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SUMR Research Presentation

SUMR Research Presentation. G.J. Melendez-Torres Center for Health Outcomes and Policy Research University of Pennsylvania School of Nursing. Acuity-Adjusted Staffing Ratios. Based on a tutorial presented to the Vermont-Oxford Network G.J. Melendez-Torres Robyn Cheung, PhD, RN

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SUMR Research Presentation

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  1. SUMR Research Presentation G.J. Melendez-Torres Center for Health Outcomes and Policy Research University of Pennsylvania School of Nursing

  2. Acuity-Adjusted Staffing Ratios Based on a tutorial presented to the Vermont-Oxford Network G.J. Melendez-Torres Robyn Cheung, PhD, RN Eileen Lake, PhD, RN, FAAN

  3. Acuity Weights We developed a set of five acuity categories with descriptors. An acuity weight is the proportion of a nurse required daily to care for an infant in an acuity category. It is calculated from the data on all nurses, who reported the number of infants and the acuity of all infants on the last shift.

  4. Acuity Weights:2008 Nurse Survey Data from 104 NICUs An infant at level 5 needs 94% of a nurse’s time. Similarly, an infant at level 1 only needs about a third of a nurse’s time.

  5. How did we calculate acuity-adjusted staffing ratios? Each hospital has an observed ratio. We adjust each hospital’s ratio by accounting for the unit’s acuity mix. We calculate each hospital’s “expected” staffing ratio based on the acuity mix.

  6. How to interpret the ratios We compare the staffing ratios to the average staffing ratio across all the NICUs in our study. So, if the acuity-adjusted staffing ratio is lower than the average, staffing is lower than expected. If the acuity-adjusted staffing ratio is higher than the average, staffing is higher than expected.

  7. And now, easier to interpret… Finally, we can examine the difference between observed staffing ratio and expected staffing ratio by dividing observed over expected. If the result is <1, staffing is lower than expected. If the result is >1, staffing is higher than expected.

  8. Compare this staffing level… 1.5 1.25 Acuity adjusted staffing level (O/E ratio) 1 .75 .5 0 20 40 60 80 100 Rank

  9. …to this staffing level. 1.5 1.25 Acuity adjusted staffing level (O/E ratio) 1 .75 .5 0 20 40 60 80 100 Rank

  10. And, finally, staffing in this hospital. 1.5 1.25 Acuity adjusted staffing level (O/E ratio) 1 .75 .5 0 20 40 60 80 100 Rank

  11. What’s coming up next? • Link staffing ratios, practice environments, and healthcare outcomes • Use several indicators • Nosocomial infections • Severe intraventricular hemorrhage • Chronic lung disease • Mortality • What is the optimal staffing ratio for a NICU?

  12. Used up or energetic, frustrated or exhilarated? Associations between scope of nursing practice and burnout G.J. Melendez-Torres Robyn Cheung, PhD, RN

  13. Background • Nursing specialties have differential burnout rates (Browning et al., 2007). • Nurse burnout translates to lower patient satisfaction (Vahey, et al., 2004). • Nurse burnout affects healthcare outcomes in hospitals (Sochalski, 2001). • Nurse burnout leads to nurse turnover (Lake, 1998).

  14. Objectives Examine the potential relationship between burnout and scope of practice, defined as practice as an NP, CNM, or CRNA or a non-advanced practice registered nurse (RN). Examine potential correlates to burnout as a function of scope of nursing practice.

  15. Methods • The Maslach Burnout Inventory was included as part of the 2006 Nursing Care and Patient Safety Survey, sent to RNs in CA, PA, and NJ. • We used Pearson’s chi-square test to verify statistically significant differences in burnout rates and satisfaction amongst APNs and non-APNs.

  16. Results

  17. Conclusions • These findings suggest that APNs experience less burnout than non-APNs. • These results also suggest that work environments differ between APNs and non-APNs. • Further research is necessary to determine what creates differential burnout amongst APNs and non-APNs.

  18. Thanks to… Eileen Lake, PhD, RN, FAAN for the opportunity to work at CHOPR The remarkably patient and helpful Robyn Cheung, PhD, RN and Jeannie Cimiotti, DNSc, RN Tim Cheney for valuable skills learned Linda Aiken, PhD, RN, FAAN, FRCN, CHOPR Director Joanne Levy and the staff of LDI

  19. Acknowledgements • The University of Pennsylvania Provost’s Diversity Fund • The Center for Health Equity Research and Promotion (CHERP) • Pennsylvania Department of HealthOffice of Health Equity

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