Nurse forecasting in Europe (RN4CAST): Rationale, design and methodology

BMC Nursing - Tập 10 - Trang 1-9 - 2011
Walter Sermeus1, Linda H Aiken2, Koen Van den Heede1, Anne Marie Rafferty3, Peter Griffiths4, Maria Teresa Moreno-Casbas5, Reinhard Busse6, Rikard Lindqvist7, Anne P Scott8, Luk Bruyneel1, Tomasz Brzostek9, Juha Kinnunen10, Maria Schubert11, Lisette Schoonhoven12, Dimitrios Zikos13
1Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium
2Center for Health Outcomes and Policy Research, University of Pennsylvania, 418 Curie Blvd., Philadelphia, USA
3Florence Nightingale School of Nursing & Midwifery, King's College London, James Clerk Maxwell Building, London, UK
4School of Health Sciences, University of Southampton, Southampton, UK
5National Spanish Research Unit, Instituto de Salud Carlos III. Ministry of Science and Innovation, Madrid, Spain
6Department of Health Care Management, WHO Collaborating Centre for Health Systems Research and Management, Technische Universität Berlin, Berlin, Germany
7Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
8School of Nursing, Dublin City University, Dublin, Ireland
9Department of Internal Diseases and Community Nursing, Jagiellonian University Medical College, Krakow, Poland
10Department of Health Policy and Management, University of Eastern Finland, Kuopio, Finland
11Institute of Nursing Science, University of Basel, Basel, Switzerland
12Scientific Institute for Quality of Healthcare, UMC St Radboud, Postbus 9101, Nijmegen, The Netherlands
13Laboratory of Health Informatics, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece

Tóm tắt

Current human resources planning models in nursing are unreliable and ineffective as they consider volumes, but ignore effects on quality in patient care. The project RN4CAST aims innovative forecasting methods by addressing not only volumes, but quality of nursing staff as well as quality of patient care. A multi-country, multilevel cross-sectional design is used to obtain important unmeasured factors in forecasting models including how features of hospital work environments impact on nurse recruitment, retention and patient outcomes. In each of the 12 participating European countries, at least 30 general acute hospitals were sampled. Data are gathered via four data sources (nurse, patient and organizational surveys and via routinely collected hospital discharge data). All staff nurses of a random selection of medical and surgical units (at least 2 per hospital) were surveyed. The nurse survey has the purpose to measure the experiences of nurses on their job (e.g. job satisfaction, burnout) as well as to allow the creation of aggregated hospital level measures of staffing and working conditions. The patient survey is organized in a sub-sample of countries and hospitals using a one-day census approach to measure the patient experiences with medical and nursing care. In addition to conducting a patient survey, hospital discharge abstract datasets will be used to calculate additional patient outcomes like in-hospital mortality and failure-to-rescue. Via the organizational survey, information about the organizational profile (e.g. bed size, types of technology available, teaching status) is collected to control the analyses for institutional differences. This information will be linked via common identifiers and the relationships between different aspects of the nursing work environment and patient and nurse outcomes will be studied by using multilevel regression type analyses. These results will be used to simulate the impact of changing different aspects of the nursing work environment on quality of care and satisfaction of the nursing workforce. RN4CAST is one of the largest nurse workforce studies ever conducted in Europe, will add to accuracy of forecasting models and generate new approaches to more effective management of nursing resources in Europe.

Tài liệu tham khảo

Chen L, Evans T, Anand S, Boufford JI, Brown H, Chowdhury M, Cueto M, Dare L, Dussault G, Elzinga G, Fee E, Habte D, Hanvoravongchai P, Jacobs M, Kurowski C, Michael S, Pablos-Mendez A, Sewankambo N, Solimano G, Stilwell B, de Waal A, Wibulpolprasert S: Human resources for health: overcoming the crisis. Lancet. 2004, 364: 1984-1990. 10.1016/S0140-6736(04)17482-5. OECD OECD Health Data 2006: 2006, Ref Type: Data File Buchan J, Aiken L: Solving nursing shortages: a common priority. J Clin Nurs. 2008, 17: 3262-3268. 10.1111/j.1365-2702.2008.02636.x. Simoens S, Villeneuve M, Hurst K: Tacling Nurse Shortages in OECD Countries. 2010, Paris, OECD Publishing, Ref Type: Report Buerhaus PI, Donelan K, Ulrich BT, Norman L, DesRoches C, Dittus R: Impact of the nurse shortage on hospital patient care: comparative perspectives. Health Aff (Millwood ). 2007, 26: 853-862. 10.1377/hlthaff.26.3.853. WHO: The World Health Report 2006 - working together for health. 2007, Geneva, World Health Organization Joint Learning Initiative. Human Resources for Health: Overcoming the Crisis. 2004, Washington, D.C., Communications Development Incorporated, 1-412. O'Brien-Pallas L, Baumann A, Donner G, Murphy GT, Lochhaas-Gerlach J, Luba M: Forecasting models for human resources in health care. J Adv Nurs. 2001, 33: 120-129. Dreesch N, Dolea C, Dal Poz MR, Goubarev A, Adams O, Aregawi M, Bergstrom K, Fogstad H, Sheratt D, Linkins J, Scherpbier R, Youssef-Fox M: An approach to estimating human resource requirements to achieve the Millennium Development Goals. Health Policy Plan. 2005, 20: 267-276. 10.1093/heapol/czi036. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH: Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002, 288: 1987-1993. 10.1001/jama.288.16.1987. Aiken LH, Clarke SP, Sloane DM, Lake ET, Cheney T: Effects of hospital care environment on patient mortality and nurse outcomes. J Nurs Adm. 2008, 38: 223-229. 10.1097/01.NNA.0000312773.42352.d7. Aiken LH, Sloane DM, Cimiotti JP, Clarke SP, Flynn L, Seago JA, Spetz J, Smith HL: Implications of the California nurse staffing mandate for other states. Health Serv Res. 2010, 45: 904-921. 10.1111/j.1475-6773.2010.01114.x. Rafferty AM, Clarke SP, Coles J, Ball J, James P, McKee M, Aiken LH: Outcomes of variation in hospital nurse staffing in English hospitals: cross-sectional analysis of survey data and discharge records. Int J Nurs Stud. 2007, 44: 175-182. 10.1016/j.ijnurstu.2006.08.003. Van den Heede K, Lesaffre E, Diya L, Vleugels A, Clarke SP, Aiken LH, Sermeus W: The relationship between inpatient cardiac surgery mortality and nurse numbers and educational level: analysis of administrative data. Int J Nurs Stud. 2009, 46: 796-803. 10.1016/j.ijnurstu.2008.12.018. Kane RL, Shamliyan TA, Mueller C, Duval S, Wilt TJ: The association of registered nurse staffing levels and patient outcomes: systematic review and meta-analysis. Med Care. 2007, 45: 1195-1204. 10.1097/MLR.0b013e3181468ca3. Needleman J, Buerhaus P, Mattke S, Stewart M, Zelevinsky K: Nurse-staffing levels and the quality of care in hospitals. N Engl J Med. 2002, 346: 1715-1722. 10.1056/NEJMsa012247. OECD Health at a Glance 2009: OECD Indicators. 2009, Paris, OECD Publishing Kohn LT, Corrigan JM, Donaldson M: To Err is Human: Building a Safer Health System. 1999, Washington, D.C.: National Academy Press Van den Heede K, Sermeus W, Diya L, Clarke SP, Lesaffre E, Vleugels A, Aiken LH: Nurse staffing and patient outcomes in Belgian acute hospitals: cross-sectional analysis of administrative data. Int J Nurs Stud. 2009, 46: 928-939. 10.1016/j.ijnurstu.2008.05.007. Aiken LH, Clarke SP, Sloane DM: Hospital staffing, organization, and quality of care: Cross-national findings. Nurs Outlook. 2002, 50: 187-194. 10.1067/mno.2002.126696. Gunnarsdottir S, Clarke SP, Rafferty AM, Nutbeam D: Front-line management, staffing and nurse-doctor relationships as predictors of nurse and patient outcomes. a survey of Icelandic hospital nurses. Int J Nurs Stud. 2009, 46: 920-927. 10.1016/j.ijnurstu.2006.11.007. Estryn-Béhar M, Van der Heijden BI, Ogińska H, Camerino D, Le Nézet O, Conway PM, Fry C, Hasselhorn HM, NEXT Study Group: The impact of social work environment, teamwork characteristics, burnout, and personal factors upon intent to leave among European nurses. Med Care. 2007, 45: 939-950. Milisen K, Abraham I, Siebens K, Darras E, Dierckx de Casterlé B: Work environment and workforce problems: a cross-sectional questionnaire survey of hospital nurses in Belgium. Int J Nurs Stud. 2006, 43: 745-754. 10.1016/j.ijnurstu.2005.10.008. Lake ET: Development of the practice environment scale of the Nursing Work Index. Res Nurs Health. 2002, 25: 176-188. 10.1002/nur.10032. Bruyneel L, Van den Heede K, Diya L, Aiken L, Sermeus W: Predictive validity of the International Hospital Outcomes Study questionnaire: an RN4CAST pilot study. J Nurs Scholarsh. 2009, 41: 202-210. 10.1111/j.1547-5069.2009.01272.x. Lake ET, Friese CR: Variations in nursing practice environments: relation to staffing and hospital characteristics. Nurs Res. 2006, 55: 1-9. 10.1097/00006199-200601000-00001. Vahey DC, Aiken LH, Sloane DM, Clarke SP, Vargas D: Nurse burnout and patient satisfaction. Med Care. 2004, 42: II57-II66. 10.1097/01.mlr.0000109126.50398.5a. Maslach C, Jackson SE, Leiter M: Maslach Burnout Inventory: Manual. 1996, Palo Alto, CA: Consulting Psychologist Press, 3 Poghosyan L, Aiken LH, Sloane DM: Factor structure of the Maslach burnout inventory: an analysis of data from large scale cross-sectional surveys of nurses from eight countries. Int J Nurs Stud. 2009, 46: 894-902. 10.1016/j.ijnurstu.2009.03.004. Stamps P, Piedmonte EB: Nurses and Work Satisfaction: An index for Measurement. 1986, Ann Arbor, MI, Health Administration Press Perspectives Wanous JP, Reichers AE, Hudy MJ: Overall job satisfaction: how good are single-item measures?. J Appl Psychol. 1997, 82: 247-252. 10.1037/0021-9010.82.2.247. Cina-Tschumi B, Schubert M, Kressig RW, De Geest S, Schwendimann R: Frequencies of falls in Swiss hospitals: concordance between nurses' estimates and fall incident reports. Int J Nurs Stud. 2009, 46: 164-171. 10.1016/j.ijnurstu.2008.09.008. AHRQ Hospital Survey on Patient Safety Culture: [http://www.ahrq.gov/qual/patientsafetyculture/hospsurvindex.htm] Aiken LH, Clarke SP, Cheung RB, Sloane DM, Silber JH: Educational levels of hospital nurses and surgical patient mortality. JAMA. 2003, 290: 1617-1623. 10.1001/jama.290.12.1617. Kutney-Lee A, McHugh MD, Sloane DM, Cimiotti JP, Flynn L, Neff DF, Aiken LH: Nursing: a key to patient satisfaction. Health Aff (Millwood). 2009, 28: w669-w677. 10.1377/hlthaff.28.4.w669. Estabrooks CA, Midodzi WK, Cummings GG, Ricker KL, Giovannetti P: The impact of hospital nursing characteristics on 30-day mortality. Nurs Res. 2005, 54: 74-84. 10.1097/00006199-200503000-00002. Roger France FH: Case mix use in 25 countries: a migration success but international comparisons failure. Int J Med Inform. 2003, 70: 215-219. 10.1016/S1386-5056(03)00044-3. Jha AK, Orav EJ, Zheng J, Epstein AM: Patients' perception of hospital care in the United States. N Engl J Med. 2008, 359: 1921-1931. 10.1056/NEJMsa0804116. AHRQ CAHPS Hospital Survey (H-CAHPS): [https://www.cahps.ahrq.gov/] Polit DF, Beck CT, Owen SV: Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health. 2007, 30: 459-467. 10.1002/nur.20199. D'Hoore W, Sicotte C, Tilquin C: Risk adjustment in outcome assessment: the Charlson comorbidity index. Methods Inf Med. 1993, 32: 382-387. Silber JH, Kennedy SK, Even-Shoshan O, Chen W, Koziol LF, Showan AM, Longnecker DE: Anesthesiologist direction and patient outcomes. Anesthesiology. 2000, 93: 152-163. 10.1097/00000542-200007000-00026. Silber JH, Rosenbaum PR, Schwartz JS, Ross RN, Williams SV: Evaluation of the complication rate as a measure of quality of care in coronary artery bypass graft surgery. JAMA. 1995, 274: 317-323. 10.1001/jama.274.4.317. Hox J: Multilevel Analysis: Techniques and Applications. 2002, Mahwah, NJ: lawrence Erlbaum Associates, Publishers Gajewski BJ, Boyle DK, Miller PA, Oberhelman F, Dunton N: A multilevel confirmatory factor analysis of the Practice Environment Scale: a case study. Nurs Res. 2010, 59: 147-153. 10.1097/NNR.0b013e3181d1a71e. Newbold D: The production economics of nursing: a discussion paper. Int J Nurs Stud. 2008, 45: 120-128. 10.1016/j.ijnurstu.2007.01.007. Needleman J, Buerhaus PI, Stewart M, Zelevinsky K, Mattke S: Nurse staffing in hospitals: is there a business case for quality?. Health Aff (Millwood ). 2006, 25: 204-211. 10.1377/hlthaff.25.1.204. Rothberg MB, Abraham I, Lindenauer PK, Rose DN: Improving nurse-to-patient staffing ratios as a cost-effective safety intervention. Med Care. 2005, 43: 785-791. 10.1097/01.mlr.0000170408.35854.fa. Van den Heede K, Sermeus W, Diya L, Lesaffre E, Vleugels A: Adverse outcomes in Belgian acute hospitals: retrospective analysis of the national hospital discharge dataset. Int J Qual Health Care. 2006, 18: 211-219. 10.1093/intqhc/mzl003. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6955/10/6/prepub