Study links pandemic stress to persistent increases in nursing-sensitive quality indicators

Editor's Note

A study analyzing data from the National Database of Nursing Quality Indicators (NDNQI) revealed that nursing-sensitive quality indicators (NSIs) worsened during the COVID-19 pandemic and remain elevated years after the onset of the pandemic, reflecting ongoing challenges in nursing practice. Published in the journal Nursing Research, the findings highlight the enduring impact of pandemic stress on nursing care and patient outcomes even as NSIs return to baseline.

Researchers assessed annual trends for five NSIs—falls, central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), hospital-acquired pressure injuries (HAPI), and ventilator-associated events (VAE)—from 2019 through 2022. Data were drawn from over 24,000 nursing units in 2,346 hospitals, encompassing medical-surgical and critical care units. Key findings include:

• NSI rates rose significantly starting in 2020, peaking in 2020 for falls and in 2021 for other indicators. Increases ranged from 12% (CAUTI) to 49% (CLABSI in critical care).
• Rates for all NSIs improved in 2022 compared to their peaks but remained above 2019 levels.
• Critical care units saw greater increases in VAEs and HAPIs, reflecting higher patient acuity during the pandemic.
• Falls and HAPIs showed greater variability across unit types, while CAUTI and CLABSI remained more stable.

Researchers write that the findings underscore the critical role of nursing in preventing adverse events. Hospitals must prioritize nurse staffing, enhance surveillance protocols, and adopt innovative care models to support nursing practice and mitigate future disruptions. Further research is needed to explore the relationship between nurse staffing levels and NSIs, the efficacy of nurse-driven protocols in reducing NSIs, and the influence of patient acuity and adherence to prevention strategies on NSI trends.