Document Type

Article

Language

eng

Format of Original

22 p.

Publication Date

12-2014

Publisher

Wiley

Source Publication

Health Services Research

Source ISSN

1475-6773

Original Item ID

10.1111/1475-6773.12236

Abstract

Objective

The aims of the study were to (1) estimate the relative nurse effectiveness, or individual nurse value-added (NVA), to patients’ clinical condition change during hospitalization; (2) examine nurse characteristics contributing to NVA; and (3) estimate the contribution of value-added nursing care to patient outcomes.

Data Sources/Study Setting

Electronic data on 1,203 staff nurses matched with 7,318 adult medical–surgical patients discharged between July 1, 2011 and December 31, 2011 from an urban Magnet-designated, 854-bed teaching hospital.

Study Design

Retrospective observational longitudinal analysis using a covariate-adjustment value-added model with nurse fixed effects.

Data Collection/Extraction Methods

Data were extracted from the study hospital's electronic patient records and human resources databases.

Principal Findings

Nurse effects were jointly significant and explained 7.9 percent of variance in patient clinical condition change during hospitalization. NVA was positively associated with having a baccalaureate degree or higher (0.55, p = .04) and expertise level (0.66, p = .03). NVA contributed to patient outcomes of shorter length of stay and lower costs.

Conclusions

Nurses differ in their value-added to patient outcomes. The ability to measure individual nurse relative value-added opens the possibility for development of performance metrics, performance-based rankings, and merit-based salary schemes to improve patient outcomes and reduce costs.

Comments

Accepted version. Health Services Research, Vol. 49, No. 6 (December 2014): 1767–1786. DOI. © 2014 Wiley. Used with permission.

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