Document Type

DNP Project


School of Nursing

Date of Degree

Spring 2018


Doctor of Nursing Practice (DNP)

Primary Advisor

Jean Johnson, PhD, RN, FAAN; Jacqueline A. Payne-Borden, PhD, RN, PMHCNS-BC


Background: An incorporation of licensed practical nurses (LPNs) in the RN staffing mix was made in a small community hospital. Research shows that RNs at the bedside equates to less adverse patient outcomes such as falls, pressure ulcers and an increase on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

Objectives: To evaluate the effects of incorporating LPNs in the staffing mix on the number of patient falls, pressure ulcers and HCAHPS survey results.

Methods: A Pre and Post study design was used to compare baseline data obtained four months prior to implementing and four months during the implementation of LPNs into the staffing mix on falls, pressure ulcers and HCAHPS results.

Results: The relationship between nursing staff skill mix and the frequency of patient falls were significant, X²(1, N=1339) =5.176, p= 0.023. There was no relationship between the nursing staff skill mix and pressure ulcer development. The staff skill mix was independent from patient’s opinion in each of the four survey questions. The overall staff to patient mean ratio was slightly higher for the RN and LPN skill mix (M = 6.77, SD =0.217) than for the RN-only staff (M = 6.2, SD =0.255). A Z-test for two sample means revealed a statistically significant difference between the staffing skill mix during the months with the staffing changes (p = 0.001)

Conclusions: The findings of this research project support a nursing skill mix that is predominantly RNs for the acute care setting

Open Access




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