Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 10, Number 11—November 2004
THEME ISSUE
ICEID & ICWID 2004
International Conference on Women and Infectious Diseases (ICWID)

Nurses’ Working Conditions: Implications for Infectious Disease

Patricia W. Stone*Comments to Author , Sean Clarke†, Jeannie Cimiotti*, and Rosaly Correa-de-Araujo‡
Author affiliations: *Columbia University School of Nursing, New York, New York, USA; †University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA; ‡Agency for Healthcare Research and Quality, Rockville, Maryland, USA

Main Article

Table

Summary of studies on nurse staffing and healthcare-associated infectionsa

Investigator Sample Findings
Outbreak investigations
   Anderson et al. (17) 36-bed neonatal ICU; 8 cases During MRSA outbreak, 42% staff untrained, 
up to 62% from outside facility
   Archibald et al. (28) 1 pediatric ICU; 43 patients Decrease 2 infections/1,000 patient days for each 
unit increase in RN h: patient-day ratiob
   Fridkin et al. (25) 230-bed VA center; 170 patients Patient-nurse ratio increased during BSI outbreakc
   Harbarth et al. (22) 15-bed neonatal ICU; 8 cases Enterobacter cloacae outbreak terminated 
after decrease workload
   Vicca (23) 1 adult unit; 50 cases MRSAb cases associated with increase workload, 
decrease RN-patient ratio
Prospective studies
   Alonso-Echanove et al. (16) 8 ICUs; 4,535 patients Float RNs >60% central venous catheter days 
increased risk for BSId
   Haley et al. (26) 85-bed neonatal ICU; 76 infants MRSA infections increased within 1 month
 of worsening workloadc
   Robert et al. (21) 20-bed surgical ICU; 28 cases BSI associated with lower regular nurse-patient 
and higher pooled staff-patient ratiosb
Retrospective studies
   Amaravadi et al. (19) 32 hospitals; 353 patients Night nurse-patient ratio <1:2 associated with 
pneumoniac and BSIc
   Arnow et al. (27) 1 burn unit; 147 patients New cases MRSAb paralleled number of overtime h 
and number of shifts by outside staff
   Knauf et al. (30) 502 hospitals Pneumonia,c postoperative infection,c UTIc associated 
with low RN h and skill mix
   Kovner et al. (15) 530–570 hospitals; 10 states Increase nurse h per adjusted patient day associated 
with decreased pneumoniac
   Kovner & Gergen (24) 589 hospitals; 1,993 patients Increase RN FTEs associated with decreased UTIb 
and pneumoniab
   Lichtig et al. (20) 1,575 hospitals Pneumonia,b postoperative infection,b UTIb associated 
with low RN skill mix
   Needleman et al. (29) 799 hospitals; 6,180,628 patients Higher proportion RN h, higher RN h per day 
resulted in decreased UTIb
   Stegenga et al. (18) 44-bed pediatric unit; 
2,929 admissions <10.5 nurse h per patient day resulted in increased gastrointestinal infectionsc

aHAI, healthcare-associated infections; RN, registered nurse; MRSA, methicillin-resistant Staphylococcus aureus; BSI, bloodstream infection; UTI, urinary tract infection; VA, Veterans Administration; ICU, intensive care unit; FTE, full-time equivalent.
bSignificant at <0.005.
cSignificant at <0.05.
dSignificant at 0.01.

Main Article

References
  1. Institute of Medicine. To err is human: building a safer health system. Washington: National Academy Press; 2000.
  2. Institute of Medicine. Keeping patients safe: transforming the work environment of nurses (prepublication copy). Washington: National Academies Press; 2004. p. 435.
  3. Clarke  SP, Sloane  DM, Aiken  LH. Effects of hospital staffing and organizational climate on needlestick injuries to nurses. Am J Public Health. 2002;92:1115–9. DOIPubMedGoogle Scholar
  4. First Consulting Group. Health care workforce shortage and its implications for American hospitals. Washington: The Group; 2001.
  5. Health Resources and Services Administration, Bureau of Health Professions. Projected supply, demand, and shortages of registered nurses: 2000–2020. Washington: The Administration; 2002.
  6. Steel  R. Turnover theory at the empirical interface: problems of fit and function. Acad Manage Rev. 2002;27:346–60. DOIGoogle Scholar
  7. Jones  CB. Staff nurse turnover costs: Part II, Measurements and results. J Nurs Adm. 1990;20:27–32.PubMedGoogle Scholar
  8. Manias  E, Aitken  R, Peerson  A, Parker  J, Wong  K. Agency nursing work in acute care settings: perceptions of hospital nursing managers and agency nurse providers. J Clin Nurs. 2003;12:457–66. DOIPubMedGoogle Scholar
  9. Rogers  A, Hwang  W, Scott  L, Aiken  L, Dinges  D. The working hours of hospital staff nurses and patient safety. Health Aff (Millwood). 2004;23:202–12. DOIPubMedGoogle Scholar
  10. Aiken  LH, Buchan  J, Sochalski  J, Nichols  B, Powell  M. Trends in international nurse migration. Health Aff (Millwood). 2004;23:69–77. DOIPubMedGoogle Scholar
  11. Organisation for Economic Co-operation and Development. International migration of physicians and nurses: causes, consequences and health policy implications. Paris: The Organisation; 2002.
  12. Sprately  E, Johnson  A, Sochalski  J, Fritz  M, Spencer  W. The registered nurse population march 2000. Washington: U.S. Department of Health and Human Services, Bureau of Health Professions, Division of Nursing; 2001.
  13. Stilwell  B, Diallo  K, Zurn  P, Dal Poz  M, Adams  O, Buchan  J. Developing evidence-based ethical policies on the migration of health workers: conceptual and practical challenges. Hum Resour Health. 2003;1:8. DOIPubMedGoogle Scholar
  14. Hickman  D, Severance  S, Feldstein  A. The effect of health care working conditions on patient safety. Rep.74. Rockville (MD): Agency for Healthcare Research and Quality; 2003.
  15. Kovner  C, Jones  C, Zhan  C, Gergen  PJ, Basu  J. Nurse staffing and postsurgical adverse events: an analysis of administrative data from a sample of U.S. hospitals, 1990–1996. Health Serv Res. 2002;37:611–29. DOIPubMedGoogle Scholar
  16. Alonso-Echanove  J, Edwards  JR, Richards  MJ, Brennan  P, Venezia  RA, Keen  J, Effect of nurse staffing and antimicrobial-impregnated central venous catheters on the risk for bloodstream infections in intensive care units. Infect Control Hosp Epidemiol. 2003;24:916–25. DOIPubMedGoogle Scholar
  17. Andersen  BM, Lindemann  R, Bergh  R, Nesheim  B, Syversen  G, Solheim  N, Spread of methicillin-resistant Staphylococcus aureus in a neonatal intensive unit associated with understaffing, overcrowding and mixing of patients. J Hosp Infect. 2002;50:18–24. DOIPubMedGoogle Scholar
  18. Stegenga  J, Bell  E, Matlow  A. The role of nurse understaffing in nosocomial viral gastrointestinal infections on a general pediatrics ward. Infect Control Hosp Epidemiol. 2002;23:133–6. DOIPubMedGoogle Scholar
  19. Amaravadi  RK, Jacobson  BC, Solomon  DH, Fischer  MA. ICU nurse-to-patient ratio is associated with complications and resource use after esophagectomy. Intensive Care Med. 2000;26:1857–62. DOIPubMedGoogle Scholar
  20. Lichtig  LK, Knauf  RA, Risen-McCoy  R, Wozniak  L. Nurse staffing and patient outcomes in the inpatient hospital setting. Washington: American Nurses Association; 2000.
  21. Robert  J, Fridkin  SK, Blumberg  HM, Anderson  B, White  N, Ray  SM, The influence of the composition of the nursing staff on primary bloodstream infection rates in a surgical intensive care unit. Infect Control Hosp Epidemiol. 2000;21:12–7. DOIPubMedGoogle Scholar
  22. Harbarth  S, Sudre  P, Dharan  S, Cadenas  M, Pittet  D. Outbreak of Enterobacter cloacae related to understaffing, overcrowding, and poor hygiene practices. Infect Control Hosp Epidemiol. 1999;20:598–603. DOIPubMedGoogle Scholar
  23. Vicca  AF. Nursing staff workload as a determinant of methicillin-resistant Staphylococcus aureus spread in an adult intensive therapy unit. J Hosp Infect. 1999;43:109–13. DOIPubMedGoogle Scholar
  24. Kovner  C, Gergen  PJ. Nurse staffing levels and adverse events following surgery in U.S. hospitals. Image J Nurs Sch. 1998;30:315–21. DOIPubMedGoogle Scholar
  25. Fridkin  SK, Peear  SM, Williamson  TH, Galgiani  JN, Jarvis  WR. The role of understaffing in central venous catheter-associated bloodstream infections. Infect Control Hosp Epidemiol. 1996;17:150–8. DOIPubMedGoogle Scholar
  26. Haley  RW, Cushion  NB, Tenover  FC, Bannerman  TL, Dryer  D, Ross  S, Eradication of endemic methicillin-resistant Staphylococcus aureus infections from a neonatal intensive care unit. J Infect Dis. 1995;171:614–24. DOIPubMedGoogle Scholar
  27. Arnow  P, Allyn  PA, Nichols  EM, Hill  DL, Pezzlo  M, Bartlett  RH. Control of methicillin-resistant Staphylococcus aureus in a burn unit: role of nurse staffing. J Trauma. 1982;22:954–9. DOIPubMedGoogle Scholar
  28. Archibald  LK, Manning  ML, Bell  LM, Banerjee  S, Jarvis  WR. Patient density, nurse-to-patient ratio and nosocomial infection risk in a pediatric cardiac intensive care unit. Pediatr Infect Dis J. 1997;16:1045–8. DOIPubMedGoogle Scholar
  29. Needleman  J, Buerhaus  P, Mattke  S, Stewart  M, Zelevinsky  K. Nurse-staffing levels and the quality of care in hospitals. N Engl J Med. 2002;346:1715–22. DOIPubMedGoogle Scholar
  30. Knauf  RA, Lichtig  LK, Risen-McCoy  R, Singer  AD, Wozniak  L. Implementing nursing’s report card: a study of RN staffing, length of stay and patient outcomes. Washington: American Nurses Association;1997.
  31. Jackson  M, Chairello  L, Gaynes  RP, Gerberding  JL. Nurse staffing and health care-associated infections: proceedings from a working group meeting. Am J Infect Control. 2002;30:199–206. DOIPubMedGoogle Scholar
  32. Centers for Disease Control and Prevention. Worker health chartbook, 2000. Cincinnati (OH): US Department of Health and Human Services, Public Health Service; 2000.
  33. U.S. Bureau of Labor Statistics. Lost-worktime injuries and illnesses: characteristics and resulting days away from work. Washington: The Bureau; 2003.
  34. Occupational outlook handbook, 2002–2003 edition. Washington: U.S. Department of Labor, Bureau of Labor Statistics; 1999.
  35. Varia  M, Wilson  S, Sarwal  S, McGeer  A, Gournis  E, Galanis  E, Investigation of a nosocomial outbreak of severe acute respiratory syndrome (SARS) in Toronto, Canada. CMAJ. 2003;169:285–92.PubMedGoogle Scholar
  36. Booth  CM, Boone  RH, Tomlison  G, Detsky  AS. Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area. JAMA. 2003;289:2801–9. DOIPubMedGoogle Scholar
  37. Loeb  M, McGeer  A, Henry  B, Ofner  M, Rose  D, Hylwka  T. SARS among critical care nurses, Toronto. Emerg Infect Dis. 2004;10:251–5.PubMedGoogle Scholar
  38. Moisiuk  SE, Robson  D, Klass  LK, Kliewer  G, Wasyliuk  W, Davi  M, Outbreak of parainfluenza virus type 3 in an intermediate care neonatal nursery. Pediatr Infect Dis J. 1998;17:49–53. DOIPubMedGoogle Scholar
  39. Aiken  LH, Clarke  SP, Sloane  DM. Hospital staffing, organization, and quality of care: Cross-national findings. Nurs Outlook. 2002;50:187–94. DOIPubMedGoogle Scholar
  40. Zhan  C, Miller  MR. Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA. 2003;290:1868–74. DOIPubMedGoogle Scholar

Main Article

Page created: April 21, 2011
Page updated: April 21, 2011
Page reviewed: April 21, 2011
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external