Association_of_Nurse_Engagement_and_Nurse_Staffing.8 (1).pdf


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Association of Nurse Engagement and Nurse Staffing on Patient Safety J. Margo Brooks Carthon, PhD, APRN, FAAN; Linda Hatfield, PhD, RN, NNP-BC; Colin Plover, MSN, RN, MPH; Andrew Dierkes, BSN, RN; Lawrence Davis, BSN, RN; Taylor Hedgeland, BSN, RN; Anne Marie Sanders, BSN, RN; Frank Visco, BSN, RN, RN-BC; Sara Holland, DNP, RN; Jim Ballinghoff, MSN, MBA, RN, NEA-BC; Mary Del Guidice, MSN, RN, CENP; Linda H. Aiken, PhD, RN, FAAN, FRCN ABSTRACT Background: Nurse engagement is a modifiable element of the work environment and has shown promise as a potential safety intervention. Purpose: Our study examined the relationship between the level of engagement, staffing, and assessments of patient safety among nurses working in hospital settings. Methods: A secondary analysis of linked cross-sectional data was conducted using survey data of 26 960 nurses across 599 hospitals in 4 states. Logistic regression models were used to examine the association between nurse engagement, staffing, and nurse assessments of patient safety. Results: Thirty-two percent of nurses gave their hospital a poor or failing patient safety grade. In 25% of hospitals, nurses fell in the least or only somewhat engaged categories. A 1-unit increase in engagement lowered the odds of an unfavorable safety grade by 29% ( P < .001). Hospitals where nurses reported higher levels of engagement were 19% ( P < .001) less likely to report that mistakes were held against them. Nurses in poorly staffed hospitals were 6% more likely to report that important information about patients “fell through the cracks” when transferring patients across units ( P < .001). Conclusions: Interventions to improve nurse engagement and adequate staffing serve as strategies to im- prove patient safety. Key words: nurse engagement, nurse staffing, nurses, patient safety N early 20 years have passed since the re- lease of the Institute of Medicine (IOM) re- port, To Err Is Human: Building a Safer Health Author Affiliations: Center for Health Outcomes and Policy Research, and School of Nursing, University of Pennsylvania, Philadelphia (Drs Brooks Carthon, Hatfield and Aiken and Messrs Dierkes and Plover); Pennsylvania Hospital, Philadelphia (Dr Hatfield, Mss Sanders and Del Guidice and Mr Visco); and Penn Presbyterian Medical Center, Philadelphia, Pennsylvania (Dr Holland, Messrs Davis and Ballinghoff, and Ms Hedgeland). This research was supported by the National Institute of Nursing Research (NR14855-NR04513, T32-NR0714; L. Aiken, Principal Investigator). The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (). Correspondence: J. Margo Brooks Carthon, PhD, APRN, FAAN, Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia PA 19104 ([email protected]).
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