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.
Uvod: Večje delovne obremenitve medicinskih sester povečujejo verjetnost smrti pacientov. Delovno okolje medicinskih sester pomembno vpliva na izide zdravljenja. Namen raziskave je bil pojasniti povezavo med izidi zdravljenja pacientov in delovnimi razmerami medicinskih sester v bolnišnicah.
Metode: Zbrani so bili administrativni podatki o odpustu kirurških pacientov iz leta 2019 v osmih splošnih bolnišnicah in dveh univerzitetnih kliničnih centrih v Sloveniji, da bi ugotovili bolnišnično umrljivost v 30 dneh po sprejemu. Za zajem podatkov pri medicinskih sestrah v istih bolnišnicah je bil uporabljen vprašalnik raziskave RN4CAST. Sodelovalo je 1.010 medicinskih sester. Ti podatki so bili zbrani v začetku leta 2020. Izračunana sta bila število zaposlenih medicinskih sester v delovni izmeni ter razmerje med številom pacientov in številom medicinskih sester v delovni izmeni. Za analizo podatkov so bile uporabljene univariatne, bivariatne in multivariatne statistične metode.
Rezultati: Tridesetdnevna bolnišnična umrljivost kirurških pacientov je bila v vzorčenih bolnišnicah 1,00-odstotna in je znašala od 0,27 do 1,62 %. Razmerje možnosti za osebje kaže, da je vsako povečanje za enega pacienta na diplomirano medicinsko sestro povezano s 6-odstotnim povečanjem verjetnosti, da bo pacient umrl v 30 dneh po sprejemu. Povprečno razmerje pacientov na eno diplomirano medicinsko sestro je bilo 15,56 (SD = 2,50) in se je gibalo med 10,29 in 19,39. Štiri od trinajstih preverjenih nalog pri pacientu v zadnji izmeni niso bile opravljene.
Zaključek: Rezultati niso spodbudni, saj je pomanjkanje diplomiranih medicinskih sester izjemno kritično. Izpostavljena je njihova velika obremenitev. Število pacientov na eno diplomirano medicinsko sestro je najvišje v evropskih državah in širše ter predstavlja izjemno tveganje za kakovost zdravstvene nege in zdravstvene oskrbe kot celote v Sloveniji. Priporočilo za akutne internistične in kirurške oddelke, brez obravnav na intenzivni negi, je štiri paciente na eno diplomirano medicinsko sestro v delovni izmeni.
Keywords: Bachelor of science; Management; Mortality; Patient deaths; Practice environment; Quality; RN; Staffing; Unfinished tasks; Work conditions.
© 2023 Brigita SKELA-SAVIČ et al., published by Sciendo.