Patient outcomes and hospital nurses’ workload : a cross-sectional observational study in Slovenian hospitals using the RN4CAST Survey

Skela-Savič, Brigita (author), Albreht, Tit (author), Sermeus, Walter (author), Lobe, Bojana (author), Bahun, Mateja (author), Dello, Simon (author)

Introduction: Higher nursing workload increases the odds of patient deaths, as the work environment has a significant effect on patient outcomes. The aim of the study was to explore the relation between patient outcomes and nurses’ working conditions in hospitals. Methods: Administrative data on discharges of surgical patients for the year 2019 in eight general hospitals and two university medical centres in Slovenia were collected to determine in-hospital mortality within 30 days of admission. The RN4CAST survey questionnaire was used to gather data from nurses in these hospitals, with 1,010 nurses participating. Data was collected at the beginning of 2020. The number of nurses per shift and the nurse-to-patient ratio per shift were calculated. Univariate, bivariate and multivariate statistical methods were used to analyse the data. Results: The 30-day in-hospital mortality for surgical patients was 1.00% in the hospitals sampled and ranged from 0.27% to 1.62%. The odds ratio for staffing suggests that each increase of one patient per RN is associated with a 6% increase in the likelihood of a patient dying within 30 days of admission. The mean patient-to-RN ratio was 15.56 (SD=2.50) and varied from 10.29 to 19.39. Four of the 13 tasks checked were not performed on patients during the last shift. Conclusion: The results are not encouraging, with an extremely critical shortage of RNs and thus a high RN workload. The number of patients per RN is the highest in Europe and also higher than in some non-European countries, and represents an extreme risk to the quality of nursing and healthcare as a whole. The recommendation for acute non-emergency internal medicine and surgery departments is four patients per RN per shift.

• Language: English
• Keywords: work conditions, staffing, RN, patient deaths, mortality, practice environment, bachelor of science, unfinished tasks, quality, management
• Work type: Article
• Typology: 1.01 - Original Scientific Article
• Organization: FDV - Faculty of Social Sciences
• Publication status: Published
• Publication version: Version of Record
• Year: 2023
• Number of pages: Str. 59-66
• Numbering: Letn. 62, št. 2
• PID: 20.500.12556/RUL-146156
• UDC: 614
• ISSN on article: 0351-0026
• DOI: 10.2478/sjph-2023-0009
• COBISS.SI-ID: 146203395
• Publication date in RUL: 22.05.2023

Record is a part of a journal

• Title: Zdravstveno varstvo. Slovenian journal of public health
• Publisher: Nacionalni inštitut za javno zdravje, Sciendo
• ISSN: 0351-0026
• COBISS.SI-ID: 3287810

Licences

• License: CC BY-NC-ND 3.0, Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported
• Link: http://creativecommons.org/licenses/by-nc-nd/3.0/
• Description: You are free to reproduce and redistribute the material in any medium or format. You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you may not distribute the modified material. You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.

Secondary language

• Language: Slovenian
• Title: Izidi zdravljenja pacientov in delovna obremenitev medicinskih sester v bolnišnicah : presečna opazovalna raziskava RN4CAST v slovenskih bolnišnicah
• Keywords: delovne razmere, zaposlovanje, medicinske sestre, smrti bolnikov, umrljivost, delovno okolje, dodiplomski študij, nedokončane naloge, kakovost, menedžment

Projects

• Funder: EC - European Commission
• Funding programme: ERASMUS +, Action KA2
• Project number: 601092-EPP-1-2018-1-SI-EPPKA2-KA
• Name: Hospitals and faculties together for prosperous and scientific based healthcare