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Clinical Investigation
Nurse Staffing and Postsurgical Outcomes in Black Adults
Article first published online: 12 JUN 2012
DOI: 10.1111/j.1532-5415.2012.03990.x
© 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society
Additional Information
How to Cite
Brooks Carthon, J. M., Kutney-Lee, A., Jarrín, O., Sloane, D. and Aiken, L. H. (2012), Nurse Staffing and Postsurgical Outcomes in Black Adults. Journal of the American Geriatrics Society, 60: 1078–1084. doi: 10.1111/j.1532-5415.2012.03990.x
Publication History
- Issue published online: 12 JUN 2012
- Article first published online: 12 JUN 2012
Funded by
- Penn Minority Aging for Community Health Center
- Resource Center for Minority Aging Research. Grant Number: P30AG031043
- National Institutes of Health
- National Institute on Aging
- National Institutes of Health
- National Institute of Nursing Research. Grant Numbers: R01-NR04513, T32-NR007104, K01NR012006
- Agency for Healthcare Research and Quality. Grant Number: 1K08-HS018534
- Abstract
- Article
- References
- Cited By
Keywords:
- disparities;
- nursing care;
- surgical outcomes
Objectives
To determine the association between nurse staffing and postsurgical outcomes for older black adults, including 30-day mortality and failure to rescue.
Design
A cross-sectional study of University of Pennsylvania Multi-State Nursing Care and Patient Safety Survey data, linked to 2006–2007 administrative patient discharge data from four states (CA, PA, NJ, FL), American Hospital Association Annual Survey data, and a U.S. Census-derived measure of socioeconomic status (SES). Risk-adjusted logistic regression models with correction for clustering were used for the analysis.
Setting
Five hundred ninety-nine adult nonfederal acute care hospitals in California, Pennsylvania, New Jersey, and Florida
Participants
Five hundred forty-eight thousand three hundred ninety-seven individuals ages 65 and older undergoing general, orthopedic, or vascular surgery (94% white, 6% black).
Measurements
Thirty-day mortality and failure to rescue (death after a complication).
Results
In models adjusting for sex and age, 30-day mortality was significantly higher for black than white participants (odds ratio (OR) = 1.42, 95% confidence interval (CI) = 1.32–1.52). In fully adjusted models that accounted for SES, surgery type, and comorbidities, as well as hospital characteristics, including nurse staffing, the odds of 30-day mortality were not significantly different for black and white participants. In the fully adjusted models, one additional patient in the average nurse's workload was associated with higher odds of 30-day mortality for all patients (OR = 1.03, 95% CI = 1.01–1.05). A significant interaction was found between race and nurse staffing for 30-day mortality, such that blacks experienced higher odds of death with each additional patient per nurse (OR = 1.10, 95% CI = 1.03–1.18) compared to whites (OR = 1.03, 95% CI = 1.01–1.06). Similar patterns were detected in failure-to-rescue models.
Conclusion
Older surgical patients experience poorer postsurgical outcomes, including mortality and failure to rescue, when cared for by nurses with higher workloads. The effect of nurse staffing inadequacies is more significant in older black individuals.