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Research papers on Nurse staffing and patient outcomes

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  1. Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction

    Linda H. Aiken · 2002 · JAMA · 5,214 citations

    CONTEXT: The worsening hospital nurse shortage and recent California legislation mandating minimum hospital patient-to-nurse ratios demand an understanding of how nurse staffing levels affect patient outcomes and nurse retention in hospital practice. OBJECTIVE: To determine the association between the patient-to-nurse ratio and patient mortality, failure-to-rescue (deaths following complications) among surgical patients, and factors related to nurse retention. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analyses of linked data from 10 184 staff nurses surveyed, 232 342 general, orthopedic, and vascular surgery patients discharged from the hospital between April 1, 1998, and November 3

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  2. The Association of Registered Nurse Staffing Levels and Patient Outcomes

    Robert L Kane, Tatyana Shamliyan, Christine Mueller, et al. · 2007 · Medical Care · 1,201 citations

    OBJECTIVE: To examine the association between registered nurse (RN) staffing and patient outcomes in acute care hospitals. STUDY SELECTION: Twenty-eight studies reported adjusted odds ratios of patient outcomes in categories of RN-to-patient ratio, and met inclusion criteria. Information was abstracted using a standardized protocol. DATA SYNTHESIS: Random effects models assessed heterogeneity and pooled data from individual studies. Increased RN staffing was associated with lower hospital related mortality in intensive care units (ICUs) [odds ratios (OR), 0.91; 95% confidence interval (CI), 0.86-0.96], in surgical (OR, 0.84; 95% CI, 0.80-0.89), and in medical patients (OR, 0.94; 95% CI, 0.94

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  3. Nurse???Patient Ratios

    Thomas A. Lang, Margaret Blakeman Hodge, Valerie Olson, et al. · 2004 · JONA The Journal of Nursing Administration · 429 citations

    OBJECTIVE: To determine whether the peer-reviewed literature supports specific, minimum nurse-patient ratios for acute care hospitals and whether nurse staffing is associated with patient, nurse employee, or hospital outcomes. BACKGROUND: Hospital care may be compromised by forces that have increased patient acuity, reduced the ratio of caregivers to patients, and lowered the level of training of these caregivers. METHODS: We systematically reviewed studies of the effects of nurse staffing on patient, nurse employee, and hospital outcomes published between 1980 and 2003 to determine whether they could guide the setting of minimum licensed nurse-patient ratios in acute care hospitals. RESULTS

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  4. Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals

    Matthew D. McHugh, Linda H. Aiken, Douglas M. Sloane, et al. · 2021 · The Lancet · 387 citations

    Summary Background Substantial evidence indicates that patient outcomes are more favourable in hospitals with better nurse staffing. One policy designed to achieve better staffing is minimum nurse-to-patient ratio mandates, but such policies have rarely been implemented or evaluated. In 2016, Queensland (Australia) implemented minimum nurse-to-patient ratios in selected hospitals. We aimed to assess the effects of this policy on staffing levels and patient outcomes and whether both were associated. Methods For this prospective panel study, we compared Queensland hospitals subject to the ratio policy (27 intervention hospitals) and those that discharged similar patients but were not subject t

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  5. Nurse staffing and patient outcomes in critical care: A concise review

    Daleen Penoyer · 2010 · Critical Care Medicine · 292 citations

    BACKGROUND: Studies over the past several decades have shown an association between nurse staffing and patient outcomes. Most of those studies were generated from general acute care units. Critically ill patients demand increased nurse staffing resources and nurses who have specialized knowledge and skills. Appropriate nurse staffing in critical care units may improve the quality of care of critically ill patients. OBJECTIVES: To review the literature evaluating the association of nurse staffing with patient outcomes in critical care units and populations. METHODS: An annotated review of major nursing and medical literature from 1998 to 2008 was performed to find research studies conducted i

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  6. Nurses' Work Schedule Characteristics, Nurse Staffing, and Patient Mortality

    Alison M. Trinkoff, Meg Johantgen, Carla L. Storr, et al. · 2010 · Nursing Research · 208 citations

    BACKGROUND: Although nurse staffing has been found to be related to patient mortality, there has been limited study of the independent effect of work schedules on patient care outcomes. OBJECTIVE: To determine if, in hospitals where nurses report more adverse work schedules, there would be increased patient mortality, controlling for staffing. METHODS: A cross-sectional design was used, with multilevel data from a 2004 survey of 633 nurses working in 71 acute nonfederal hospitals in North Carolina and Illinois. Mortality measures were the risk-adjusted Agency for Healthcare Research and Quality Inpatient Quality Indicators, and staffing data were from the American Hospital Association Annual

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  7. The Relationship Between Nurse Staffing and Patient Outcomes

    Thitinut Akkadechanunt, Cynthia C. Scalzi, Abbas F. Jawad · 2003 · JONA The Journal of Nursing Administration · 160 citations

    OBJECTIVES: To examine the association between in-hospital mortality and four nurse staffing variables-the ratio of total nursing staff to patients, the proportion of RNs to total nursing staff, the mean years of RN experience, and the percentage of nurses with bachelor of science in nursing degrees. BACKGROUND: Studies suggest that nurse staffing changes affect patient and organizational outcomes, but the impact of nurse staffing on patient outcomes has not been studied sufficiently and the results of the previous studies are equivocal. Additionally, the studies of the relationship between nurse staffing and patient outcomes or the impact of nurse staffing on patient outcomes had not been p

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  8. HOSPITAL NURSE STAFFING AND PATIENT OUTCOMES

    Linda H. Aiken, Consuelo Cerón, Marta Simonetti, et al. · 2018 · Revista Médica Clínica Las Condes · 124 citations

    RN4CAST-Chile builds upon two decades of global nursing outcomes research and the successful implementation of the RN4CAST study in 30 countries around the world to replicate this research for the first time in South America. Over 70 scientific papers in leading nursing and interdisciplinary journals have resulted just from the RN4CAST-EU study, making it the most productive study ever funded by the European Commission (www.rn4cast.eu). The results of this program of research have been influential in changing clinical practice, managerial policies, and governmental policies in many countries. Based upon the establishment of a link between lower patient to nurse ratios and better patient outc

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  9. Impact of California’s Licensed Nurse-Patient Ratios on Unit-Level Nurse Staffing and Patient Outcomes

    Nancy Donaldson, Linda Burnes Bolton, Carolyn Aydin, et al. · 2005 · Policy, Politics, & Nursing Practice · 103 citations

    This article presents the first analysis of the impact of mandated minimum-staffing ratios on nursing hours of care and skill mix in adult medical and surgical and definitive-observation units in a convenience sample of 68 acute hospitals participating in the California Nursing Outcomes Coalition project. Findings, stratified by unit type and hospital size, reveal expected changes as hospitals made observable efforts toward regulatory compliance. These data cannot affirm compliance with ratios per shift, per unit, at all times; however, they give evidence of overall compliance. Assessment of the impacts of the mandated ratios on two common indicators of patient care quality, the incidence of

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  10. Patient outcomes and cost savings associated with hospital safe nurse staffing legislation: an observational study

    K. Lasater, L. Aiken, D. Sloane, et al. · 2021 · BMJ Open · 99 citations

    Objective To evaluate variation in Illinois hospital nurse staffing ratios and to determine whether higher nurse workloads are associated with mortality and length of stay for patients, and cost outcomes for hospitals. Design Cross-sectional analysis of multiple data sources including a 2020 survey of nurses linked to patient outcomes data. Setting: 87 acute care hospitals in Illinois. Participants 210 493 Medicare patients, 65 years and older, who were hospitalised in a study hospital. 1391 registered nurses employed in direct patient care on a medical–surgical unit in a study hospital. Main outcome measures Primary outcomes were 30-day mortality and length of stay. Deaths avoided and cost

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  11. Evaluation of hospital nurse-to-patient staffing ratios and sepsis bundles on patient outcomes

    Karen B. Lasater, Douglas M. Sloane, Matthew D. McHugh, et al. · 2020 · American Journal of Infection Control · 80 citations

    BACKGROUND: Despite nurses' responsibilities in recognition and treatment of sepsis, little evidence documents whether patient-to-nurse staffing ratios are associated with clinical outcomes for patients with sepsis. METHODS: Using linked data sources from 2017 including MEDPAR patient claims, Hospital Compare, American Hospital Association, and a large survey of nurses, we estimate the effect of hospital patient-to-nurse staffing ratios and adherence to the Early Management Bundle for patients with Severe Sepsis/Septic Shock SEP-1 sepsis bundles on patients' odds of in-hospital and 60-day mortality, readmission, and length of stay. Logistic regression is used to estimate mortality and readmi

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  12. Will Mandated Minimum Nurse Staffing Ratios Lead to Better Patient Outcomes?

    Julie A. Sochalski, Rita Tamara Konetzka, Jingsan Zhu, et al. · 2008 · Medical Care · 73 citations

    BACKGROUND: Mandatory hospital nurse staffing ratios are under consideration in a number of states without strong empirical evidence of the optimal ratio. OBJECTIVE: To determine whether increases in medical-surgical licensed nurse staffing levels are associated with improvements in patient outcomes for hospitals having different baseline staffing levels. RESEARCH DESIGN: Cross-sectional and fixed-effects regression analyses using a 1993-2001 panel of patient and hospital data from California. Splines define 4 staffing ratios. SUBJECTS: Adult acute myocardial infarction (AMI) (n = 348,720) and surgical failure to rescue (FTR) (n = 109,066) patients discharged between 1993 and 2001 from 343 C

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  14. The Impact of Nurse–Patient Ratios on Patient Outcomes in Intensive Care Units

    Ashraf Elmdni · 2025 · Nursing in Critical Care · 16 citations

    Intensive care units (ICUs) are complex and fast‐paced environments where nurse‐to‐patient ratios significantly influence patient outcomes. Existing research highlights the relationship between staffing levels and outcomes such as mortality, hospital‐acquired infections, length of ICU stays, patient safety incidents, and nurse job satisfaction.

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  15. Minimum Nurse-to-Patient Ratios Improve Staffing, Patient Outcomes

    Karen Esther Rosenberg · 2021 · AJN American Journal of Nursing · 10 citations

    According to this study: Minimum nurse-to-patient staffing ratios not only improve nurse staffing and patient outcomes but also yield a good return on investment.Staffing improvements of one fewer patient per nurse led to improvements in mortality, readmissions, and length of stay.

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  16. Are minimum nurse-to-patient staffing ratios needed in hospitals? An observational study in British Columbia, Canada

    K. Lasater, Heather Brom, L. Aiken, et al. · 2025 · BMJ Open · 9 citations

    Objective To evaluate staffing conditions, patient outcomes, quality of care, patient safety and nurse job outcomes in British Columbia (BC), Canada hospitals. Design Cross-sectional study of 58 hospitals in BC with surveys of nurses and independent measures of patient outcomes. Setting 58 hospitals in BC. Participants 6685 hospital-based nurses working in a direct patient care role. Exposures Hospital-wide and unit-specific patient-to-nurse staffing ratios derived from registered nurse reports of how many patients and how many nurses were on their unit during their last shift worked. Main outcomes and measures Objective patient outcome measures included the Hospital Standardized Mortality R

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  17. Association of nurse staffing and unit occupancy with mortality and morbidity among very preterm infants: a multicentre study

    M. Beltempo, Sharina Patel, R. Platt, et al. · 2023 · Archives of Disease in Childhood · 9 citations

    Objective In a healthcare system with finite resources, hospital organisational factors may contribute to patient outcomes. We aimed to assess the association of nurse staffing and neonatal intensive care unit (NICU) occupancy with outcomes of preterm infants born <33 weeks’ gestation. Design Retrospective cohort study. Setting Four level III NICUs. Patients Infants born 23–32 weeks’ gestation 2015–2018. Main outcome measures Nursing provision ratios (nursing hours worked/recommended nursing hours based on patient acuity categories) and unit occupancy rates were averaged for the first shift, 24 hours and 7 days of admission of each infant. Primary outcome was mortality/morbidity (bronchopulm

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  18. The Relationship of Nurse and Physician Staffing in Intensive Care Units with Patient Outcomes in Postoperative Patients on Ventilators: An Analysis Using Korean National Health Insurance Data

    Yunmi Kim, Seon-Ha Kim · 2023 · Healthcare · 7 citations

    This study examined the associations of nurse and physician staffing in intensive care units (ICUs) with hospital-acquired pneumonia (HAP) incidence and in-hospital mortality in postoperative patients on ventilators. National Health Insurance claims data and death statistics were used to investigate the nurse staffing level and the presence or absence of a dedicated resident and specialist in each ICU. The participants were patients aged 20–85 who underwent any of 13 surgical procedures and were placed on a ventilator in the ICU after the procedure. Of 11,693 patients, 307 (2.6%) experienced HAP and 1280 (10.9%) died during hospitalization. Compared to hospitals with lower nurse-to-patient r

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  21. Nurse staffing skill mix and acuity-adjusted provision ratios in Swedish neonatal care: A cohort benchmark study

    Pernilla Dillner, K. Göransson, Mikael Norman, et al. · 2025 · International Journal of Nursing Studies Advances · 3 citations

    Background The development of neonatal intensive care has substantially reduced infant mortality, still, infants remain at high risk for adverse outcomes. Safe care relies on adequate nurse staffing and an appropriate skill mix, which is especially important in neonatal intensive care as infants are extremely vulnerable to harm when quality lapses occur. Although international guidelines recommend optimal nurse-to-patient ratios for neonatal care, these standards have not been fully implemented, leaving it unclear whether current staffing levels align with recommendations for safe staffing. Objective To benchmark the acuity-adjusted registered nurse staffing provision ratio in neonatal inten

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  22. Evaluating associations between patient-to-nurse ratios and mortality, process of care events and vital sign documentation on paediatric wards: a secondary analysis of data from the EPOCH cluster-randomised trial

    O. Gawronski, C. Parshuram, C. Cecchetti, et al. · 2024 · BMJ Open · 3 citations

    Objective To describe the associations between patient-to-nurse staffing ratios and rates of mortality, process of care events and vital sign documentation. Design Secondary analysis of data from the evaluating processes of care and outcomes of children in hospital (EPOCH) cluster-randomised trial. Setting 22 hospitals caring for children in Canada, Europe and New Zealand. Participants Eligible hospitalised patients were aged>37 weeks and <18 years. Primary and secondary outcome measures The primary outcome was all-cause hospital mortality. Secondary outcomes included five events reflecting the process of care, collected for all EPOCH patients; the frequency of documentation for each of eigh

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  24. The Impact of Nursing Staffing Levels on Patient Outcomes: A Systematic Review with Implications for Healthcare Policy and Practice

    Yashvi Gupta, D. Philip, Anusha Raj, et al. · 2024 · Asian Journal of Advanced Research and Reports · 2 citations

    Nursing staffing levels play a critical role in shaping patient outcomes across healthcare settings. This review synthesizes literature to explore the relationship between nursing staffing and patient safety, satisfaction, and clinical outcomes. Specific improvements associated with adequate staffing include reduced infection rates, lower mortality, and shorter recovery times. The review focuses on healthcare settings such as hospitals and long-term care facilities within regions like North America and Europe, providing a comprehensive understanding of global staffing practices. Key factors influencing staffing levels include financial constraints, regulatory requirements, and hospital polic

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