Background: The nursing workforce is critical to improving patient outcomes. Without adequate
evidence to guide decision making, restructuring of the nursing workforce to meet increasingly
complex patient care needs in the context of registered nurse shortages might fail to produce
desired outcomes.
Objective: To develop a suite of nursing-sensitive outcome indicators for monitoring the safety
of multi-day adult medical and surgical patients associated with nurse workloads and nursing
workforce models.
Design: A feasibility study was conducted.
Setting: Adult acute metropolitan public hospitals in Western Australia.
Data sources: Patient data for testing the suite were sourced from 2006 to 2010 coded discharge
morbidity abstracts.
Method: Indicator development followed the American Nurses Association (2011) approach:
clarifying indicator scope and purpose; determining selection criteria; reviewing the literature
for potential indicators; identifying data sources; review by experts; documenting each
indicator; and determining baselines.
Results: The proposed suite comprises 9 indicators pertaining to medical and surgical patients:
failure-to-rescue; in-hospital 30-day mortality; average length of stay; hospital-acquired urinary
tract infections, sepsis, pneumonia and pressure injuries; falls with injury occurring in hospital;
nurse staffing levels (comprising skill mix and nursing care hours per patient day).
Conclusions: Sufficiently robust administrative data is available to calculate retrospective
monthly and annual rates of nursing-sensitive outcomes at unit level and further analysed by
ward category for metropolitan patients. Further work is required to pilot test the suite and
develop processes for reporting to the Department of Health and hospitals on the impact of
nurse staffing and care delivery models on patient outcomes