Ensuring an adequate number of RNs among a unit's nursing staff may reduce the use of physical restraints in hospitalized patients, a recent study shows. Restraints, such as belts, mittens, vests, and bed rails, are commonly used to protect patients from falls or prevent them from removing needed medical equipment. But they aren't without risk, since patients whose movement is limited can become upset, agitated, and confused. Moreover, restraint use has been associated with deconditioning, pressure ulcers, and, in rare cases, strangulation and death.

Researchers undertook their study with two hypotheses: that restraint use might reflect a need to ensure patient safety when staffing is inadequate, and that it might vary according to the number or skill level of nurses on duty.

Using a national nursing database, the researchers obtained data about restraint use and nurse staffing on 3,101 medical, surgical, and medical-surgical units in 869 U.S. hospitals over 17 quarters, from October 2006 through December 2010. Information regarding patient restraint came from quarterly surveys on the total number of patients restrained. Nurse staffing information included total monthly hours worked by RNs, licensed practical/vocational nurses, and other assistive personnel on the unit.

The use of restraints each quarter was analyzed alongside the staffing level (total nursing hours per patient day) and skill mix (the proportion of nursing hours provided by RNs) during the same time period to determine whether differences in staffing were related to the number of patients restrained. Restraint rates were highest in quarters where the staffing level or skill mix was below the unit's average. The finding that restraint use increased with lower skill mix was statistically significant. Staffing level overall didn't have a statistically significant effect on restraint use.

The presence of an adequate number of RNs on the unit appears to decrease restraint use. The authors note that the mix of nursing skills appears key; simply increasing non-RN hours may not optimize patient safety and care when patient volume or nursing need fluctuates.-Joan Zolot, PA

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