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Health Services Research & Development

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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3073 — A Longitudinal Study of the Effects of Nurse Staffing Levels, Nursing Characteristics, and Job Tenure on Patient Outcomes for VA Long Term Care

Phibbs CS (COE-Palo Alto), Bartel AP (Columbia University), Schmitt SK ( COE-Palo Alto), Stone PW (Columbia University)

Objectives:
There is growing evidence of the effect of nurse staffing levels on patient outcomes in acute-care hospitals, but the evidence is more limited for long term care (LTC). This study examines relationships between nurse staffing levels, skill-mix, and experience, and patient outcomes in VA LTC units.

Methods:
All skilled nursing and LTC (or CLC) unit data for FY 03-08 were examined. Staffing data for all nursing personnel types (i.e., registered nurses [RN], licensed vocational nurses [LVN] and aides) were obtained from the Decision Support System. Payroll data were used to determine each nurse’s education and tenure on the unit. Patient data were obtained from the Patient Treatment File and the Minimum Dataset. Acute care hospitalizations, pressure ulcers and catheter-associated infections were the outcomes. All data were aggregated by month for each unit. Fixed-effects regressions were used to control for unobserved heterogeneity. Site visits were conducted at selected VA facilities to talk with LTC nursing staff.

Results:
On average, the total nursing hours per patient day (HPPD) was 4.8 and 33% of these hours were provided by RNs. Mean time a nurse had been working on the specific unit was 4.3 years, and this was similar for RNs, LVNs, and aides. Higher HPPD, lower use of aides, and lower staff turnover were associated with lower adverse event rates (pressure ulcers, catheter associated infections, acute care hospitalizations). The magnitude of these effects was quite small, e.g. a 1 hour increase in HPPD (a 20% increase in staffing) was associated with a 1% reduction in adverse events.

Implications:
Compared to the norm in the private sector, VA LTC units had relatively high staffing levels and much lower turnover. Even at the high levels observed, staffing did have an effect on outcomes, but these effects were much smaller than has been observed in the private sector.

Impacts:
Nurse staffing at VA LTC facilities is different than the private sector. The higher staffing levels and lower turnover in VA LTC units contributes to lower rates of preventable complications.


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