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Nurse Staffing and Quality of Patient Care
Evidence Reports/Technology Assessments, No. 151
Investigators: Robert L Kane, MD, Tatyana Shamliyan, MD, MS, Christine Mueller, PhD, RN, Sue Duval, PhD, and Timothy J Wilt, MD, MPH.
Structured Abstract
Objectives:
To assess how nurse to patient ratios and nurse work hours were associated with patient outcomes in acute care hospitals, factors that influence nurse staffing policies, and nurse staffing strategies that improved patient outcomes.
Data Sources:
MEDLINE® (PubMed®), CINAHL, Cochrane Databases, EBSCO research database, BioMed Central, Federal reports, National Database of Nursing Quality Indicators, National Center for Workforce Analysis, American Nurses Association, American Academy of Nurse Practitioners, and Digital Dissertations.
Review Methods:
In the absence of randomized controlled trials, observational studies were reviewed to examine the relationship between nurse staffing and outcomes. Meta-analysis tested the consistency of the association between nurse staffing and patient outcomes; classes of patient and hospital characteristics were analyzed separately.
Results:
Higher registered nurse staffing was associated with less hospital-related mortality, failure to rescue, cardiac arrest, hospital acquired pneumonia, and other adverse events. The effect of increased registered nurse staffing on patients safety was strong and consistent in intensive care units and in surgical patients. Greater registered nurse hours spent on direct patient care were associated with decreased risk of hospital-related death and shorter lengths of stay. Limited evidence suggests that the higher proportion of registered nurses with BSN degrees was associated with lower mortality and failure to rescue. More overtime hours were associated with an increase in hospital related mortality, nosocomial infections, shock, and bloodstream infections. No studies directly examined the factors that influence nurse staffing policy. Few studies addressed the role of agency staff. No studies evaluated the role of internationally educated nurse staffing policies.
Conclusions:
Increased nursing staffing in hospitals was associated with lower hospital-related mortality, failure to rescue, and other patient outcomes, but the association is not necessarily causal. The effect size varied with the nurse staffing measure, the reduction in relative risk was greater and more consistent across the studies, corresponding to an increased registered nurse to patient ratio but not hours and skill mix. Estimates of the size of the nursing effect must be tempered by provider characteristics including hospital commitment to high quality care not considered in most of the studies. Greater nurse staffing was associated with better outcomes in intensive care units and in surgical patients.
Contents
- Preface
- Acknowledgments
- Executive Summary
- 1. Introduction
- 2. Methods
- 3. Results
- Association Between Nursing Hours and Ratios and Patient Outcomes
- Question 1. Association Between Nurse to Patient Ratios and Hospital-Related Mortality
- Question 2. Association Between Nurse Hours per Patient Day and Patient Outcomes
- Question 3. What Factors Influence Nurse Staffing Policies?
- Question 4. Association Between Nurse Staffing Strategies and Patient Outcomes
- 4. Discussion
- List of Acronyms/Abbreviations
- Appendixes
- References and Included Studies
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-02-0009. Prepared by: Minnesota Evidence-based Practice Center, Minneapolis, Minnesota.
Suggested citation:
Kane RL, Shamliyan T, Mueller C, Duval S, Wilt T. Nursing Staffing and Quality of Patient Care. Evidence Report/Technology Assessment No. 151 (Prepared by the Minnesota Evidence-based Practice Center under Contract No. 290-02-0009.) AHRQ Publication No. 07-E005. Rockville, MD: Agency for Healthcare Research and Quality. March 2007.
No investigators have any affilications or financial involvement (e.g., employment, consultancies, honoraria, stock options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in this report.
This report is based on research conducted by the Minnesota Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0009). The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.
This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
- 1
540 Gaither Road, Rockville, MD 20850. www
.ahrq.gov
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- The relationship between nurse staffing and patient outcomes.[J Nurs Adm. 2003]The relationship between nurse staffing and patient outcomes.Sasichay-Akkadechanunt T, Scalzi CC, Jawad AF. J Nurs Adm. 2003 Sep; 33(9):478-85.
- Nurse Staffing and Quality of Patient CareNurse Staffing and Quality of Patient Care
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