Patricia A. Patrician, PhD, RN, FAAN
Patient safety improvement through evidence-based staffing
Patricia A. Patrician, PhD, RN, FAAN, Nursing Banton Endowed Professor in the School of Nursing and retired U.S. Army colonel, was awarded a Tri-Service award from the U.S. Department of Defense for a 2 year study to continue the analyses of the Military Nursing Outcomes Database (MilNOD) Project.
The purpose of the study, titled Workload Intensity, The Nursing Practice Environment, and Adverse Events (HU0001-10-1-TS14), is to investigate the effect of the nurse practice environment as well as that of nursing workload intensity on the relationship known to exist between staffing and adverse events in acute care hospitals.
Patient safety and quality care major concern for hospitals and lapses in patient safety have been attributed to a care environment that is chaotic, turbulent, and fragmented. Poor quality nursing practice environments in hospitals have been empirically linked to excess patient deaths and other negative patient and nurse outcomes. Inadequate nurse staffing has also been linked to worse patient outcomes, however findings are not consistent across studies due to the imprecise measurements and lack of sufficient detail in available data sources.
Dr. Patrician believes that this current project will provide the answers to questions that have not been addressed by administrative databases. Building upon on the data and previous findings from the MilNOD, a longitudinal, prospective shift level study, Patrician will seek to expand and refine the understanding of nursing workload intensity and the effect of the practice environment on the relationship between nursing staffing and adverse events. [p1] The MilNOD sample includes survey data on the quality of their respective practice environments from over 1000 nurses, from 57 units in 13 military hospitals. For nearly 115,000 in the MilNOD data set, workload intensity includes measures of daily patient acuity and of patient throughput. The practice environment was measured with cross sectional nurse surveys using the Practice Environment Scale of the Nursing Work Index. Working with her research team, Dr. Patrician will use previous models that predicted effects of staffing on outcomes and add the variable of interest (falls, falls with injury, education administration errors, and nursing needle stick injuries) and will evaluate the possibility of both mediating and moderating effects of the practice environment. Additionally, her team will investigate whether the intensity of workload moderates the relationship between staffing and outcomes.
Patrician, P. A., Loan, L., McCarthy, M., Fridman, M., Donaldson, N., Bingham, M., et al. (2011). The association of shift-level nurse staffing with adverse patient events. J Nurs Adm, 41(2), 64-70.
Patrician, P. A., Pryor, E., Fridman, M., & Loan, L. (2011a). Needlestick injuries among nursing staff: association with shift-level staffing. Am J Infect Control, 39(6), 477-482.
Patrician, P. A., Pryor, E., Fridman, M., & Loan, L. (2012). Response to "A call for consideration of needlestick injury data in evaluating staffing effectiveness". Am J Infect Control. 40(1),81.