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Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3064 — The Impact of Rehabilitation Nurses’ Characteristics on Patient Outcomes in Inpatient Settings

Author List:
Palacios PA (VISN 8 Patient Safety Center)
Nelson A (VISN 8 Patient Safety Center)
Powell-Cope G (VISN 8 Patient Safety Center)
Ahmed S (VISN 8 Patient Safety Center)
Fitzpatrick P (Uniform Data System for Medical Rehabilitation)
Gross J (University of Kentucky College of Nursing)
Nathenson P (Association of Rehabilitation Nurses)
Black T (Uniform Data System for Medical Rehabilitation)
Deininger D (James A. Haley VA Medical Center)
Christiansen B (Uniform Data System for Medical Rehabilitation)

Objectives:
Diverse staffing methodologies exist in inpatient rehabilitation settings, although few are evidence-based. Nurse staffing has been linked to patient outcomes in acute care, but not in rehabilitation. The objective of this study was to determine the impact of nurse and facility characteristics on patient outcomes in rehabilitation settings.

Methods:
We randomly selected 53 rehabilitation facilities from Uniform Data System for Medical Rehabilitation participating sites. The one month data collection included 1) unit level data (nurse characteristics, and facility’s CARF/JCAHO accreditation), and 2) patient level data (demographics, and daily admission/discharge FIM scores). The outcome measure was the patient’s total FIM gain (Discharge FIM – Admission FIM). The total FIM measures functional independence, ranging from 18 (dependent) to 126 (independent). Linear mixed modeling was used to study the impact of rehabilitation certification, and years of experience in nursing and rehabilitation on mean FIM gain.

Results:
We analyzed 25 facilities (1080 patients) to date. RNs had an average of 7.7 years of rehabilitation experience with 18% having CRRN (Certified Rehabilitation Registered Nurse). Sixty-seven percent of facilities were CARF certified. Patients were primarily older than 60 years (80%), female (61%), white (90%), and had a rehabilitation stay less than 30 days (95%). Mean FIM scores increased from Admission (65.33) to Discharge (80.16). When independent variables were modeled individually, only CARF designation and CRRN accreditation were significantly related to the FIM gain. When all variables were included, regression models showed that RN years of experience in nursing (p=0.05) and rehabilitation nursing (p=0.03) and CARF accreditation (p=0.002) were all significant predictors of FIM gain. CRRN was not found to be significant.

Implications:
Changes in FIM gain were related to more experienced RNs and CARF designation of the facility. The experience and expertise of rehabilitation nurses greatly impacted the FIM gain and thus reduced burden of care.

Impacts:
Regulatory and legislative solutions to the nursing shortage are being established without empirical data. Evidence-based nurse staffing models are required by JCAHO and to provide sound rationale for new Staffing Effectiveness Standards. Although the present study includes only non-VA sites, we will replicate the study with VA rehabilitation units.


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