“In Progress”

Over the past decade, nurses working in hospital settings have experienced numerous changes in staffing plans and patterns in providing care to patients. Hospital nursing administrators are challenged by staffing issues and the impact such issues may have on patient outcomes. In 2004, the registered nurse vacancy rate for the United States was reported as 8.1%. With increasing RN vacancy rates, the demand for agency nurses has proliferated dramatically. The use of agency staff may have an impact on patient outcomes because agency staff are often unfamiliar with hospital policies, procedures, and standards. Studies addressing the effects of agency staffing on patient outcomes are scare in the nursing literature.

Purpose: The primary purposes of this study are to: (a) examine the relationships between agency staff use and patient outcome indicators within acute care nursing units (critical care, medical-surgical, and telemetry) and (b) examine the relationships among hours of nursing care, staff skill mix, RN education level, RN certification, and patient outcome indicators within acute care nursing units.

Study Design: A retrospective, descriptive, correlational design will be used to examine relationships between the independent variables (agency staff use,  nurse staffing levels, nursing hours per patient day, RN education level, and RN certification) and dependent variables (code occurrences, restraint use, falls, injury falls, hospital acquired pressure ulcers, and medication error occurrences).

Sample and Setting: The study will be conducted in a five hospital integrated healthcare system located in an urban city in a Southeastern state. The sample will consist of 28 acute care nursing units (critical care, medical-surgical, and telemetry) within the healthcare system. Agency staffing, staff skill mix, and outcome data for the calendar years 2004 and 2005 will be used to address the study questions. <>Research Questions: 

1.      What are the relationships between use of agency staff and patient outcomes  (code occurrences, restraint use, falls, injury falls, hospital acquired pressure ulcers, and medication error occurrences) in acute care nursing units?

2.      What are the relationships among hours of nursing care, staff skill mix, RN education level, RN certification, and patient outcomes (code occurrences, restraint use, falls, injury falls, hospital acquired pressure ulcers, and medication error occurrences) in acute care nursing units?

3.      Are hours of nursing care, staff skill mix, agency use, RN education level, and RN certification predictors of patient outcomes (code occurrences, restraint use, falls, injury falls, hospital acquired pressure ulcers, and medication error occurrences) in acute care nursing units?

Data Collection: Calendar year 2004 and 2005 data will be retrieved from sources within the healthcare system that are currently collecting data on the independent and dependent variables.

Data Analysis: Data will be analyzed with descriptive and inferential statistics using SPSS for Windows Release 12.0. Statistical methods will include frequencies, percentages, means, standard deviations, bivariate correlations, and multiple linear regressions.