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24/7 Registered Nurse Staffing Coverage in Saskatchewan Nursing Homes and Acute Hospital Use

Published online by Cambridge University Press:  16 November 2015

Margaret J. McGregor*
Affiliation:
Vancouver Coastal Health Research Institute Centre for Clinical Epidemiology & Evaluation Department of Family Practice, University of British Columbia Centre for Health Services and Policy Research, University of British Columbia
Janice M. Murphy
Affiliation:
Health Research Consultant, Balfour, British Columbia
Jeffrey W. Poss
Affiliation:
Vancouver Coastal Health Research Institute Centre for Clinical Epidemiology & Evaluation School of Public Health and Health Systems, University of Waterloo
Kimberlyn M. McGrail
Affiliation:
Vancouver Coastal Health Research Institute Centre for Clinical Epidemiology & Evaluation Centre for Health Services and Policy Research, University of British Columbia School of Population and Public Health, University of British Columbia
Lisa Kuramoto
Affiliation:
Vancouver Coastal Health Research Institute Centre for Clinical Epidemiology & Evaluation
Huei-Chung Huang
Affiliation:
Vancouver Coastal Health Research Institute Centre for Clinical Epidemiology & Evaluation
Stirling Bryan
Affiliation:
Vancouver Coastal Health Research Institute Centre for Clinical Epidemiology & Evaluation School of Population and Public Health, University of British Columbia
*
Correspondence and requests for reprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: Margaret J. McGregor, M.D., M.H.Sc. Department of Family Practice University of British Columbia Room 713, 828 West 10th Avenue Vancouver, BC V5Z 1L8 (mrgret@mail.ubc.ca)

Abstract

In many jurisdictions, legislation requires long-term care (LTC) facilities to have a registered nurse on duty 24 hours a day, seven days per week. Although considerable research exists on LTC nurse staffing intensity, no empirical research on this requirement exists. Our retrospective observational study in Saskatchewan compared facilities with 24/7 RN coverage to facilities with less coverage supplemented with various night-shift staffing models. Adjusted for nurse staffing intensity and other potential confounders, risk ratios associated with less-than-24/7 RN coverage supplemented with licensed practical nurse night-shift staffing were 1.17, 95% CI [0.91, 1.50] and 1.00, 95% CI [0.72, 1.39]; and with less-than-24/7 RN coverage supplemented with care aide night-shift staffing, risk ratios were 1.46, 95% CI [1.11, 1.91] and 1.11, 95% CI [0.78, 1.58], for inpatient hospital admissions and Emergency Department visits respectively. Findings suggest that acute services utilization may be negatively influenced by the absence of 24/7 RN coverage.

Résumé

La législation, dans de nombreuses juridictions, nécessite les établissements des soins de longue durée (SLD) d'avoir une infirmière en service 24 heures par jour, 7 jours par semaine. Bien que la recherche considérable existe sur l'intensité SLD de la dotation en personnel infirmier, il n'existe pas de la recherche empirique relative à cette exigence. Notre étude rétrospectif d'observation a comparé des installations en Saskatchewan avec 24/7 RN couverture aux établissements offrant moins de couverture, complétées par divers modèles de dotation des postes de nuit. Les ratios de risque associés à moins de 24/7 couverture RN complété de la dotation infirmière autorisé de nuit, ajusté pour l'intensité de dotation en personnel infirmier et d'autres facteurs de confusion potentiels, étaient de 1,17, IC 95% [0,91, 1,50] et 1.00, IC à 95% [0,72, 1,39], et avec moins de couverture 24/7 RN complété avec soin par aides personnels de nuit, les ratios de risque étaient de 1,46, IC 95% [1,11, 1,91] et 1,11, IC 95% [0,78, 1,58], pour les patients hospitalisés et de visites aux services d'urgence, respectivement. Ces résultats suggèrent que l'utilisation des soins de courte durée peut être influencée négativement par l'absence de la couverture 24/7 RN.

Type
Articles
Copyright
Copyright © Canadian Association on Gerontology 2015 

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