Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)

Graduate Group


First Advisor

Matthew McHugh

Second Advisor

Linda Aiken


Depression is common among older surgical patients and increases their risk of adverse events, including complications, readmissions, and even death. Although recent initiatives have focused on the importance of ameliorating the negative effects of depression in hospitalized patients, little attention has focused on the relationship between depression and surgical patient outcomes and the critical role that the Registered Nurse (RN) workforce can play in improving these outcomes. The purpose of this study was to examine the relationship between depression and hospital nursing factors (the work environment, staffing, and education), and 30-day mortality, failure to rescue (FTR), and 30-day readmission. This study was a secondary analysis of observational data from 2006-2007 and employed three linked data sets: 1) The 2006-2007 Multi-State Nursing Care and Patient Safety Survey; 2) The 2006-2007 American Hospital Association (AHA) Annual Survey; and 3) Medicare claims data from 2006-2007, which included claims data for older adult patients, 65-90, who underwent general, orthopedic, or vascular surgery in acute care general hospitals in 2006-2007. The final sample included: 311,679 patients, 24,837 nurses, and 533 hospitals. Logistic regression models controlling for patient, hospital, and hospital nursing characteristics were employed to study the association between depression, hospital nursing factors, and 30-day mortality, FTR, and 30-day readmission. Logistic regression models including interactions between depression and hospital nursing factors were also assessed to analyze this relationship. It was found that an increase of the patient to nurse ratio above the median (5.2) was associated with a 1% increase in mortality in patients without depression and a 15% increase in mortality in patients with depression (p<0.05). Additionally, a 10% increase in the proportion of bachelors prepared nurses in a hospital was associated with a 4% decrease in mortality for patients without depression, but a 9% decrease in patients with depression (p<0.05). The focus on improving mental health care in the general hospital setting continues to grow in the context of the Affordable Care Act (ACA). Decreasing patient to nurse ratios and increasing the proportion of baccalaureate nurses are potential strategies to decrease surgical patient mortality in older adults with and without depression.

Included in

Nursing Commons