Exploring the association between nurse workload and nurse-sensitive patient safety outcome indicators.

BACKGROUND Nurses affect patient safety. Although studies have associated patient safety with nurse staffing levels, Taiwan's Department of Health does not yet support changing nurse workforce standards for medical institutions. PURPOSE This study was designed to gain insight into the workload of nurses employed at medical institutions and to determine the relationship between nurse workload and nurse-sensitive patient safety outcome indicators. METHODS This study adopted a cross-sectional quantitative method and collected data using a self-designed logbook. The study population comprised nurses from acute medical institutions, including medical centers and regional and district hospitals. One thousand five hundred logbooks were distributed to participants selected by random sampling from 21 city/county nursing associations across Taiwan. One thousand three hundred seventy-three questionnaires were retrieved; the 1,358 valid responses yielded a valid response rate of 90.5%. Nurses used the logbook to record individual working conditions for 2 weeks. Descriptive statistics included mean values, standard deviations, and percentages; inferential statistics included the Spearman rho correlation and odds ratios. RESULTS Nurse overtime working hours were positively associated with the following nurse-sensitive patient safety outcome indicators: patient falls, decubitus/pressure ulcers, near errors in medication, medication errors, unplanned extubation, hospital-acquired pneumonia, and hospital-acquired urinary tract infections; risks of patient falls, decubitus/pressure ulcers, unplanned extubation, hospital-acquired pneumonia, and hospital-acquired urinary tract infections significantly increased when the patient-nurse ratio exceeded 7:1. CONCLUSION Nurse workforce and nurse-sensitive patient outcome indicators are positively correlated. The results of this study will help professional nursing groups define suitable nursing workforce standards for medical institutions.