RN4CAST abstract
Researchers from 12 European countries (Belgium, Finland, Germany, Greece, Ireland, Norway, Poland, Spain, Sweden, Switzerland, The Netherlands and England) are collaborating in one of the largest nursing workforce studies ever conducted in the EU. This 3 year study is coordinated by the Catholic University of Leuven (Belgium) in cooperation with the Center for Health Outcomes and Policy Research at the University of Pennsylvania (USA).
The objective of the study is to determine how hospital nurse staffing, skill mix, educational composition, and quality of the nurse work environment impact hospital mortality, failure to rescue, quality of care, and patient satisfaction. The findings from the study will allow researchers to refine existing nurse workforce forecasting models by addressing both volume and quality of nursing staff and patient care.
The first phase of the project (January 2009-June 2010) focused on instrument development, instrument validation and data collection. In each participating country at least 30 general acute hospitals were sampled and data were obtained from nurse, patient and organizational surveys as well as routinely-collected hospital discharge data. In each of the hospitals (n=459) general medical and surgical nursing units (at least 2 per hospital) were randomly selected to conduct a survey of all staff nurses involved in direct patient care activities (n=30,769 nurses; response rate: 58%).
The nurse survey aimed to measure, within and across countries, characteristics of the hospital nurse workforce, nurses' future employment intentions, and nurses' perspectives on quantity and quality of care provided. This allowed the creation of hospital-level and unit-level measures of staffing and working conditions for nurses.
The patient survey (a voluntary component of the study) was conducted in all hospitals in 5 countries (Belgium, Poland, Greece, Finland, Switzerland) and on a selection of hospitals in 3 countries (Spain, Germany, Ireland). A one-day census approach was used to select all eligible patients from the selected nursing units in the participating hospitals (n=200). In England, patient survey data were obtained from a standardized, routinely collected patient survey. In total, data from about 11,000 patients are available (response rate: 72%).
The organizational survey was used to obtain the organizational profile (e.g. hospital size), as well as detailed information on other hospital workers (e.g. unlicensed assistive personnel, physicians) in order to control the analyses for institutional differences. Hospital discharge abstract datasets will be used to calculate additional patient outcomes like in-hospital mortality and failure-to-rescue. For each participating hospital, the hospital discharge data for an entire year are obtained, resulting in a database of millions of patients. These datasets will all be linked by common identifiers.
In the second phase of the study (July 2010 - December 2011), this dataset will be used to study the effects of hospital nurse staffing, skill mix, educational composition, and quality of the nurse work environment on hospital mortality, failure to rescue, quality of care, and patient satisfaction with care. These results will be used to improve the accuracy of forecasting models and generate new approaches to more effective management of nursing resources in Europe. In addition to these research activities, the project also involves dissemination and stakeholder activities.
Strategic collaboration is maintained with an international stakeholder panel consisting of thirteen health care organizations (www.rn4cast.eu) and national stakeholder committees. The study is also conducted in three countries outside Europe ( Botswana, China, and South Africa ) to provide a broader international perspective.
The ambition of the RN4CAST project is to produce actionable recommendations to improve nursing care and patient outcomes at the individual hospital level and to inform national policies that could improve care outcomes by strategic investments in nursing.