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Nurse Dose: Linking Staffing Variables to Adverse Patient Outcomes Open Access


Author or creator
Manojlovich, Milisa
Sidani, Souraya
Covell, Christine L.
Antonakos, Cathy L.
Additional contributors
Outcome assessment
Personnel staffing
Nursing theory
Type of item
Journal Article (Published)
Background: Inconsistent findings in over 100 studies have made it difficult to explain how variation in nurse staffing affects patient outcomes. Nurse dose, defined as the level of nurses required to provide patient care in hospital settings, draws on variables used in staffing studies to describe the influence of many staffing variables on outcomes. Objectives: The purpose of this study was to examine the construct validity of nurse dose by determining its association with MRSA infections and reported patient falls on a sample of inpatient adult acute care units. Method: Staffing data came from 26 units in Ontario Canada and Michigan. Financial and human resource data were data sources for staffing variables. Sources of data for MRSA came from Infection Control departments. Incident reports were the data source for patient falls. Data analysis consisted of bivariate correlations and Poisson regression. Results: Bivariate correlations revealed that nurse dose attributes (active ingredient and intensity) were significantly associated with both outcomes. Active ingredient (education, experience, skill mix), and intensity (FTE, RN-patient ratio, RN-HPPD) were significant predictors of MRSA. Coefficients for both attributes were negative and almost identical. Both attributes were significant predictors of reported patient falls and coefficients were again negative, but coefficient sizes differed. Discussion: By conceptualizing nurse and staffing variables (education, experience, skill mix, FTEs, RN-patient ratio, RN-HPPD) as components of nurse dose, and by including these in the same analysis, we were able to determine their relative influence on MRSA infections and reported patient falls.
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Citation for previous publication
Manojlovich, M., Sidani, S., Covell, C.L., & Antonakos, C.L. (2011). Nurse dose: Linking staffing variables to adverse patient outcomes. Nursing Research, 60(4), 214-220.


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