AbstractsMedical & Health Science

The influence of nurse staffing on patient outcomes is an increasing focus of research as hospital administrators reorganize nursing care delivery to contain costs. One nurse-staffing variable, nurse continuity, and its influence on patient outcomes has been infrequently studied, in part due to multiple continuity definitions and difficulty in measuring this concept. This dissertation first presents literature support for a new conceptual model of nurse continuity to guide research. A review of the worldwide, English language research literature on nurse continuity was performed and evidence supporting the proposed conceptual model was described. We then present findings from applying this conceptual model to examine the influence of nurse continuity on hospital-acquired pressure ulcers (HAPUs). A secondary data analysis of the Hands on Automated Nursing Data System (HANDS), an electronic nursing plan of care database with standardized nursing terminologies, was conducted. The database contained 42,403 episodes documented by 787 nurses in four hospitals on nine units to include nurse staffing and patient characteristics. Data mining created an analytic dataset of 840 care episodes, 210 with and 630 without HAPUs, matched by patient characteristics, patient age, and with nursing units. Logistic regression analysis estimated the influence of nurse continuity and additional nurse-staffing variables on HAPUs. Nurse continuity was not significantly associated with HAPU development. Similarly, none of the interaction terms created with nurse continuity and the additional nurse-staffing variables generated statistically significant relationships with HAPU development. These initial findings suggest that nurse continuity and other nurse staffing variables may not be primary factors in HAPU development. Future studies with a multivariate continuity definition and more than one hospital-acquired adverse event are indicated to continue examining the potential influence of nurse continuity on patient outcomes. Understanding the importance of nurse-staffing variables such as nurse continuity when scheduling nurses and assigning patients may be a critical strategy for nurse leaders seeking to reduce adverse patient outcomes.