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Association of Use of Contract Nurses With Hospitalized Patient Pressure Injuries and Falls

Name

University of Louisiana at Lafayette

Nursing 406: Evidence-Based Practice for RN-BSN

Dr. Helen Fox McCloy DNP, MSN, CPNP

August 28, 2020

Method/Design:

A cross sectional study design of unit level nursing was performed for this study using unit-based patients. The study was conducted from 2015 to 2016 from organizations from the Collaborative Alliance for Nursing Outcomes database using identical data from all participating hospitals. The study also used such things as: hospital characteristics, contract nurses, nurse staffing levels, patient variables, and nurse sensitive outcomes to compile data. These outcomes were compared to similar units using cluster analysis. A total of 166 hospitals participated to the contribution of data.

The study used correlation coefficients to evaluate variables from inclusion in the cluster model and cluster analysis to examine relationships between nurse staffing and patient outcomes to detect groupings in the model. Patient’s gender, age, patient turn over, hospital acquired patient injury, and falls were not included in the study. Ward’s linkage hierarchical methods of cluster analysis was used with Euclidean distance as it produced clusters that made connections ( Ferguson, Bradywood, Williams, and Blackmore 2020). The results of the clusters were validated comparing from 100 Monte Carlo simulations of the K-means model. The Calinski/Harabasz pseudo-F scores and Duda/Hart pseudo T-squared measures represented live clusters. One-way analysis of variance (ANOVA) was used to compare statistical differences between clusters. An analysis was performed using Stata MP version 15.1 (Ferguson, Bradywood, Williams, and Blackmore 2020). The Institutional review board determined the study to be exempt from review.

Problem Statement:

Hospitals across the country use contract or travel nurses to supplement staffing shortages. Staffing ratios are often blamed for injuries occurring in the hospital setting. These nurses typically have various degrees of skills, knowledge, experience, and training as a nurse. In contrast, many of them have spent less than five years as a nurse before treading the waters of becoming a contract nurse. Unfortunately, the driving force is often due to the lucrative salary and flex schedule offered by many nursing agencies. As these nurses enter the hospital setting, training and knowledge on hospital policy and practices lack precedent in nursing care. Facilities should identify the strengths and weaknesses of learners to improve patient outcomes (Barrington & Street, 2009). Often, the compassion in care does not transfer into skills and training in preventing hospital acquired injuries and falls. Nurse staffing ratios of hospitals has been found to be a significant predictor for several patient outcomes, as well as falls. According to Ferguson, Bradywood, Willams, & Blackmore (2020) more than 1 million falls and 2.5 million hospital acquired injuries occur annually in U.S hospital.

Not all contract nurses are trained to understand the importance of measures to prevent falls and hospital acquired pressure injuries. Many contract nurses fail to understand payment practices by Medicaid and Medicare when patients are injured through falls or hospital acquired injuries. Medicaid provides limited payment reimbursement to hospitals for injuries related to falls or hospital acquired pressure injuries that are staged at 3, 4, and unstageable (Ferguson, Bradywood, Williams, & Blackmore, 2020).

Falls and hospital acquired pressure injuries can be prevented if proper training and skill assessment is evaluated prior to contract nurses being staffed on a nursing unit. There is limited information and literature available between the relationship of falls and hospital acquired injuries who are cared for by contract nurses. Systematic reviews have not identified consistent relations between staffing levels and HAPIs or falls outside of the critical care units (Ferguson, Bradywood, Williams, & Blackmore, 2020).

The objective of this research study was to examine contributing factors to hospital acquired injuries and determine if the use of contract (travel) nurses contributed to more HAPIs and falls than patients cared for by hospital staffed nurses in the medical and surgical units.

Purpose Statement:

The purpose of this research study is to explore the relationship between the use of contract nurses as it relates to the occurrence of hospital acquired injuries and falls in the hospital setting on medical and surgical units.

Independent Variable:

Use of contract (travel) nurses is the independent variable.

Dependent Variable:

Prevalence and incident of HAPI’s and number of falls in the hospital setting will be measured as the dependent variable.

Intervention:

The intervention for this study is the use of contract nurses. Use of contract nurse staff levels to patient ratio (effecting rate of falls and hospital acquired injury)

Hypothesis Research Question:

The aim of the question is to answer the following question: What is the relationship between the use of contract nurses to the contribution of the number of HAPI’s and falls in the hospital setting of floor level medical and surgical patients?

References

Barrington, K., & Street, K. (2009). Learner contracts in nurse education: Interaction within the practice

context. Nurse Education in Practice, 9(2), 109–118.

https://ezproxyprod.ucs.louisiana.edu:4128/10.1016/j.nepr.2008.10.004

Ferguson, A., Bradywood, A., Williams, B., & Blackmore, C. C. (2020). Association of use of contract

nurses with hospitalized patient pressure injuries and falls. Journal of Nursing Scholarship: An

Official Publication of Sigma Theta Tau International Honor Society of Nursing.

https://ezproxyprod.ucs.louisiana.edu:4128/10.1111/jnu.12572