The costs of healthcare in the United States are of national concern. The systematic review of the literature (SRL) explored the practice-focused nursing question regarding the relationship between the use of acuity-based staffing (ABS) models and positive patient outcomes. Analyzing the impact of ABS models on patient quality outcomes and the potential economic value could provide evidence essential for the healthcare executives responsible for fiscally prudent labor management and for creating an evidence-based business case for adequate, patient-centric nurse staffing. The synergy model for patient care and Covell's nursing intellectual capital theory guided the doctoral project. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review process steps were completed to organize the SRL and report findings. A comprehensive review of the literature yielded 527 articles, with 5 studies that met inclusion criteria in the final review. Analysis and synthesis of the SRL identified several patient outcomes that were significantly correlated with ABS staffing, including medication errors, falls, patient safety incidents, missed care, and mortality. The current body of evidence was insufficiently robust to demonstrate ABS staffing was superior to other nurse staffing models. The implications of this project for positive social change include demonstrating a need for additional research on ABS and the impact of ABS on patient outcomes.

To ensure quality patient care hospitals invest in nursing intellectual capital by allocating financial, human and material resources for nurses to acquire the knowledge and skills necessary to provide safe patient care. This study’s purpose was to test selected propositions of the middle-range theory of nursing intellectual capital which provides a conceptualization of the influence of nurses’ knowledge, skills and experience (nursing human capital) to patient and organizational outcomes. The theory was systematically developed after a critical review of the literature. It proposes that nursing human capital (registered nurses’ experience, and knowledge and skills acquired from continuing professional development including university courses, conferences, workshops, in-services, specialty certification) is related to variables within the work environment (nurse staffing, employer support for nurse continuing professional development), which in turn, is associated with the quality of patient care (adverse events) and the recruitment and retention of nurses. The theory also proposes that nursing structural capital, nursing knowledge available within practice guidelines, is associated with the quality of patient care. A cross-sectional design was used to test the proposed relationships. The study took place in 6 acute care hospitals in two provinces of Canada. Financial, human resource and risk management data were collected from hospital departmental databases and a survey of unit managers. Data from 91 inpatient units were used with structural equation modeling to test the theory’s propositions. The results indicated that nurses’ knowledge and skills represented by the proportion of RNs with degrees and proportion of RNs with specialty certification were directly associated with low hospital-acquired infection rates. Nurse experience, measured as mean years RN professional experience and RN unit tenure, was found to be significantly related to higher RN recruitment and retention. The proportion of RNs with degrees was found to partially mediate the influence of nurse staffing on hospital-acquired infections. The results provide preliminary evidence of the association of nursing intellectual capital with patient and organizational outcomes. The findings may assist administrators with fiscal and human resource decision-making related to the education of nurses within acute care hospitals, and professional organizations with policies governing nursing education and continuing professional development.

To ensure quality patient care hospitals invest in nursing intellectual capital by allocating financial, human and material resources for nurses to acquire the knowledge and skills necessary to provide safe patient care. This study’s purpose was to test selected propositions of the middle-range theory of nursing intellectual capital which provides a conceptualization of the influence of nurses’ knowledge, skills and experience (nursing human capital) to patient and organizational outcomes. The theory was systematically developed after a critical review of the literature. It proposes that nursing human capital (registered nurses’ experience, and knowledge and skills acquired from continuing professional development including university courses, conferences, workshops, in-services, specialty certification) is related to variables within the work environment (nurse staffing, employer support for nurse continuing professional development), which in turn, is associated with the quality of patient care (adverse events) and the recruitment and retention of nurses. The theory also proposes that nursing structural capital, nursing knowledge available within practice guidelines, is associated with the quality of patient care. A cross-sectional design was used to test the proposed relationships. The study took place in 6 acute care hospitals in two provinces of Canada. Financial, human resource and risk management data were collected from hospital departmental databases and a survey of unit managers. Data from 91 inpatient units were used with structural equation modeling to test the theory’s propositions. The results indicated that nurses’ knowledge and skills represented by the proportion of RNs with degrees and proportion of RNs with specialty certification were directly associated with low hospital-acquired infection rates. Nurse experience, measured as mean years RN professional experience and RN unit tenure, was found to be significantly related to higher RN recruitment and retention. The proportion of RNs with degrees was found to partially mediate the influence of nurse staffing on hospital-acquired infections. The results provide preliminary evidence of the association of nursing intellectual capital with patient and organizational outcomes. The findings may assist administrators with fiscal and human resource decision-making related to the education of nurses within acute care hospitals, and professional organizations with policies governing nursing education and continuing professional development.

PURPOSE: Substantial research demonstrates that many nursing homes are not providing adequate quality of care for residents because of inadequate processes of care and insufficient numbers and training of nursing staff. Some residents experience poor-quality outcomes, such as pressure ulcers and unintended weight loss. To address these issues, the long-term care industry has focused on improving quality of care by improving staff education about care processes and reducing nurse turnover rate. The aim of this study was to compare the association between - licensed nurse hours of care and turnover rate to five quality measures—incidence of ADL decline, physical restraints, prevalence of pressure ulcers among residents with risk factors for skin breakdown, and prevalence of unintended weight loss. DESIGN: The study population included 618 freestanding Texas nursing facilities. A cross-sectional multiple regression analysis was conducted using 2007 data to examine the relationship between nurse staffing levels and turnover and resident outcomes with control variables for facility and resident characteristics. RESULTS: The high-risk pressure ulcer variable accounted for 10% of the variation in the regression model. LVN (hprd) was positively associated with an increase in high-risk pressure ulcers. The ADL decline variable accounted for 7.5% of the variation in the regression model, and RN hprd was positively associated with ADL decline. The prevalence of weight loss variable accounted for 3% of the variation in the regression model. RN turnover rate was approaching significance. The physical restraint variable accounted for 2% of the variation in the regression model. LVN contract hprd was significant and positively associated with an increase in physical restraint use although a minimal contribution to the model given the low percentage of LVN contract hprd. The prevalence of low-risk pressure ulcers was not significant. The control variable case mix index was positively associated with ADL decline, high-risk pressure ulcers, and weight loss. CONCLUSIONS: This research will contribute to understanding the relationship of licensed nursing staff to resident outcomes. Additionally, it will contribute to nursing education, research, and policy. While controlling for acuity using case mix index, some negative findings were still noted that requires further research. / text

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