Source avec lien : BMJ Quality & Safety, 2020(Prépublication), 8/13/2020. 10.1136/bmjqs-2020-011512
Les efforts déployés pour promulguer une législation sur la dotation en personnel infirmier manquent souvent de preuves locales et opportunes sur la manière dont des politiques spécifiques pourraient avoir un impact direct sur la santé publique. Malgré de nombreuses études indiquant qu’une meilleure dotation en personnel est associée à des résultats plus favorables pour les patients, un seul État américain (la Californie) fixe des normes de dotation en personnel infirmier pour les patients. Afin d’éclairer la législation relative à la dotation en personnel qui est en cours d’examen dans deux autres États américains (New York, Illinois), nous avons cherché à déterminer si la dotation en personnel varie d’un hôpital à l’autre et quelles en sont les conséquences pour les résultats des patients. Par coïncidence, la collecte de données a eu lieu juste avant l’épidémie de COVID-19 ; ainsi, ces données fournissent également un exemple en temps réel des conséquences sur la santé publique du manque chronique d’infirmières dans les hôpitaux.
Introduction Efforts to enact nurse staffing legislation often lack timely, local evidence about how specific policies could directly impact the public’s health. Despite numerous studies indicating better staffing is associated with more favourable patient outcomes, only one US state (California) sets patient-to-nurse staffing standards. To inform staffing legislation actively under consideration in two other US states (New York, Illinois), we sought to determine whether staffing varies across hospitals and the consequences for patient outcomes. Coincidentally, data collection occurred just prior to the COVID-19 outbreak; thus, these data also provide a real-time example of the public health implications of chronic hospital nurse understaffing. Methods Survey data from nurses and patients in 254 hospitals in New York and Illinois between December 2019 and February 2020 document associations of nurse staffing with care quality, patient experiences and nurse burnout. Results Mean staffing in medical-surgical units varied from 3.3 to 9.7 patients per nurse, with the worst mean staffing in New York City. Over half the nurses in both states experienced high burnout. Half gave their hospitals unfavourable safety grades and two-thirds would not definitely recommend their hospitals. One-third of patients rated their hospitals less than excellent and would not definitely recommend it to others. After adjusting for confounding factors, each additional patient per nurse increased odds of nurses and per cent of patients giving unfavourable reports; ORs ranged from 1.15 to 1.52 for nurses on medical-surgical units and from 1.32 to 3.63 for nurses on intensive care units. Conclusions Hospital nurses were burned out and working in understaffed conditions in the weeks prior to the first wave of COVID-19 cases, posing risks to the public’s health. Such risks could be addressed by safe nurse staffing policies currently under consideration.