The effect of skill level differentiation between vocational and bachelor trained nurses, on the incidence of pressure ulcers, malnutrition and delirium risk: a before and after study.

Abstract

Background: Providing and ensuring quality of care is increasingly challenging because of the growing complexity of healthcare needs. An upcoming reform in the Individual Healthcare Professions Act (wet BIG) about differentiation of professional levels of nursing, has driven many initiatives to implement skill level differentiation in healthcare organizations in the Netherlands. However, the effect of skill level differentiation has not been widely evaluated. Aim: To assess the effect of skill level differentiation between vocational and bachelor trained nurses, on the incidence of pressure ulcers, malnutrition, and delirium risk in adult patients admitted to a general hospital in the Netherlands. Methods: A before and after study has been performed in a general hospital. Clinical registered data of 3347 patients admitted during Jan-Mar and Oct-Dec 2017 and data of 108 registered nurses, who worked during these periods at five general wards with implementation of skill level differentiation, were extracted from the hospital management system. Multiple linear regression models were used to test the effect of skill level differentiation on the incidences of pressure ulcers, malnutrition and delirium risk. Results: Skill level differentiation has effect on the incidence of malnutrition with a decrease of 2.4% and on the incidence of delirium risk with a decrease of 14.1%. For pressure ulcers an increase of 0.4% on the incidence was found. Conclusion: There is a significant effect of skill level differentiation on the incidence of pressure ulcers, malnutrition and delirium risk. However, findings of this study are hardly generalizable to a larger population of vocational and bachelor trained nurses because of limitations of registered clinical data and small sample size of screened patients. Recommendation: More awareness is needed for registration of data at patient level, personnel level and ward level. These data can be an important source for improving the quality of nursing care.