Nurse-sensitive quality indicators: A multicenter analysis

Nuran Ayşen Pamir Aksoy; Fatma Eti Aslan

doi:10.31067/acusaglik.1669100

Nurse-sensitive quality indicators: A multicenter analysis

Abstract

Purpose: The quality of nursing care is strongly related to patient safety and satisfaction. Although previous studies have reported various nurse-sensitive quality indicators, a gap still exists for some countries such as Türkiye regarding the definition and determination of the nurse-sensitive indicators, selecting the appropriate monitoring tools, the results, and using the results to enhance nursing practice. This study aimed to evaluate nurse-sensitive quality indicators and to explore the association between these indicators and nurse-staffing characteristics. Methods: This multicenter retrospective study presents data from 528 hospital-month units by investigating digital nursing reports across 15 hospitals in Turkey. Variables related to nurse staffing and nurse-sensitive quality indicators, including falls, thrombophlebitis, pressure ulcers, and patient satisfaction, were examined with descriptive analysis. Results: This study reveals that during the months with documented falls there were more patients and longer hospital stays but lower patient satisfaction. Conversely, during the months without thrombophlebitis, there were more nurses with higher education levels and higher patient satisfaction. Increased incidence of patients with thrombophlebitis was correlated with higher nurse-to-patient ratios. During the months with documented pressure ulcers, there were more patients and longer hospital stays. Conclusion: The findings of this study suggest that certain nurse-sensitive quality indicators such as falls, pressure ulcers, and thrombophlebitis are associated with the profile of the nurse workforce.

Keywords

Ethical Statement

The study protocol was approved by the Bahcesehir University Scientific Research and Publication Ethics Committee (Approval Date: November 27, 2019; session: 2019/10; approval number: 20021704-604.02)

Thanks

We would like to express our appreciation to Saliha Koç Aslan (Nursing Directorate of the hospitals) and all members of the administrative committees for their support during our study. We extend our sincere gratitude to Professor Meryem Yavuz Van Giersbergen for her significant contribution to the conceptual framework of our research through her extensive knowledge and experience. We would like to thank Enago English Editing Services, Expert Editing & Proofreading for the linguistic and grammatical editing of the manuscript.

References

1. Oner, B., Zengul, F. D., Oner, N, et al. Nursing-sensitive indicators for nursing care: A systematic review (1997-2017). Nurs Open, 2021;8(3):1005–1022. https://doi.org/10.1002/nop2.654
2. Gormley E, Connolly M, Ryder M. The development of nursingsensitive indicators: A critical discussion. Int J Nurs Stud Adv. 2024;7:100227. https://doi.org/10.1016/j.ijnsa.2024.100227
3. Bell L. Importance of metrics and nurse-sensitive indicators. J Crit Care: an official publication, American Association of Critical-Care Nurses, 2020;29(6):479. https://doi.org/10.4037/ajcc2020231
4. Hughes RG. Patient safety and quality: an evidence-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality. US: 2008
5. Institute of Medicine (IOM). Keeping patients safe: transforming the work environment of nurses. Washington (DC): National Academies Press (US):2004
6. Clarke SP, Donaldson NE. Nurse staffing and patient care quality and safety. In: Hughes RG, ed. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD Agency for Healthcare Research and Quality. US:2008
7. Juvé-Udina ME, Adamuz J, González-Samartino M, et al. Association Between Nurse Staffing Coverage and Patient Outcomes in a Context of Prepandemic Structural Understaffing: A Patient- Unit-Level Analysis. J Nurs Manag. 2025;8003569. https://doi. org.10.1155/jonm/8003569
8. Twigg DE, Kutzer Y, Jacob E, Seaman K. A quantitative systematic review of the association between nurse skill mix and nursingsensitive patient outcomes in the acute care setting. J Adv Nurs. 2019;75(12):3404-3423. https://doi.org/10.1111/jan.14194

9. McEvoy NL, Kalvas LB, Walsh K, and Curley MAQ. The identification and characterization of nurse-sensitive outcomes in acute and critical care: A systematic review. Nursing Outlook. 2025;73(2), 102379. https://doi.org/10.1016/j.outlook.2025.102379
10. Ward ST, Dimick JB, Zhang W, Campbell DA, Ghaferi AA. Association between hospital staffing models and failure to rescue. Ann Surg. 2019;270(1):91-94. https://doi.org/10.1097/ SLA.0000000000002744
11. Kim, C. G., and Bae, K. S. Relationship between nurse staffing level and adult nursing-sensitive outcomes in tertiary hospitals of Korea: Retrospective observational study. Int J Nurs Stud 2018;80:155– 164. https://doi.org/10.1016/j.ijnurstu.2018.01.001
12. Fogg C, Bridges J, Meredith P, et al. The association between ward staffing levels, mortality and hospital readmission in older hospitalised adults, according to presence of cognitive impairment: A retrospective cohort study. Age Ageing. 2021;50(2):431-439. https://doi.org/10.1093/ageing/afaa133
13. Aiken LH, Simonetti M, Sloane DM, et al. Hospital nurse staffing and patient outcomes in Chile: a multilevel cross-sectional study. Lancet Glob Health. 2021;9(8):e1145-e1153. https://doi.org/10.1016/ S2214-109X(21)00209-6
14. Griffiths, P., Recio-Saucedo, A., Dall’Ora, C., et al. The association between nurse staffing and omissions in nursing care: A systematic review. J Adv Nurs, 2018;74(7):1474–1487. https://doi.org/10.1111/ jan.13564
15. Audet LA, Bourgault P, Rochefort CM. Associations between nurse education and experience and the risk of mortality and adverse events in acute care hospitals: A systematic review of observational studies. Int J Nurs Stud. 2018;80:128-146. https://doi.org/10.1016/j. ijnurstu.2018.01.007
16. Gormley, E., Connolly, M., and Ryder, M. The development of nursing-sensitive indicators: A critical discussion. Int. J. Nurs. Stud. Adv. 2024;7,100227. https://doi.org/10.1016/j.ijnsa.2024.100227
17. Heng, S. Y., Yap, R. T., Tie, J., and McGrouther, D. A. Peripheral vein thrombophlebitis in the upper extremity: A systematic review of a frequent and ımportant problem. Am J Med, 2020;133(4):473–484 https://doi.org/10.1016/j.amjmed.2019.08.054
18. Garcia PC, Tronchin DMR, Fugulin FMT. Care time and quality indicators in Intensive Care Units. Rev Bras Enferm. 2019;72(suppl 1):166-172. https://doi.org/10.1590/0034-7167-2018-0067
19. Al-Ghraiybah T, Sim J, Lago L. The relationship between the nursing practice environment and five nursing-sensitive patient outcomes in acute care hospitals: A systematic review. Nurs Open. 2021;8(5):2262-2271. https://doi.org/10.1002/nop2.828
20. Liu, J., Zheng, J., Liu, K., and You, L. Relationship between work environments, nurse outcomes, and quality of care in ıcus: Mediating role of nursing care left undone. J Nurs Care Qual, 2019;34(3):250– 255. https://doi.org/10.1097/NCQ.0000000000000374
21. Bowden, V., Bradas, C., and McNett, M. Impact of level of nurse experience on falls in medical surgical units. J Nurs Manag 2019;27(4):833–839. https://doi.org/10.1111/jonm.12742
22. Danielis, M., Destrebecq, A. L. L., Terzoni, S., & Palese, A. Nursing care factors influencing patients’ outcomes in the intensive care unit: Findings from a rapid review. Int J Nurs Pract, 2022;28(2):e12962. https://doi.org/10.1111/ijn.12962
23. Wang L, Lu H, Dong X, et al. The effect of nurse staffing on patient-safety outcomes: A cross-sectional survey. J Nurs Manag. 2020;28(7):1758-1766. https://doi.org/10.1111/jonm.13138
24. Zadvinskis, I. M., Carr, J., Schweitzer, et al. (2019). The ımpact of nursing work and engagement on patient falls. J Nurs Adm, 2019;49(11):531–537. https://doi.org/10.1097/ NNA.0000000000000808
25. Gonçalves, I., Mendes, D. A., Caldeira, S., et al. The primary nursing care model and inpatients’ nursing-sensitive outcomes: A systematic review and narrative synthesis of quantitative studies. Int J Environ Res Public Health, 2023;20(3):2391. https://doi. org/10.3390/ijerph20032391
26. Koch, D., Kutz, A., Conca, A., et al. The relevance, feasibility and benchmarking of nursing quality indicators: A Delphi study. J Adv Nurs, 2020;76(12):3483–3494. https://doi.org/10.1111/jan.14560
27. Kemp, E., Trivitt, J., and Davis, C. Evidence-based performance ındicators of positive ınpatient experiences. J Healthc Manag, 2023;68(2):106–120. https://doi.org/10.1097/JHM-D-22-00147
28. Dall’Ora C, Saville C, Rubbo B, et al. Nurse staffing levels and patient outcomes: A systematic review of longitudinal studies. Int J Nurs Stud. 2022;134:104311. https://doi.org/10.1016/j. ijnurstu.2022.10431
29. The Organisation for Economic Co-operation and Development (OECD). OECD.Stat, Healthcare Quality Indicators. https://stats. oecd.org/Index.aspx?DataSetCode=HEALTH_HCQI# (Accessed March 5, 2025).

Details

Primary Language

English

Subjects

Nursing Workforce , Nursing (Other)

Journal Section

Research Article

Authors

Nuran Ayşen Pamir Aksoy ^*
0000-0002-0073-6267
Türkiye

Fatma Eti Aslan
0000-0003-0965-1443
Türkiye

Early Pub Date

September 15, 2025

Publication Date

October 1, 2025

Submission Date

April 2, 2025

Acceptance Date

May 29, 2025

Published in Issue

Year 2025 Volume: 16 Number: 4

DOI

https://doi.org/10.31067/acusaglik.1669100

IZ

https://izlik.org/JA44MD34AP

Cite

RIS / Bibtex

EndNote

Pamir Aksoy NA, Eti Aslan F (October 1, 2025) Nurse-sensitive quality indicators: A multicenter analysis. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 16 4 575–583.