The Impact of Nursing Resources on Chronic Wound Management: A Cross-Sectional Analysis

Abstract

Aim: Evaluate the relationship between hospital nursing resources and outcomes among patients with chronic wounds.

Design: Cross-sectional observational.

Methods: Hospital-level predictors included the nurse work environment, proportion of Bachelor of Science (BSN)-prepared nurses, and skill mix (i.e., registered nurses [RN] as proportion of nursing personnel). Outcomes included in-hospital and 30-day mortality, discharging to a higher level of care and length of stay. Individual-level nurse data were aggregated to create hospital-level measures of nursing resources. We utilised multi-level modelling with nurses nested within hospitals and outcomes at the patient level.

Data: Three datasets from 2021: RN4CAST-New York/Illinois survey, Medicare Provider Analysis and Review claims and American Hospital Association Annual Survey.

Results: The sample included 34,113 patients with chronic wounds in 215 hospitals in New York and Illinois. In adjusted models, a 1 standard deviation improvement in the work environment was associated with 12% lower odds of in-hospital mortality, 8% lower odds of discharging to a higher level of care and a shorter length of stay by a factor of 0.96. A 10% increase in BSN composition was associated with 8% reduced odds of in-hospital mortality and 6% reduced odds of 30-day mortality. A 10% increase in skill mix was associated with 12% lower odds of in-hospital mortality and a shorter length of stay by a factor of 0.91.

Conclusion: Improved nursing resources are associated with better outcomes among patients with chronic wounds.

Implications: Nurses manage the care of patients with chronic wounds; thus, hospital investment in nursing resources is imperative for good outcomes.

Impact: Modifiable hospital nursing resources are associated with outcomes among patients with chronic wounds, a complex population.

Reporting: STROBE.

Keywords: nursing workforce; patient outcomes; wound care.