University of Oulu

Jansson, M, Ohtonen, P, Syrjälä, H, Ala‐Kokko, T. The proportion of understaffing and increased nursing workload are associated with multiple organ failure: A cross‐sectional study. J Adv Nurs. 2020; 76: 2113– 2124. https://doi.org/10.1111/jan.14410

The proportion of understaffing and increased nursing workload are associated with multiple organ failure : a cross‐sectional study

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Author: Jansson, Miia1,2; Ohtonen, Pasi3,4; Syrjälä, Hannu5;
Organizations: 1Research Group of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
2Oulu University Hospital, Oulu, Finland
3Division of Operative care, Oulu University Hospital, Oulu, Finland
4Medical Research Center Oulu, University of Oulu, Oulu, Finland
5Department of Infection Control, Oulu University Hospital, Oulu, Finland
6Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland
7Research Group of Surgery, Anesthesiology and Intensive Care, Medical Research Center Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.5 MB)
Persistent link: http://urn.fi/urn:nbn:fi-fe2020062445584
Language: English
Published: John Wiley & Sons, 2020
Publish Date: 2020-06-24
Description:

Abstract

Aims: To determine whether nurse staffing and nursing workload are associated with multiple organ failure and mortality.

Design: A cross‐sectional study.

Methods: This study was conducted in a single tertiary‐level teaching hospital during 2008–2017. The association between nurse staffing, nursing workload and prognosis was determined using daily nurse‐to‐patient ratios, Therapeutic Intervention Scoring System scores, Intensive Care Nursing Scoring System scores and Intensive Care Nursing Scoring System indexes. In addition, the timing of intensive care unit admission was considered. Multiple organ failure was defined according to the Sequential Organ Failure Assessment score.

Results: During the study period, 10,230 patients were included in the final analysis. Generally, the mean daily highest Therapeutic Intervention Scoring System score and Intensive Care Nursing Scoring System score were significantly higher in patients with multiple organ failure and in non‐survivors. The proportion of understaffing was significantly more common in patients with multiple organ failure than in those without. The mean daily lowest nurse‐to‐patient ratio and the mean daily highest Intensive Care Nursing Scoring System index did not differ between survivors and non‐survivors. The levels of nursing associated with workload and understaffing were at their worst on weekends.

Conclusions: The proportion of understaffing and increased nursing workload are associated with multiple organ failure, demonstrating that an adequate level of nurse staffing in relation to patient complexity is a prerequisite for the availability and quality of critical care services. The proportion of understaffing did not differ between survivors and non‐survivors.

Impact: This is the first study that evaluates nurse staffing and nursing workload as potential risk factors for multiple organ failure and mortality. There is a need to ensure that intensive care units are consistently staffed based on real patient needs, 7 days a week and that personnel and services are available at all times for high‐risk patients.

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Series: Journal of advanced nursing
ISSN: 0309-2402
ISSN-E: 1365-2648
ISSN-L: 0309-2402
Volume: 76
Issue: 8
Pages: 2113 - 2124
DOI: 10.1111/jan.14410
OADOI: https://oadoi.org/10.1111/jan.14410
Type of Publication: A1 Journal article – refereed
Field of Science: 316 Nursing
Subjects:
Copyright information: © 2020 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
  https://creativecommons.org/licenses/by/4.0/