Nurse Staffing and Patient Outcomes of Magnet

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Nurse Staffing and Patient Outcomes of Magnet
Non-Magnet Facilities

• Nancy Dunton, PhD,
• Byron Gajewski, PhD, Ali Ammouri
• Annual Magnet Conference
• October 16, 2004
• Sacramento, CA

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Presentation Aims

• Address the following 2 questions
• Do units in Magnet facilities have higher
  staffing and better patient outcomes than units
  in non-Magnet facilities?
• What are the trends in patient outcomes for Older
  Magnets, Newer Magnets, and non-Magnet facilities?

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Data Source NDNQI

• The National Database of Nursing Quality
  Indicators was established by ANA in 1998
• Twin purposes
• Provide benchmarking information to hospitals
• Develop database for policy analysis
• Operated by the University of Kansas School of
  Nursing

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Hospital Sites-September 2004 640 Hospitals in 50
States and DC
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16
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National Database of Nursing Quality Indicators
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NDNQI Data

• Hospital Characteristics
• Size, Teaching Status, Case Mix
• 5 Unit Types
• Critical care, Step Down, Medical, Surgical
  Combined Medical-Surgical
• Nurse Staffing Measures
• NHPPD, RN, Education, Certification, RN
  Satisfaction
• Patient Outcome Measures
• Falls, Pressure Ulcers

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Many Magnet FacilitiesParticipate in NDNQI

• Use quarterly reports to monitor staffing and
  patient outcomes
• Compare their outcomes to other hospitals across
  the nation in NDNQI
• Unit-level statistics

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Some NDNQI Non-Magnet Facilities Are on
theMagnet Journey

• Facilities have an incentive to report to NDNQI
  when they become Magnet applicants
• NDNQI does not know which facilities are working
  toward an application

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How do Magnet Units Compare with Other NDNQI
Non-Magnet Units?

• 3rd Quarter 2003 Data
• Risk Stratified by Unit Type
• Not controlled for hospital characteristics

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Magnet UnitsMixed Picture on Nursing HoursPer
Patient Day

• Significantly higher NHPPD on Critical Care and
  Medical units
• Significantly lower NHPPD on Step Down and
  Combined Med-Surg units
• Findings mixed for Surgical units

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Magnet Units HadSignificantly Higher Skill Mix

• 7 higher RN hours on Medical units
• 1-3 higher RN hours on other unit types
• Lower LPN hours
• Mixed picture for Nursing Aide hours

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Contract Hours

• Magnet facilities had significantly fewer nursing
  hours supplied by contract or agency staff than
  non-Magnet facilities on all five unit types.

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Magnet Facilities Had More Highly Educated Nurses

• Magnet units had a significantly higher
  percentage of BSN nurses
• Magnet units had a significantly higher
  percentage of nurses with national
  certifications

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Fall Rates Were Significantly Lower on Magnet
Units

• The difference was largest for medical units,
  where most falls occur

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Pressure Ulcers

• No consistent differences between Magnet and
  non-Magnet units on pressure ulcers

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Magnet Facilities Had HigherRN Job Satisfaction

• The differences were significant and consistent
  across unit types for
• Professional Development
• Autonomy

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More Magnet Units in Top 25th Percentile
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NDNQI and Magnet Facilities Are a Select Group

• Interested in quality
• Larger than hospitals across nation
• Magnet larger than NDNQI
• Magnet facilities have slightly higher patient
  acuity than other NDNQI facilities
• More Academic Medical Centers
• Magnet more AMCs than NDNQI

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Staffed Bed Size
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Teaching Status
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Part of Difference Between Magnet Units and Other
NDNQI Units Was Due to Differences in Facility
Characteristics
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After Taking Facility Characteristics Into Account

• Contract Nursing Hours were significantly lower
  in Magnet facilities for all unit types
• Fall rates were significantly lower in Magnet
  facilities for all unit types except critical
  care
• RN Hours was significantly higher only for
  Magnet medical units

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Differencesin RN Satisfaction

• RN Satisfaction with Autonomy was significantly
  higher in Magnet facilities for all unit types
• RN Satisfaction with Professional Development was
  significantly higher in Magnet facilities for all
  unit types
• RN Satisfaction with Task was significantly
  higher in Magnet facilities for critical care,
  step down, and medical units

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Differences in Facility Characteristics Accounted
for Magnet-Non-Magnet Differences in

• Nursing Hours Per Patient Day
• Except in combined Med-Surg units where
  Non-Magnets had higher nursing hours
• RN Education and Certification for all unit types

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Are There Differences Between Older and Newer
Magnets?
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Divided NDNQI Hospitals into 3 Groups

• Older Magnets recognized before April 2002
  (n35)
• Newer Magnets recognized after April 2002, but
  before April 2004 (n45)
• Non-Magnet NDNQI facilities (n134)
• Some of whom may be on Magnet Journey
• Based on 224 hospitals active in 2Q02

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Followed Same Hospitals Over Time

• From 2nd Quarter 2002
• Through 1st Quarter 2004

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Trends in NHPPD2Q/2002-1Q/2004

• All 3 groups experienced a significant increase
  in NHPPD
• Concentrated after October 2003
• No significant differences among 3 groups

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Trends in RN Hours

• Significant, but small, upward trend for all
  groups
• Older Magnets had a significantly higher share of
  nursing hours supplied by RNs than Newer Magnets
  or non-Magnets
• Newer Magnets had significantly higher rate of
  increase nursing hours supplied by RNs than the
  non-Magnets

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Trends in Fall Rates

• Significant increase in fall rate over time for
  all 3 groups
• Magnets, whether Older or Newer, had
  significantly lower fall rates than non-Magnets

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Trends in Pressure Ulcer Rate

• No change over time for any of 3 groups
• No significant group differences

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Summary

• All NDNQI hospitals are interested in nursing
  quality
• Magnet facilities are larger and more likely to
  be academic medical centers than other NDNQI
  facilities

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Summary, Cont

• Magnet facilities consistently had better nursing
  outcomes than non-Magnets in indicators that
  reflect some of the Forces of Magnetism
• Use of contract nurses
• Fall rates
• RN Satisfaction with Autonomy
• RN Satisfaction with Professional Development

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Summary , Cont

• Some apparent differences between Magnet and
  non-Magnet units are due to the fact that many
  Magnet facilities are academic medical centers
  and are large facilities
• NHPPD
• RN Education and Certification

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Summary, Cont

• There are some cohort differences in the
  outcomes of Magnet facilities
• Older Magnets had higher RN Hours than Newer or
  non-Magnets
• Magnets, Older Newer, had lower fall rates than
  non-Magnets
• Newer Magnets had lower pressure ulcer rates than
  non-Magnets

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Conclusion

• NDNQI provides a valuable resource to examine the
  outcomes of Magnet facilities relative to other
  US hospitals that are interested in quality
  outcomes

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For Further InformationContact

• Nancy Dunton, PhD
• Director, National Database of Nursing Quality
  Indicators
• University of Kansas
• School of Nursing
• 913.588.1456
• ndunton_at_kumc.edu