Exploring the Relationship between RN Turnover and Unit Acquired Pressure Ulcers

Purpose:
To explore the relationship between RN turnover and staffing and unit acquired pressure ulcers (UAPU) in adult med-surg units that participate in the National Database of Nursing Quality Indicators (NDNQI).

Background/Significance:
In Q3 2007, NDNQI began offering nurse turnover as one of its quarterly processing indicators. Now, there is sufficient sample to investigate the relationship between nurse turnover and patient outcomes. Although there is research on what contributes to nurse turnover, the research on how nurse turnover impacts patient outcomes such as unit acquired pressure ulcers is evolving.

Methods:
Quarter 2, 2008 through Quarter 1, 2009 data were extracted from the NDNQI database. Analysis sample included adult med-surg units that submitted complete turnover, staffing, and UAPU data for all four quarters. Unit-level, annual rates were calculated for each variable. Approximate transformation was conducted to normalize variables and Pearson's coeffient was performed on the continuous variables. To describe the sample, turnover rate was classified into three categories: low, medium and high. Low turnover units had an annual turnover rate less than 25th percentile. High turnover units had a turnover rate above the 75th percentile.

Results:
The relationship between UAPU and RN turnover was significant (R = 0.14, p =0.02). The percentage of patients with UAPU, by RN turnover rate category, was 1.91 and 3.43 for low and high turnover respectively. Significant associations were also found between RN turnover and percent of RN hours supplied by agency staff (R = 0.17, p =0.003). Percentage of RN hours supplied by agency staff was highest in the high turnover category (3.50) and lowest among low turnover units (1.45). Total nursing hours per patient day, RN hours per patient day, UAPU stage II and above, and percentage of patients with ulcer risk assessment performed within 24 hours were not significantly related to RN turnover.

Conclusions and Implications for Practice:
The analysis demonstrates the direct relationship between RN turnover and UAPU in adult med-surg units. More long-term research is needed to investigate deeper implications and explore the possibility that turnover is a proxy for underlying issues in the unit environment.