Utilization of nurse-sensitive indicators in nursing practice: A comparative qualitative study in German and U.S. hospitals
Abstract
Background Nurse-sensitive indicators represent data that can be used in a learning health system to systematically generate knowledge, identify opportunities to improve nursing practice and enhance patient care. Aim To analyze and compare the utilization of nurse-sensitive indicators in nursing practice between selected hospitals from Germany and the U.S. Method A qualitative study was conducted, comprising 17 semi-structured interviews with 19 nurses carried out from June to September 2025. Purposive sampling was applied, including nine participants from four hospitals in Germany that were part of the Magnet4Europe study, and ten participants from four U.S. Magnet® hospitals. The interview guide followed the cycles of a learning health system. Data were analyzed using qualitative content analysis according to Mayring. The reporting adhered to the standards for reporting qualitative research (SRQR). The study was not registered. Results Three themes and eight subthemes emerged. First, differences were observed in the scope of nurse-sensitive indicators collected, with interviewees from U.S. hospitals reporting a broader range and higher assessed documentation quality. Second, access to and internal structures of working with nurse-sensitive indicators differed between countries. Interviewees from U.S. hospitals described systematic data transparency, clinical roles for data analysis, and structured data discussions across all organizational levels. Interviewees from German hospitals reported sharing data internally with more restricted access, diverse analytical roles, and data discussions mainly within unit teams. All interviewees recognized opportunities to improve nursing care through trends and benchmarking, with U.S. hospitals placing a stronger emphasis on quantitative data and evidence-based practice. Third, interviewees from U.S. hospitals explained standardized evaluation and extensive recognition processes of success, while interviewees from German hospitals reported unstructured or absent evaluation processes and a need to strengthen recognition of achievements. Discussion A systematic utilization of nurse-sensitive indicators was demonstrated by the interviewees from U.S. hospitals, whereas interviewees from German hospitals reported a high divergence in their utilization, indicating potential to strengthen their use in the future. Further research is needed to identify enabling factors and barriers for integrating nurse-sensitive indicators into nursing practice.