Association Between the Nursing Practice Environment, Registered Nurse Staffing, and Patient Outcomes in the Pediatric Acute Care Setting
Abstract
Objectives: The purpose of this study was to investigate the association of the nurse practice
environment and nurse staffing on pediatric acute care outcomes: FALLS, HAPI, CLABSI,
CAUTI, and VAP. The hypothesis was that nurse practice environment would have a greater
association on improved pediatric acute care outcomes through lower outcome rates.
Participants: A total of 216 pediatric units from 94 hospitals were included in the study.
Individual units were placed into groups for analysis: critical care (n=33, 15.3%), acute care (n =
89, 41.2%), neonatal (n = 75, 34.7%), and mixed (n = 19, 8.9%). Study Method: Secondary data
analysis of cross-sectional data was used for 2019 calendar year of the National Database of
Nursing Quality Indicators (NDNQI). Purposive sampling was used for pediatric units that
participated in NDNQI submitted data and utilized the PES-NWI. The NDNQI provides a
national repository which allows hospitals to confidentially compare nursing sensitive indicators
at the unit level to similar units across the country. Findings: Significant associations were
decreased Falls with RN Staffing (B = -.201, p = .012) in the acute care group, Collegial Nurse-
Physician Relations (B = -4.317, p = <.001) in the neonatal group, Collegial Nurse-Physician
Relations (B = -1.674 p = .028) in the pediatric units; decreased HAPI with Total Staffing
Categories (B = -1.038, p = .003) and RN Staffing Categories (B = -1.018, p = .003).
Conclusions: This study provides broader understanding of the association of the nurse practice
environment, nurse staffing, and pediatric acute care outcomes.