gms | German Medical Science

Background and Purpose: Activity-based funding systems (e.g. DRGs) have been introduced in healthcare systems internationally to finance hospital services and nursing is often under pressure because of decreasing patients’ length of stay, increasing acuity and cost containment measures. The Matching Registered Nurse Services with Changing Care Demands (MatchRN) study aims to examine how nursing processes and structures have changed since the introduction of SwissDRGs in 2012 and to describe their associations with patient and nurse outcomes.

Model/Framework: MatchRN is based on Donaldson’s contingency theory (2001) and Dubois et al.’s (2013) model of nursing care performance.

Research Focus: The MatchRN study is a multi-centre cross-sectional observational study, which included 124 units from 23 Swiss acute care hospitals where 1833 registered nurses (RNs) completed questionnaires assessing e.g. nurses’ work environment, rationing of nursing care, work schedule flexibility and organizational readiness for implementing change (ORIC). Furthermore, 2073 patients completed surveys measure, e.g. patient-centred care (PCC) and readiness for hospital discharge.

Methodological and Theoretical Focus: We applied Generalized Linear Mixed Models to describe the association between nurse structures and processes and different nurse and patient outcomes.

Results: Patients reported high levels of PCC, e.g. 82% received sufficient information. However, 1/3 did not felt sufficient involved in treatment decisions. Adequate work environment was associated with higher levels of PCC. Work schedule flexibility (β-.07; [95%-CI -.12, -.02]) and nurse manager ability (β-.34; [95%-CI -.57, -.11]) were negatively related to self-reported burnout. RNs responded positively on ORIC. Nursing foundation for quality of care (β 0.33 (95%-CI 0.08 - 0.58), β 0.32 (95%-CI 0.10 - 0.55)) and supportive leadership (β 0.40 (95%-CI 0.27 - 0.53), β 0.49 (95%-CI 0.37 - 0.61)) were directly associated with change efficacy and commitment. Less than half (47.8%) of patients were ready for hospital discharge and more than half (58%) of them had received discharge preparation interventions of self-care. From 2010 to 2015 the number of patients per RN decreased from 6.28 [95%-CIs: 6.07-6.48] to 5.58 [5.17-5.99], while the proportion of RNs of all nursing staff decreased by 4.3% [3.1-5.6]. Rationing of care decreased from 1.07 [1.03-1.12] to 0.91 [0.79-1.01] while staffing and resource adequacy increased by 0.12 [0.06-0.18].

Conclusions: Swiss hospitals expand nursing services under activity-based funding without disrupting the nursing work environment. An adequate nursing work environment increased the level of ORIC and work schedule flexibility lowered nurse-reported burnout. Nurses perception of staff and resource adequacy was associated with PCC. Discharge preparation intervention was associated with readiness for hospital discharge.

Programme Overview:

1.

Sharma: Organizational readiness for implementing change in acute care hospitals in Switzerland

2.

Dhaini: Work schedule flexibility influences burnout among registered nurses in Swiss hospitals

3.

Bachnick: Patient-Centered Care, Nurse Work Environment and Rationing of Nursing Care in Swiss Hospitals

4.

Mabire: Patient readiness for hospital discharge and its relationship with nursing interventions and organizational context

5.

Simon: Assessing the impact of the DRG introduction on nurse staffing and rationing of nursing care in Swiss acute-care hospitals