The Association between Nursing Skill Mix and Mortality for Adult Medical and Surgical Patients: Protocol for a Systematic Review.

Skill mix refers to the number and educational experience of nurses working in clinical settings. Authors have used several measures to determine the skill mix, which includes nurse-to-patient ratio and the proportion of baccalaureate-prepared nurses. Observational studies have tested the association between nursing skill mix and patient outcomes (mortality). To date, this body of research has not been subject to systematic review or meta-analysis. The aim of this study is to systematically review and meta-analyse observational and experimental research that tests the association between nursing skill mix and patient mortality in medical and surgical settings. We will search four key electronic databases-MEDLINE [OVID], EMBASE [OVID], CINAHL [EBSCOhost], and ProQuest Central (five databases)-from inception. Title, abstract, and full-text screening will be undertaken independently by at least two researchers using COVIDENCE review management software. We will include studies where the authors report an association between nursing skill mix and outcomes in adult medical and surgical inpatients. Extracted data from included studies will consist measures of nursing skill mix and inpatient mortality outcomes. A meta-analysis will be undertaken if there are at least two studies with similar designs, exposures, and outcomes. The findings will inform future research and workforce planning in health systems internationally.

The Association between the Mental Health Nurse-to-Registered Nurse Ratio and Patient Outcomes in Psychiatric Inpatient Wards: A Systematic Review.

Nursing skill mix in inpatient mental health wards varies considerably between countries. Some countries have an all-registered mental health nurse workforce; others have a mix of registered mental health and registered nurses. Understanding the optimal nursing skill mix in mental health inpatient units would inform service planning. This report aims to examine the association between the registered mental health nurse-to-registered nurse ratio and psychiatric readmission (or referral to community crisis services) in adult mental health inpatients. A systematic review was performed. We searched key databases for observational and experimental studies. Two researchers completed title-and-abstract and full-text screening. Our search identified 7956 citations. A full-text review of four papers was undertaken. No studies met our inclusion criteria. We report an empty review. Despite the obvious importance of the research question for the safe staffing of inpatient mental health services, there are no studies that have tested this association.

The association between mental health nurse to registered nurse ratio and patient outcomes in psychiatric inpatient wards: Protocol for a systematic review.

WHAT IS KNOWN ON THE SUBJECT?: Nursing skill mix research has primarily focused on medical and surgical patients. The association between nursing skill mix and clinical outcomes for psychiatric inpatients has not been adequately explored. No systematic reviews have been reported that have examined the association between the ratio of mental health to registered nurses and patient outcomes. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Our protocol sets out, in detail, the methods we intend to follow to ensure that this review is conducted and reported to the highest possible standards. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The review will summarize evidence about safe staffing in mental health inpatient units internationally. The review will inform health policy and planning of health services. ABSTRACT: Aim To assess the association between mental health nurse to comprehensive/general nurse ratio and relapse-determined by hospital admission-in adult psychiatric inpatients. Background information There is considerable variation in psychiatric inpatient nursing skill mix internationally. In most countries, wards are typically staffed by a mix of mental health and comprehensive/general nurses. To date, there have been no systematic reviews that have examined the association between the ratio of mental health to registered nurses and patient outcomes. Method We will systematically search five databases. Risk of bias will be determined using the Effective Public Health Practice Project Quality Assessment Tool. A meta-analysis will be undertaken if there are at least two similar studies. Results For included studies, we will produce table summarizing risk of bias and extracted data. If we are able to undertake a meta-analysis, this will be reported as a forest plot. Discussion This paper sets out a detailed plan for a systematic review of mental health nurse skill mix research. Implications for practice High-quality evidence about the association between nursing skill mix and patient outcomes is important to inform the planning of mental health services internationally.