospitals that in a context of lack of nurses are able to retain these professionals. Both the original study, as later developments (McClure) identified specific characteristics that are a magnet for nurses, while it becomes clear that these hospitals also obtain better clinical results.

And at this point I would highlight the elements that best describe the magnetism (you can see them in the above graph rectangles with rounded corners):
  • Nurse autonomy and “accountability"
  • Presence of support supervisors
  • Control over nursing practice and the environment in which it is practiced
  • Support for continuing education
  • Work oriented towards the global concern for the patient
  • Good relationship and good communication between nurses and doctors
  • Work climate where clinical competence stands out
Note that the financial reward doesn’t seem to be a magnetic factor.

The Credentialing Center of American Nurses (ANCC) has a program that recognizes healthcare organisations for quality and excellence in care and innovation in the professional practice of nurses.

“Essentials of Magnetism,” in Magnet Hospitals Revisited: Attraction and Retention of Professional Nurses, M. McClure and A. Hinshaw (eds). Kansas City, Mo., American Nurses Publishing, 2002.

Jordi Varela



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