Associations between rates of unassisted inpatient falls and levels of registered and non-registered nurse staffing

OBJECTIVE To enhance understanding of how nurse staffing relates to unassisted falls by exploring non-linear associations between unassisted fall rates and levels of registered nurse (RN) and non-RN staffing on 5 nursing unit types, thereby enabling managers to improve patient safety by making better-informed decisions about staffing. DESIGN Cross-sectional analysis of routinely collected data using hierarchical negative binomial regression. SETTING 8069 nursing units in 1361 U.S. hospitals participating in the National Database of Nursing Quality Indicators(®). Main outcome measure Rate of unassisted falls per inpatient day. RESULTS Associations between unassisted fall rates and nurse staffing varied by unit type. For medical-surgical units, higher RN staffing was weakly associated with lower fall rates. On step-down and medical units, the association between RN staffing and fall rates depended on the level of staffing: At lower staffing levels, the fall rate increased as staffing increased, but at moderate and high staffing levels, the fall rate decreased as staffing increased. Higher levels of non-RN staffing were generally associated with higher fall rates.. CONCLUSIONS Increasing non-RN staffing seems ineffective at preventing unassisted falls. Increasing RN staffing may be effective, depending on the unit type and the current level of staffing.