RESUMEN
In response to Manthous, we discuss the role of unions in health care. The ethical quandary that Manthous perceives in health care worker unions is overstated because patient and worker interests are frequently aligned. The search for a "selfless" union overlooks the importance of adequate compensation for providing excellent care. The collective actions employed by health care workers' unions need not include strikes or slowdowns and can be consistent with patient safety and well-being.
Asunto(s)
Personal de Salud/organización & administración , Administración Hospitalaria , Sindicatos/organización & administración , HumanosRESUMEN
The minimum nurse-patient staffing legislation in California was fully implemented in 2004. The purpose of this study was to explore the effects on the minimum nurse-patient staffing legislation on the demographic, human capital, and work characteristics of the working RN population, focusing specifically on direct care nurses in the acute care setting. The most interesting finding of this study was an increase in nurse satisfaction after the minimum staffing law was implemented. Findings also suggest that work environments need to change to accommodate the changes that have occurred in the nurse population. Nurses should practice to the full extent of their education and training; nurses should be full partners in redesigning the health care system; nurse education should promote seamless academic progression; and effective workforce planning and policymaking should be conducted. Administrators, health policymakers, and advocates must develop job descriptions and work environments that maximize the attachment of the labor force in terms of hours worked per week of RNs for all nurses but especially for those over 50 years of age and non-Whites.
Asunto(s)
Personal de Enfermería/provisión & distribución , Admisión y Programación de Personal/legislación & jurisprudencia , California , Estudios TransversalesRESUMEN
Many conceptual models have been applied in the investigation of college retention of nursing students. We tested a model that specifies four general constructs as predictors of student success in nursing education-dispositional factors, career value factors, situational factors, and institutional factors. The purpose of this article is to describe predictors of nursing students' success, specifically: (a) What factors predict success of nursing students graduating from community colleges in California? and (b) What factors predict success of nursing students graduating on time from community colleges in California? The study design was correlational and descriptive in nature, with a convenience sample of six intervention colleges and six matched-pair control colleges. Results of the logistic regressions indicated on-time and any-time graduations were predicted by higher grade point averages in prenursing and science. Higher prenursing grades are positive predictors of graduation; improvements in performance prior to commencing nursing education should improve student success.
Asunto(s)
Graduación en Auxiliar de Enfermería/estadística & datos numéricos , Evaluación Educacional/estadística & datos numéricos , Modelos Educacionales , Estudiantes de Enfermería/estadística & datos numéricos , Logro , Adulto , California , Graduación en Auxiliar de Enfermería/normas , Evaluación Educacional/normas , Etnicidad/estadística & datos numéricos , Femenino , Humanos , Masculino , Investigación en Educación de Enfermería , Valor Predictivo de las PruebasRESUMEN
In 2001, Oregon enacted a law mandating the creation of hospital nurse staffing committees to oversee staffing in acute care hospitals. The study design is a descriptive case study (qualitative method) using semistructured interviews and focus groups to assess the law requiring hospital nurse staffing committees to monitor nurse staffing in Oregon. One significant theme of the study was the wide variation among facilities in the way the staffing legislation is viewed, interpreted, understood, appreciated, and implemented. Another was that the chief nursing officer's view of the legislation tended to be the prevailing view expressed by the managers and staff nurses from those same organizations. A significant difference between a functional versus nonfunctional committee was whether the chief nurse viewed the legislation in a positive way and was using the legislation to enhance his/her work.
Asunto(s)
Enfermeras y Enfermeros/provisión & distribución , Admisión y Programación de Personal/legislación & jurisprudencia , OregonRESUMEN
The objective of the study was to examine whether unionization is associated with job satisfaction among RNs in the United States using nationally representative surveys of RNs. Factors that predict job satisfaction for RNs in healthcare continue to be of great concern to nurse administrators and managers because job satisfaction remains an important aspect of nurse retention. In addition, the notion of having unions for RNs has also gained prominence on the national stage. The relationship between RN job satisfaction and having an RN union has rarely been studied, but in 2 studies, a paradox was found; hospitals with RN unions had higher job dissatisfaction but greater retention. This study will test the relationship between having an RN union and job satisfaction with data that are both more recent and nationally representative. We analyze the public-use data from the 2004 and 2008 National Sample Surveys of Registered Nurses. In both 2004 and 2008, union representation was negatively associated with job satisfaction, although this relationship was not statistically significant in 2008. Some nurse administrators and executives would not be surprised by this finding. However, although union nurses may express more dissatisfaction, they may also be more vocal and less fearful about voicing concerns. If managers can harness this ability of the nurses to be articulate and outspoken, working with unions and union nurses can be productive and satisfying.
Asunto(s)
Satisfacción en el Trabajo , Sindicatos , Enfermeras Clínicas/psicología , Rol de la Enfermera , Personal de Enfermería en Hospital/psicología , Autonomía Profesional , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Investigación en Administración de Enfermería , Selección de Personal , Encuestas y Cuestionarios , Estados Unidos , Carga de Trabajo , Adulto JovenRESUMEN
OBJECTIVES: To determine whether nurse staffing in California hospitals, where state-mandated minimum nurse-to-patient ratios are in effect, differs from two states without legislation and whether those differences are associated with nurse and patient outcomes. DATA SOURCES: Primary survey data from 22,336 hospital staff nurses in California, Pennsylvania, and New Jersey in 2006 and state hospital discharge databases. STUDY DESIGN: Nurse workloads are compared across the three states and we examine how nurse and patient outcomes, including patient mortality and failure-to-rescue, are affected by the differences in nurse workloads across the hospitals in these states. PRINCIPAL FINDINGS: California hospital nurses cared for one less patient on average than nurses in the other states and two fewer patients on medical and surgical units. Lower ratios are associated with significantly lower mortality. When nurses' workloads were in line with California-mandated ratios in all three states, nurses' burnout and job dissatisfaction were lower, and nurses reported consistently better quality of care. CONCLUSIONS: Hospital nurse staffing ratios mandated in California are associated with lower mortality and nurse outcomes predictive of better nurse retention in California and in other states where they occur.
Asunto(s)
Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Necesidades y Demandas de Servicios de Salud , Hospitales , Personal de Enfermería en Hospital/legislación & jurisprudencia , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Calidad de la Atención de Salud/legislación & jurisprudencia , Benchmarking/normas , Benchmarking/estadística & datos numéricos , Agotamiento Profesional , California , Atención a la Salud/organización & administración , Atención a la Salud/normas , Atención a la Salud/estadística & datos numéricos , Regulación Gubernamental , Encuestas de Atención de la Salud , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Humanos , Satisfacción en el Trabajo , Modelos Logísticos , Mortalidad/tendencias , New Jersey , Personal de Enfermería en Hospital/organización & administración , Oportunidad Relativa , Alta del Paciente/estadística & datos numéricos , Pennsylvania , Calidad de la Atención de Salud/normas , Calidad de la Atención de Salud/estadística & datos numéricos , Encuestas y Cuestionarios , Recursos Humanos , Carga de Trabajo/estadística & datos numéricosRESUMEN
Using data from the 2004 California Board of Registered Nursing Survey, a two-stage least-square equation was estimated to examine the effect of wages on hours worked by female registered nurses. Wages were found to have a nonlinear effect on hours worked, with a backward bending supply curve. Wages had a positive effect on the average hours worked per week up to $24.99 per hour and a negative effect between $30.00 and $100.00 per hour when compared with the wage category of $25.00 to $29.99. Results suggest that wages are important to secure the labor supply but do not increase aggregate supply beyond a wage threshold.
Asunto(s)
Personal de Enfermería/economía , Personal de Enfermería/provisión & distribución , Admisión y Programación de Personal/organización & administración , Salarios y Beneficios/economía , Carga de Trabajo/estadística & datos numéricos , Adulto , Anciano , Análisis de Varianza , Actitud del Personal de Salud , California , Estudios Transversales , Empleo/organización & administración , Empleo/psicología , Ergonomía , Femenino , Humanos , Satisfacción en el Trabajo , Análisis de los Mínimos Cuadrados , Persona de Mediana Edad , Motivación , Dinámicas no Lineales , Investigación en Administración de Enfermería , Personal de Enfermería/educación , Personal de Enfermería/psicología , Selección de Personal , Carga de Trabajo/psicologíaRESUMEN
In 1999, California became the first state to pass legislation mandating minimum nurse-to-patient ratios. Regulations detailing specific ratios by type of hospital unit were released in 2002, with phased-in implementation beginning in 2004 and completed in 2008. These ratios were implemented at a time of severe registered nurse (RN) shortage in the state and a worsening financial position for many hospitals. This article presents an analysis of qualitative data from interviews with healthcare leaders about the impact of nurse staffing ratios. Twenty hospitals (including public, not-for-profit, and for-profit institutions) representing major geographic regions of California were approached. Twelve agreed to participate; semistructured in-person and telephone interviews were conducted with 23 hospital leaders. Several key themes emerged from the analysis. Most hospitals found it difficult and expensive to find more RNs to hire to meet the ratios. Meeting the staffing requirements on all units, at all times, was challenging and had negative impacts, such as a backlog of patients in the emergency department and a decrease of other ancillary staff. Hospital leaders do not believe that ratios have had an impact on patient quality of care. Findings related to nurse satisfaction were mixed. Increased RN staffing improved satisfaction with patient workload, but dissatisfaction with issues of decision-making control (e.g., decisions on when best to take a meal break) were taken out of the nurse's hands to meet ratio requirements. Further research should continue to monitor patient outcomes as other states consider similar ratio regulations. Results of this study will be useful to healthcare managers searching for ways to reduce unnecessary administrative costs while continuing to maintain the level of administrative activities required for the provision of safe, effective, high-quality care.
Asunto(s)
Personal de Enfermería en Hospital/provisión & distribución , Admisión y Programación de Personal/legislación & jurisprudencia , Carga de Trabajo/legislación & jurisprudencia , California , Humanos , Liderazgo , Legislación de Enfermería , Personal de Enfermería en Hospital/legislación & jurisprudencia , Estados UnidosRESUMEN
The purpose of this study was to discover if there was relationship between nurse perception of autonomy, control over practice, or relationships with physicians and patient satisfaction with care related to pain management, teaching, or physical care on medical surgical units. The study design was correlational, descriptive, and cross-sectional. The hospital sample was a purposive convenience sample of acute care hospitals in California, with a total of 21 hospitals, 60 medical surgical nursing units, 314 nurses, and 470 patients. Findings indicated that higher patient functional status and having a doctor in the hospital 24 hours/day were related to patient satisfaction with pain management. Lower nurse perception of autonomy, having a doctor in the hospital 24 hours/day, and higher number of patient years of education were related to higher patient satisfaction with teaching. Lower total hours worked by the nurses was related to higher patient satisfaction with physical care.
Asunto(s)
Personal de Enfermería en Hospital/organización & administración , Satisfacción del Paciente , Administración de Personal en Hospitales , California , Estudios Transversales , Humanos , Relaciones Médico-Enfermero , Autonomía Profesional , Análisis de RegresiónRESUMEN
Despite substantial evidence that a diverse nursing workforce is needed, slow growth continues in the number of ethnically diverse RNs. This study examined whether students' race/ethnicity was associated with perceptions about institutional, dispositional, and situational factors and whether perceptions differed by college. African American, Latino, Asian, Filipino, Southeast Asian, and non-Latino White nursing students (N = 1,377) reported their perceptions. Seven regression models were estimated to assess the association of race/ethnicity with these factors. Being a minority was associated with negative perceptions of institutional diversity. African Americans had fewer peer and faculty interactions. Filipinos reported less work interference with attending classes. Students' ethnicity is important to institutional and situational outcomes. Adding school-level variables to the regression models helped explain some additional variance in student perceptions. A comprehensive, long-term commitment to the retention of students from diverse backgrounds is needed.
Asunto(s)
Actitud del Personal de Salud , Grupos Minoritarios/psicología , Estudiantes de Enfermería/psicología , Adulto , Negro o Afroamericano/etnología , Asiático/etnología , California , Estudios Transversales , Diversidad Cultural , Bachillerato en Enfermería , Análisis Factorial , Femenino , Hispánicos o Latinos/etnología , Humanos , Relaciones Interprofesionales , Masculino , Análisis Multivariante , Negativismo , Investigación en Educación de Enfermería , Investigación Metodológica en Enfermería , Prejuicio , Análisis de Regresión , Encuestas y Cuestionarios , Universidades , Población Blanca/etnologíaRESUMEN
Because of the most recent nurse shortage it has become important to determine retention factors of nursing students in the context of various aspects of college nursing programs and institutional systems. The purpose of this article is to describe the psychometric properties of a new measure that could be useful in examining nursing student retention related to the educational institution characteristics, educational processes, and individual student characteristics. The measurement instrument was conceptually designed around 4 constructs and was administered to a test group and a validation group. The dispositional construct loaded differently for each group (test group: math and science ability, confidence in the future, and confidence in ability; validation group: math and science ability, confidence in the future, self-expectation, and confidence in ability). The situational construct factored on 4 subscales (financial issues, social support, missed classes, and work issues); the institutional construct on 4 factors (peer, overall experience, diversity, and faculty); the career values construct on 5 factors (job characteristics, autonomy, caring, flexibility, and work style). Based on the results of the factor analyses and alpha reliability, evidence supported using the dispositional subscales of math and science ability, the career values subscales of job characteristics and work style, the situational subscales of work issues and financial issues, and the institutional subscales of diversity and faculty. The other potential subscales need further refinement and testing.
Asunto(s)
Actitud del Personal de Salud , Abandono Escolar/psicología , Estudiantes de Enfermería/psicología , Encuestas y Cuestionarios/normas , Adulto , California , Selección de Profesión , Bachillerato en Enfermería/organización & administración , Docentes de Enfermería/organización & administración , Femenino , Humanos , Relaciones Interprofesionales , Masculino , Investigación en Evaluación de Enfermería , Investigación Metodológica en Enfermería , Grupo Paritario , Análisis de Componente Principal , Psicometría , Autoeficacia , Apoyo Social , Factores SocioeconómicosRESUMEN
While a number of studies have explored questions regarding career path and job satisfaction among nurses, the data rarely are examined for distinct racial and ethnic groups. Furthermore, we have not found any study that has explored the relationship between ethnicity and factors that foster job satisfaction among nurses. The purpose of this study is to describe the work environment, job advancement, and promotion experiences of registered nurses in California who self-identify an ethnic affiliation. We tried to determine if minority nurses faced more and/or different barriers to career advancement than white nurses. Overall, we found that minority nurses have positive views of their opportunities and workplaces. They are more likely than white nurses in the sample to agree that they have opportunities to learn new skills at work, to think their job duties match their skills, and to believe they have opportunities to advance at their workplace.
Asunto(s)
Actitud del Personal de Salud/etnología , Movilidad Laboral , Satisfacción en el Trabajo , Grupos Minoritarios/psicología , Personal de Enfermería/psicología , Adulto , Negro o Afroamericano/etnología , Anciano , Asiático/etnología , California , Estudios Transversales , Femenino , Hispánicos o Latinos/etnología , Humanos , Relaciones Interprofesionales , Masculino , Persona de Mediana Edad , Grupos Minoritarios/educación , Grupos Minoritarios/estadística & datos numéricos , Enfermeras Administradoras/psicología , Investigación Metodológica en Enfermería , Personal de Enfermería/educación , Personal de Enfermería/estadística & datos numéricos , Encuestas y Cuestionarios , Lugar de Trabajo/organización & administración , Lugar de Trabajo/psicologíaRESUMEN
Aim: The environment of the nursing program dean or director within a community college or state university can be politically, fiscally, and emotionally challenging. There are few studies that investigate that environment. The purpose of this study was to describe the major barriers and incentives facing these nursing deans or directors as they implemented their proposed interventions related to the Central Valley Nursing Diversity Project. Additionally, we sought to identify successful strategies used to keep the programs competitive for resources and status within their institutions and within their local communities. Methodology: The study is descriptive; the data collection method was structured interviews and data were analyzed using content analysis. Findings: Findings indicate that among the most difficult barriers faced by the directors and the faculty was the over subscribed status (more applicants than positions) of the programs. The deans or directors described three significant points that acted as barriers. These were 1) limited space in science laboratory pre-requisite courses, 2) limited classroom space in nursing courses, and 3) limited space in clinical (hospital) sites. The largest single external pressure reported was the reduction in funding and all deans or directors indicated they had difficulty hiring qualified or credentialed faculty. Conclusion: Colleges must manage more effectively student demand by modifying admissions criteria to be more selective and admit students with greater likelihood of graduating; encourage innovative partnerships between employers and schools of nursing; and increasing funding for nursing faculty salaries, classrooms, and laboratories.
Objetivo: El ambiente de un(a) decano(a) o director(a) o de un Programa de Enfermería en un colegio comunitario o una universidad estatal puede ser un reto político, físico y emocional. Hay pocos estudios que investiguen ese ambiente. El propósito de este estudio fue describir las principales barreras e incentivos que enfrentan las(os) decanas(os) o directoras(es) al implementar las intervenciones del Proyecto de Diversidad en Enfermería en el Valle Central. Adicionalmente, se identificaron estrategias exitosas para mantener competitivos a los programas en cuanto a recursos y estatus en las comunidades locales. Metodología: El estudio es descriptivo; la información se recolectó mediante entrevistas estructuradas y fue analizada mediante análisis de contenido. Hallazgos: La barrera más difícil fue la demanda exagerada de los programas. Las(os) decanas(os) o directoras(es) describieron tres barreras significativas: 1) espacio limitado en laboratorios de ciencias para los cursos pre-requisito, 2) espacio limitado en los salones de clase para los cursos de enfermería, 3) espacio limitado en los sitios de práctica clínica. La principal presión externa fue la reducción de financiación, lo que produce dificultades para conseguir docentes calificados. Conclusión: Las instituciones deben manejar más efectivamente la demanda estudiantil, modificar los criterios de admisión para hacerlos más selectivos y admitir estudiantes con mayor posibilidad de graduarse; promover alianzas innovadoras entre empleadores y escuelas de enfermería e incrementar la financiación para salarios de docentes, aulas de clase y laboratorios.
Asunto(s)
Educación en Enfermería , Planes y Programas de Salud , Ejecutivos Médicos , Estudiantes de EnfermeríaRESUMEN
La autonomía puede ser sinónimo de independencia o libertad. Cuando se utiliza para referirse al trabajo individual, se entiende como la habilidad para tomar decisiones sin injerencia de terceros. El propósito del presente artículo consiste en realizar una crítica a dos modelos de autonomía, uno desarrollado desde la disciplina de la salud ocupacional y el otro desde la disciplina de la enfermería. Estos modelos potencialmente suscitan una reflexión sobre el trabajo de la enfermería hospitalaria. Adicionalmente, en este documento se explorará la posibilidad de aplicar estos modelos tradicionales occidentales en culturas distintas a las de Estados Unidos, Europa y Australia. La pregunta acerca de si una enfermera hospitalaria puede ser autónoma es compleja debido a la estructura social en la que se desarrolla su trabajo y a las barreras que esas estructuras le imponen. Para que las enfermeras, y las mujeres, puedan ejercer su autonomía en los ambientes de trabajo, los miembros más poderosos de la sociedad deben reconocer la realidad del subvalorado estatus de la mujer y de su trabajo, y así considerar un mayor ejercicio de su discrecionalidad.
Asunto(s)
Humanos , Autonomía Personal , Autonomía Profesional , Enfermería/clasificación , Enfermería/instrumentación , Enfermería/métodos , Enfermería/normas , Enfermería/organización & administración , Enfermería , Enfermería/tendenciasRESUMEN
Despite evidence that hospital use of licensed practical nurses (LPNs) declined in the 1990s, the current registered nurse (RN) shortage has prompted interest in LPNs as substitutes for RNs. Hospitals, being the dominant employer of RNs, have an economic incentive to use less expensive LPNs as substitutes. Beside wages, there are several forces underlying hospital demand for LPNs. In this article, the authors model and estimate hospital demand for LPNs as a function of nurse wages and hospital, market, and patient characteristics using a longitudinal data set of short-term general hospitals in the United States. The authors find evidence that higher RN wages increase hospital demand for LPNs, both in levels and relative to RNs, suggesting that hospitals at least partially substitute RNs with LPNs.
Asunto(s)
Necesidades y Demandas de Servicios de Salud , Personal de Enfermería en Hospital/provisión & distribución , Enfermería Práctica , Empleo , Recursos HumanosRESUMEN
OVERVIEW: LPNs may be able to help fill some of the gaps caused by the nursing shortage, but little research has been conducted on the demographic characteristics of LPNs, their education and scope of practice, and the demand for their services, all of which vary from state to state. In 2002 and 2003, the authors conducted a comprehensive national study, Supply, Demand, and Use of Licensed Practical Nurses, and have summarized that study's findings in this article. They found that RNs and LPNs are similar in age and tend to have similar numbers of children, but that racial and ethnic minorities, particularly African Americans, and those who are single, widowed, divorced, or separated are better represented among LPNs. Expanding LPN educational programs might draw more people into nursing. Some LPNs would like to become RNs, so expanding LPN-to-RN "ladder" programs could also be beneficial. LPNs can't replace RNs entirely, but they could perform much of the work now performed by RNs. While long-term care facilities already depend heavily on LPNs, hospitals could benefit from employing more LPNs. The authors make several specific policy recommendations to improve the education and employment of LPNs.
Asunto(s)
Actitud del Personal de Salud , Enfermería Práctica , Enfermería , Admisión y Programación de Personal , Adulto , Femenino , Grupos Focales , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana Edad , Enfermería/organización & administración , Enfermería Práctica/educación , Análisis y Desempeño de Tareas , Estados Unidos , Recursos HumanosRESUMEN
The nursing shortage has stimulated renewed attention to understanding factors that may enhance the recruitment of students into nursing programs and the retention of registered nurses in the workforce. Many activities have been initiated to address the shortage of nurses, including increasing recruitment of students to study nursing. This paper has two major goals: (1) to answer the research question, "To what extent do college students' characteristics explain the differences in their attitudes towards four service occupations (nursing, medicine, physical therapy and high school teaching)?" and (2) to demonstrate statistical methods appropriate for performing multivariate analyses of clustered data and merging independent survey items into a clustered, multivariate analysis for direct comparison of the different items. Results indicate that the more favourable rating of nursing as an occupation relative to physical therapy is due to the sample, including a large number of students majoring in nursing. Students who are not nursing majors do not appear to hold a more favourable attitude towards nurses relative to physical therapists. The lower rating of high school teachers and higher rating of physicians on most items persists even after adjusting for all the control variables, including whether or not students are nursing majors. Additionally, results support the need for a statistical method such as generalized estimating equations (GEE) to account for individual and interaction confounders, repeated measures, clustering and correlated data.
Asunto(s)
Actitud Frente a la Salud , Selección de Profesión , Enfermería/organización & administración , Estudiantes/psicología , Universidades , Adulto , California , Movilidad Laboral , Análisis por Conglomerados , Factores de Confusión Epidemiológicos , Docentes , Femenino , Identidad de Género , Humanos , Modelos Logísticos , Masculino , Medicina , Modelos Estadísticos , Análisis Multivariante , Especialidad de Fisioterapia , Rol Profesional , Salarios y Beneficios , Percepción Social , Estudiantes de Enfermería/psicología , Encuestas y CuestionariosRESUMEN
A poor public "image" of the nurse is believed to contribute to nurse shortages. We surveyed more than 3,000 college students in science and math courses in a seven-county region of California's Central Valley to assess their perceptions of a career as a nurse in relation to a career as a physical therapist, a high school teacher, or a physician. Students generally had favorable perceptions of nursing, with two-thirds agreeing that nursing has good income potential, job security, and interesting work. However, nursing lagged behind the other occupations in perceptions of independence at work and was more likely to be perceived as a "women's" occupation. Our findings suggest that these college students have generally gotten the message that nursing is a financially rewarding and desirable career, although they also perceive nursing to be less attractive on some important occupational characteristics such as job independence. Unless nursing training capacity expands substantially, the projected nurse shortage will occur. With continued aggressive marketing of nursing as a career, there is a risk of engendering a backlash from prospective students frustrated in their effort to find a slot in a nursing training program. Much work remains to be done to alter the image of nursing as a women's occupation and to transform the work environment of nurses to make a career in nursing more attractive.
Asunto(s)
Selección de Profesión , Personal de Enfermería en Hospital/provisión & distribución , Adulto , California , Recolección de Datos , Femenino , Humanos , Masculino , Estudiantes/psicología , UniversidadesRESUMEN
BACKGROUND: Numerous studies have examined cross-sectional data to determine the relationships between nurse staffing and patient outcomes. Questions have been raised about some of the studies now in the literature regarding the use of the hospital as the unit of analysis and the cross-sectional design of the studies. Additionally, there is a concern that the primary outcomes being studied are negative. OBJECTIVE: Objectives of this study are to (1) compare the relationships between nurse staffing and positive patient outcomes for 3 adult medical-surgical nursing units in one university teaching hospital across 4 years (16 fiscal quarters); and (2) explore the use of 2 new failure-to-rescue (FTR) rates as outcomes, specifically FTR from medication errors and FTR from decubitus ulcers. DESIGN: This study uses secondary analyses of data viewed retrospectively with a longitudinal repeated-measures design to estimate the relationships between nurse staffing and the outcomes of interest. RESULTS: Accounting for total dollars and case mix, all patient satisfaction measures increased as total hours of care per patient day increased, and as the skill mix became richer (more RN hours/total hours) there was a higher satisfaction with pain management and physical care requests. There was an increase in FTR from medication error as the non-RN (Other) hours of care per patient day increased and there was an increase in FTR from decubitus ulcers as patient severity increased. CONCLUSION: The overall conclusion is that it will likely be necessary to vary staffing hours and staffing mix depending on which positive patient outcome or outcomes you wish to achieve.