Effect of peri-operative certified RNs on nursing sensitive patient outcomes in respective hospital surgical units

Purpose:
We used Donabedian's Structure-Process-Outcome framework to examine the relationship between rate (percent) of specialty certified RNs in peri-operative units (structure of care) and patient outcomes on respective surgical units.

Background/Significance:
The IOM affirmed specialty certification as "added assurance to the public that [nurses] have acquired the specialized professional development, training, and competencies required to provide safe, quality care for specific patient populations.” Research is needed to undergird the statement.

Methods:
The sample included: (a) 270 NDNQI hospitals with paired peri-operative and surgical units, and (b) 178 NDNQI hospitals with paired peri-operative and surgical intensive care units (SICUs). Included peri-operative certifications were CNOR, CRNFA, CPAN, and CAPA. Outcomes were hospital-acquired pressure ulcers (HAPUs), catheter-associated urinary tract infections (CAUTI), and central line-associated blood stream infections (CLABSI). We used panel model regression design with generalized linear mixed modeling for analysis, with outcomes lagged one quarter after other variables were measured. We also controlled for unit (e.g., percent BSN) and hospital characteristics (e.g., Magnet status).

Results:
Peri-operative certification rates averaged from 62.8% (SD=26.5%) for CNORs to 3.5% (SD=10.1%) for CRNFAs. Lower SICU CLABSI rates were significantly (p ≤ 0.05) related to higher CPAN (beta = -0.12) and CRNFA (beta = -0.34) rates. On surgical units, lower HAPU rates were related to higher CAPA rates (beta = -0.08), and lower CAUTI rates were related to higher CRNFA rates (beta = -0.25).

Conclusions and Implications for Practice:
Higher peri-operative certification rates are associated with better patient outcomes and significant hospital savings. For example, a 10% increase in the rate of CRNFAs will reduce CLABSI on SICUs by 12%, while a 10% increase in CPANs will reduce CLABSI on SICUs by 29%.