NDNQI Indicators

Below is a list of the current indicators that are being monitored:

1. Nursing hours per patient day (RNs hours to patient day, LPN/LVN hours per patient day, UAP hours per patient day)

2. Nursing Turnover

3. Nosocomial Infections

4. Patient Falls

5. Patient Falls with injury (Injury level)

6. Pressure Ulcer Rate (Community-acquired, Hospital-acquired, Unit-acquired)

7. Pediatric Pain Assessment, Intervention, Reassessment (AIR) cycle

8. Pediatric Peripheral Intravenous Infiltration

9. Psychiatric Physical/Sexual Assault

10. RN Education/Certification

11. RN Survey (Job satisfaction, Practice Environment Scale (PES)

12. Restraints

13. Staff mix (RN, LPN?LVNs, UAP, Percent Agency Staff)


Are any of these indicators currently being monitored at your facility where you work? Do you believe there are additioanl indicators that need to be added to the list? If so, which ones?

Information about the NDNQI Project

The requirements to be a participant in the NDNQI project requires membership with NDNQI. An application for membership has to be completed. Once the application is accepted, a database agreement or contract along with a fee is required before enrollment into the project can be complete. The fee allows for the facility to submit data and recieve reports on a quaterly basis. A survey for RNs is offered annually. The fee associated with membership ranges from $1500 for hospitals with 25 beds or less up to $7000 for hospitals with 500 beds or greater. There are discounts offered for Magnet hospitals, member of a group that is affiliated with 10 or more facilities and multi-year membership. The complete process from application to activation is 30-45 days. There are currently over 1,100 hospitals in the United States participating in the project.
With all the challenges with patient safety and qualtiy patient care, data is crucial in improving health care. One might wonder if more hospitals would participate in the project if the fee was lower. What do you think?

Quality of Nursing Care and Unsafe Working Environments

Unsafe work environments of nurses effect the qualtiy of care given to patients. The NDNQI developed indicators to assist in measuring the quality of nursing care. Among this indicators are nursing turnover, job satisfaction, and staff mix. These specific indicators can pose a threat to patient safety. Working long hours and mutiple shifts in a row increase the chance of errors and negative patient outcomes. Due to the nursing shortage, nurses are working shifts in excess of 12 hours. "Prolonged periods of wakefulness (17 hours without sleep) can produce performance decrements equilvalent to a blood alcohol concentration of 0.05 percent (Dawson and Reid, 1997; Lamond and Dawson, 1998)" (Page, 2004). I found this to be very interesting. There have been many times that I have worked longer than 12 hours and could hardly stay awake driving home. This was not only due to the number of hours but also to physical and mental demands of the job.
Staffing mix also poses a threat to patient safety. Inadequate licensed staff reduces the time the nurse spends with each patient. Job satisfaction is related to the working environment. Working in an unsafe environment causes a decrease in job satisfaction which in turns causes an increase in turnover rate. It is a domino effect. What types of working environments have you experienced?

RN Education/Certification

The National Database for Nursing Qualtiy Indicators currently collects data related to RN Education/Certification and the outcomes of nursing care. According to the Dunton (2008), "certificatiion is a measure of nursing specialty knowledge, skills and experience."The lastest research that was done by the NDNQI showed there is a decrease in patient falls on units where there is a higher percent of RNs who are certified. I had the assumption that there was not any difference in a nurse with an Associate Degree and one with Bachelor Degree. After starting back to school for my BSN, I no longer have that assumption. I definitely believe the nurse after receiving the BSN has a greater potential to be leader and has the abiltiy to critically think when it comes to complex situations. Do you agree? What differences do you see between an AD nurse and a BSN nurse?

Challenges with Nursing Quality

Evaluating the quality of nursing care started with Florence Nightingale. In 1998, the American Nurses Association established the first nursing quality measurement program called The National Database of Nursing Quality Indicators (NDNQI). This program was developed to continue improving the quality of nursing care. During the last few years, NDNQI has submitted to the National Quality Forum (NGF) a list of nursing indicators which reflect staffing, nursing process and patient outcomes. The NDNQI collects and monitors data from participating hospitals and provides that data in order to help improve the relationship of patient care to outcomes. One of the latest researches by the NDNQI deals with how staffing and job satisfaction impacts patient outcomes. Do you believe that patient outcomes are effected by nursing care? If so, why? What are some of the staffing issues you believe to have an impact on patient outcomes?