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To determine whether better nursing resources (ie, nurse education, staffing, work environment) are each associated with improved postsurgical outcomes for patients with opioid use disorder (OUD). Background: Hospitalized patients with OUD are at increased risk of adverse outcomes. Evidence suggests that adverse postsurgical outcomes may be mitigated in hospitals with better nursing resources, but this has not been evaluated among surgical patients with OUD. Methods: Cross-sectional (2015-2016) data were utilized from the RN4CAST-US survey of hospital nurses, the American Hospital Association Annual Survey of hospitals, and state patient hospital discharge summaries. Multivariate logistic and zero-truncated negative binomial regression models were employed to examine the association between nursing resources and 30-day readmission, 30-day in-hospital mortality, and length of stay for surgical patients with OUD. Results: Of 919,601 surgical patients in 448 hospitals, 11,610 had identifiable OUD. Patients with compared to without OUD were younger and more often insured by Medicaid. Better nurse education, staffing, and work environment were each associated with better outcomes for all surgical patients. For patients with OUD, each 10% increase in the proportion of nurses with a bachelor's degree in nursing was associated with even lower odds of 30-day readmission (odds ratio [OR] = 0.88; P = 0.001), and each additional patient-per-nurse was associated with even lower odds of 30-day readmission (OR = 1.09; P = 0.024). Conclusions: All surgical patients fare better when cared for in hospitals with better nursing resources. The benefits of having more nurses with a bachelor's degree and fewer patients-per-nurse in hospitals appear greater for surgical patients with OUD.
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An understudied aspect of the opioid crisis with implications for nursing is care of hospitalized surgical patients with chronic opioid use. Care needs of these patients are not well understood. This systematic review identified salient care needs and explored the role of nursing in meeting these needs.
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BACKGROUND: Recent studies suggest that nurses may be unable to complete all aspects of necessary care due to a lack of time. Research is needed to determine whether unmet nursing care contributes to disparities in readmissions for vulnerable populations. OBJECTIVES: To examine differences in the relationship between nursing care left undone and acute myocardial infarction readmissions among older black patients compared with older white patients. RESEARCH DESIGN: Cross-sectional analysis of multiple datasets, including: 2006 to 2007 administrative discharge data, a survey of registered nurses, and the American Hospital Association Annual Survey. Risk-adjusted logistic regression models were used to estimate the association between care left undone and 30-day readmission. Interactions were used to examine the moderating effect of care left undone on readmission by race. RESULTS: The sample included 69,065 patients in 253 hospitals in California, New Jersey, and Pennsylvania. Older black patients were 18% more likely to experience a readmission after adjusting for patient and hospital characteristics and more likely to be in hospitals where nursing care was often left undone. Black patients were more likely to be readmitted when nurses were unable to talk/comfort patients [odds ratio (OR), 1.09; 95% confidence interval (CI), 1.01-1.19], complete documentation (OR, 1.16; 95% CI, 1.01-1.32), or administer medications in a timely manner (OR, 1.26; 95% CI, 1.09-1.46). CONCLUSIONS: Unmet nursing care is associated with readmissions for older black patients following acute myocardial infarction. Investment in nursing resources to improve the delivery of nursing care may decrease disparities in readmission.
Assuntos
Negro ou Afro-Americano , Infarto do Miocárdio/terapia , Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Razão de Chances , Alta do Paciente/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Fatores de Tempo , Estados Unidos , População Branca/estatística & dados numéricos , Carga de TrabalhoRESUMO
OBJECTIVES: The purpose of this study was to identify common components of diversity pipeline programs across a national sample of nursing institutions and determine what effect these programs have on increasing underrepresented minority enrollment and graduation. DESIGN: Linked data from an electronic survey conducted November 2012 to March 2013 and American Association of Colleges of Nursing baccalaureate graduation and enrollment data (2008 and 2012). PARTICIPANTS: Academic and administrative staff of 164 nursing schools in 26 states, including Puerto Rico in the United States. METHODS: Chi-square statistics were used to (1) describe organizational features of nursing diversity pipeline programs and (2) determine significant trends in underrepresented minorities' graduation and enrollment between nursing schools with and without diversity pipeline programs RESULTS: Twenty percent (n = 33) of surveyed nursing schools reported a structured diversity pipeline program. The most frequent program measures associated with pipeline programs included mentorship, academic, and psychosocial support. Asian, Hispanic, and Native Hawaiian/Pacific Islander nursing student enrollment increased between 2008 and 2012. Hispanic/Latino graduation rates increased (7.9%-10.4%, p = .001), but they decreased among Black (6.8%-5.0%, p = .004) and Native American/Pacific Islander students (2.1 %-0.3%, p ≥ .001). CONCLUSIONS: Nursing diversity pipeline programs are associated with increases in nursing school enrollment and graduation for some, although not all, minority students. Future initiatives should build on current trends while creating targeted strategies to reverse downward graduation trends among Black, Native American, and Pacific Island nursing students.