Hospital restructuring and its impact on outcomes: nursing staff regulations are premature.
OBJECTIVE: Describe restructuring in the organization and delivery of patient care and the effects of nursing structure and processes on selected patient outcomes. BACKGROUND: Restructuring has been the dominant cost-reduction strategy in acute care hospitals. Changes occurred without a systematic look at how interventions impacted on the processes and outcomes of care. METHODS: Twenty-nine university teaching hospitals participated. Uniform structure, process, and outcome data were collected from each hospital and its study, medical, and surgical units. Outcome data included fall rate, nosocomial pressure ulcer, and urinary tract infection rates and patient satisfaction scores. RESULTS: RNs were fewer in number, with an increase in Unlicensed Assistive Personnel. Outcomes were affected by registered nurse hours worked per patient/day and hours worked per patient day by all staff and their interactions with processes. Increased registered nurse hours worked per patient/day were associated with lower fall rates and higher patient satisfaction levels with pain management. Increased hours worked per patient day by all staff were associated with lower urinary tract infection rates. CONCLUSIONS: Data from this study do not enable specific staffing recommendations. Expanded hospital and unit level data should be collected and reported annually. Nursing staff regulations should be deferred until expanded structure and outcome data from all acute care hospitals are systematically collected, reported, and analyzed.