ORCID
https://orcid.org/0009-0007-9170-380X
Language
English (en)
Date of Award
5-15-2026
Degree Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Chair and Committee
Po-Yin Yen
Committee Members
Su-Hsin Chang, Marilyn Schallom, Kathryn Connell, Olawunmi Obisesan
Abstract
Background: Recent reports indicated that medication errors contributed to 10% of preventable harm among hospitalized patients with over half occurring during the administration stage. Despite emerging research using EHR data to examine care processes and clinical outcomes, limited studies have integrated objective and subjective nursing staffing measures to evaluate how nursing staffing levels could be associated with delays in care delivery.
Method: A parallel convergent mixed-methods study was conducted in four adult medical-surgical units at a Midwestern Academic Medical Center from January 1 – March 31, 2025. Quantitative data of insulin and IV antibiotic administration records, laboratory results, and nurse staffing, were extracted daily from the EHR and electronic staffing system, respectively. Descriptive statistics and multivariable mixed-effect logistic regression model were performed to examine staffing factors associated with delayed medication administration. Interaction between nursing staffing factors and other variables was tested. Qualitative data were obtained from one-on-one interviews with bedside nurses to explore their perspectives on staffing-related factors. Interview data were analyzed using inductive-deductive thematic analysis.
Results: 27% (n=1314) Insulin and 23.6% (n=777) IV antibiotics had delayed administration. Significant association between nursing staffing levels and delayed administration of these time-critical medications were found to be varied by nurses’ years of experience, employment status and the shift in which the medication was administered. A higher risk of delayed was observed among nurses with fewer years of experience and travel nurses. Subsequently, these time-critical medications had increased risk of delays when they were administered during 7am-3pm shift due to higher care demands. These findings were further confirmed through interviews, in which nurses described challenges related to care coordination and the need to prioritize multiple time-sensitive care tasks during high-intensity periods.
Conclusions: These findings highlight the importance of a well-balanced team composition and intradepartmental care coordination to prevent delayed administration of time-critical medications.
DOI
https://doi.org/10.48765/z7xv-3w82
Recommended Citation
Rachman, Mikie Desyana, "Examining the Association of Nurse Staffing Levels with Delayed Antibiotic and Insulin Administration: A Mixed Methods Study" (2026). WUSM Theses and Dissertations – All Programs. 55.
https://digitalcommons.wustl.edu/all_etd/55
