Lang, T. A., M. Hodge, V. Olson, P.S. Romano, R. L Kravitz. 2004. Nurse-patient ratios: A systematic review on the effects of nurse staffing on patient, nurse employee, and hospital outcomes. Journal of Nursing Administration, 34(7–8), 326–37. urse employee, and hospital outcomes (original) (raw)
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Journal of Nursing Management, 2019
Aims: To evaluate and summarize current evidence on the relationship between the patient-nurse ratio staffing method and nurse employee outcomes. Background: Evidence-based decision-making linking nurse staffing with staff-related outcomes is a much needed research area. Although multiple studies have investigated this phenomenon, the evidence is mixed and fragmented. Evaluation: A systematic literature search was conducted using PubMed, Embase, Web of Science, Cinahl, Cochrane Library and the ERIC databases. Thirty studies were identified, analysing eight selected key nurse outcomes. Key issue(s): Future research should focus on unit-level data, incorporate other methodologies and aim for comparability between different types of clinical settings as well as different health care systems. Conclusion: A relationship between the patient-nurse ratio and specific staff-related outcomes is confirmed by various studies. However, apart from the patient-nurse ratio other variables have to be taken into consideration to ensure quality of care (e.g., skill mix, the work environment and patient acuity). Implications for Nursing Management: Hospital management should pursue the access and use of reliable data so that the validity and generalizability of evidencebased research can be assessed, which in turn can be converted into policy guidelines.
Systematic review of the evidence related to mandated nurse staffing ratios in acute hospitals
Australian health review : a publication of the Australian Hospital Association, 2018
The purpose of this systematic review was to evaluate and summarise available research on nurse staffing methods and relate these to outcomes under three overarching themes of: (1) management of clinical risk, quality and safety; (2) development of a new or innovative staffing methodology; and (3) equity of nursing workload. The PRISMA method was used. Relevant articles were located by searching via the Griffith University Library electronic catalogue, including articles on PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Medline. Only English language publications published between 1 January 2010 and 30 April 2016 focusing on methodologies in acute hospital in-patient units were included in the present review. Two of the four staffing methods were found to have evidenced-based articles from empirical studies within the parameters set for inclusion. Of the four staffing methodologies searched, supply and demand returned 10 studies and staffing ratios ret...
Nurse staffing and patient outcomes in critical care: A concise review
Critical Care Medicine, 2010
A t the conclusion of this CME activity, participants should be able to measure nurse staffing ratios in their intensive care unit (ICU) and use this information to improve patient outcomes. Determining the right number and characteristics of nurses needed to meet patient needs has been a topic of interest because of limited resources, financial constraints, and the nursing shortage. California was the first state in the United States to mandate nurse-to-patient-ratios in 2004, and other states are considering adopting similar mandates. California's mandates for staffing were over a variety of hospital nursing settings. However, results from a study 2 yrs after regulation in California indicated that although this mandate did result in an increased licensed nurse staffing, an improvement in patient outcomes was not found in medical-surgical and step-down units. The anticipated decreases in two key nursing-sensitive outcomes, falls or prevalence of hospital-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 in intensive care units or critical care populations where nurse staffing and patient outcomes were addressed. Results: Twenty-six studies met inclusion for this review. Most were observational studies in which outcomes were retrieved from existing large databases. There was variation in the measurement of nurse staffing and outcomes. Outcomes most frequently studied were infections, mortality, postoperative complications, and unplanned extubation. Most studies suggested that decreased nurse staffing is associated with adverse outcomes in intensive care unit patients. Conclusions: Findings from this review demonstrate an association of nurse staffing in the intensive care unit with patient outcomes and are consistent with findings in studies of the general acute care population. A better understanding of nurse staffing needs for intensive care unit patients is important to key stakeholders when making decisions about provision of nurse resources. Additional research is necessary to demonstrate the optimal nurse staffing ratios of intensive care units. (Crit Care Med 2010; 38:1521-1528) KEY WORDS: nursing staff; hospital; outcome and process assessment; intensive care unit; critical care; personnel staffing and scheduling; hospital mortality; postoperative complications; nursing workload LEARNING OBJECTIVES After participating in this educational activity, the participant should be better able to: 1. Measure nurse staffing ratios. 2. Evaluate impact of nurse staffing in intensive care unit on intensive care unit outcomes.
Medical care, 2007
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 -0.96͔, in surgical (OR, 0.84; 95% CI, 0.80 -0.89), and in medical patients (OR, 0.94; 95% CI, 0.94 -0.95) per additional full time equivalent per patient day. An increase by 1 RN per patient day was associated with a decreased odds ratio of hospital acquired pneumonia (OR, 0.70; 95% CI, 0.56 -0.88), unplanned extubation (OR, 0.49; 95% CI, 0.36 -0.67), respiratory failure (OR, 0.40; 95% CI, 0.27-0.59), and cardiac arrest (OR, 0.72; 95% CI, 0.62-0.84) in ICUs, with a lower risk of failure to rescue (OR, 0.84; 95% CI, 0.79 -0.90) in surgical patients. Length of stay was shorter by 24% in ICUs (OR, 0.76; 95% CI, 0.62-0.94) and by 31% in surgical patients (OR, 0.69; 95% CI, 0.55-0.86). Conclusions: Studies with different design show associations between increased RN staffing and lower odds of hospital related mortality and adverse patient events. Patient and hospital characteristics, including hospitals' commitment to quality of medical care, likely contribute to the actual causal pathway.
Nurse Staffing and Patient Outcomes (Articles)
2000
Background: Nursing studies have shown that nursing care delivery changes affect staff and organizational outcomes, but the effects on client outcomes have not been studied sufficiently. Objective: To describe, at the level of the nursing care unit, the relationships among total hours of nursing care, registered nurse (RN) skill mix, and adverse patient outcomes. Methods: The adverse outcomes included unit rates of medication errors, patient falls, skin breakdown, patient and family complaints, infections, and deaths. The correlations among staffing variables and outcome variables were determined, and multivariate analyses, controlling for patient acuity, were completed. Results: Units with higher average patient acuity had lower rates of medication errors and patient falls but higher rates of the other adverse outcomes. With average patient acuity on the unit controlled, the proportion of hours of care delivered by RNs was inversely related to the unit rates of medication errors, decubiti, and patient complaints. Total hours of care from all nursing personnel were associated directly with the rates of
European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, 2017
Nurses are pivotal in the provision of high quality care in acute hospitals. However, the optimal dosing of the number of nurses caring for patients remains elusive. In light of this, an updated review of the evidence on the effect of nurse staffing levels on patient outcomes is required. To undertake a systematic review and meta-analysis examining the association between nurse staffing levels and nurse-sensitive patient outcomes in acute specialist units. Five electronic databases were searched for English articles published between 2006 and 2017. The primary outcomes were nurse-sensitive patient outcomes. Of 3429 unique articles identified, 35 met the inclusion criteria. All were cross-sectional and the majority utilised large administrative databases. Higher staffing levels were associated with reduced mortality, medication errors, ulcers, restraint use, infections, pneumonia, higher aspirin use and a greater number of patients receiving percutaneous coronary intervention within ...