NDNQI Nursing-Sensitive Indicators

Nursing-sensitive indicators reflect the structure, process, and patient outcomes of nursing care.
  • Structure - supply of nursing staff, skill level of staff, and education of staff
  • Process - assessment, intervention, and job satisfaction
  • Outcomes - patient outcomes that improve if there is greater quantity and quality of nursing care

How are Nursing-Sensitive Indicators Developed?

  • A potential indicator is identified that reflects nursing care and is not represented by a current indicator
  • A literature review is performed
  • If the indicator is supported by empirical evidence, it is sent to a panel of nursing experts
  • These experts determine the validity of the potential indicator in nursing practice
  • Once validity is determined, the panel asks participating facilities if data collection will place undue burden on the delivery of quality patient care
  • Once the potential indicator has been empirically supported to be meaningful in clinical practice and it has been determined that no undue burden would be placed on participating facilities, a pilot study is performed in willing facilities
  • Data collection methods are revised based on pilot study
  • Those indicators that are of most value for the effort are added to the NDNQI list and measured

List of Indicators

  • Nursing Hours per Patient Day - Structure
    • Registered Nurses (RN) Hours per Patient Day
    • Licensed Practical/Vocational Nurses (LPN/LVN) Hours per Patient Day
    • Unlicensed Assistive (UAP) Hours per Patient Day
  • Nursing Turnover Rate - Structure
  • Nosocomial Infections - Outcome
  • Patient Falls - Process and Outcome 
  • Patient Falls with Injury - Process and Outcome 
    • Injury Level
  • Pressure Ulcer Rate - Process and Outcome
    • Community-acquired
    • Hospital-acquired
    • Unit-acquired
  • Pediatric Pain Assessment, Intervention, Reassessment (AIR) Cycle - Process
  • Pediatric Peripheral Intravenous Infiltration - Outcome
  • Psychiatric Physical/Sexual Assault - Outcome
  • RN Education/Certification - Structure
  • RN Survey - Process and Outcome
    • Job Satisfaction Scales
    • Practice Environment Scale (PES) 
  • Restraints - Outcome
  • Staff Mix - Structure
    • RN
    • LPN/LVNs
    • UAP
    • Percent Agency Staff

(ANA, 2010; Gallagher & Rowell, 2003; Montalvo, 2007; NDNQI, 2010a)