Hospital nursing organization and outcomes for surgical oncology patients

As interest in the relationship between the organization of nursing care and patient outcomes grows, concerns exist that the quality of care for cancer patients is unequal. This study examined the association between the organization of hospital nursing care and outcomes for surgical oncology patients. Building upon an existing research program, data on cancer diagnosis, stage and length of illness were appended to a database which included patient discharge abstracts, hospital structure characteristics, and nurse reports of staffing, practice environment and educational preparation. The Practice Environment Scale of the Nursing Work Index (PES-NWI) measured the practice environment and classified hospitals as having favorable, mixed, and unfavorable working conditions for nurses. The analytic sample was comprised of 24,618 surgical oncology patients, cared for in 164 Pennsylvania hospitals between 1998 and 1999. Responses from 8,526 nurses were used to calculate staffing ratios, PES-NWI subscales, and educational preparation. Cross-tabulations examined patient characteristics and outcomes by hospital and nursing organization characteristics. After estimating and validating a patient risk adjustment model, multivariate logistic regression models estimated the effects of hospital and nursing organization on mortality, complications, and two calculations of failure to rescue (death after complication). Spearman rank correlations examined the outcomes by the dependent variables at the hospital level. Overall rates of death, complications and both failure measures were 3.4, 35.7, and 7.52–9.33 percent, respectively. In bivariate analysis, patient, hospital, and nursing organization variables were significantly associated with the four outcomes. Sicker patients were found in hospitals with fewer beds, lower procedure volumes, fewer high-technology services, and hospitals without National Cancer Institute designation. In multivariate analysis, 30-day mortality was predicted by nurse staffing, nursing educational preparation and nurse practice environments. Nursing educational preparation and nurse practice environments were significant predictors of failure. The Nursing Foundations for Quality of Care subscale was significantly correlated with mortality and failure. This study provides evidence that the measures of nursing organization are significant predictors of risk-adjusted surgical oncology outcomes. Improving the staffing, educational preparation, and organization of registered nurses in hospitals may result in improved outcomes for this vulnerable patient population