Select Research Summaries on Nurse Staffing and Patient Outcomes Literature
First Author,
Year & Source
Blegan (2006)
Annual Review
of Nursing
Research
24:103-125
Title
Study Design
Findings
Patient Safety in
Hospital Acute
Care Units
The paper reviews the results of
research studies concerning patient
safety in acute care hospitals and
nurse staffing published during the
years (1996-2005) describing the level
of analysis, measures of nurse staffing
and patient outcomes.
Kane RL (2007)
Medical Care,
45:1195-1204
The Association of
Registered Nurse
Staffing Levels
and Patient
Outcomes:
Systematic
Review and Metaanalysis.
Nurse Staffing and
Patient Care
Quality and
Safety. In: Hughes
RG, editor. Patient
Safety and
Quality: An
Evidence-Based
Handbook for
Nurses.
Nurse Staffing and
Patient, Nurse and
Financial
Outcomes
Meta-analysis; reviewed 96 articles
and identified 28 studies reporting
adjusted odds ratios of the patient
outcomes. The authors evaluated the
quality of the studies and estimated the
internal validity of the observational
studies according to adjustments for
confounding factors.
The review summarizes and discusses
the state of the science examining the
impact of nurse staffing in hospitals
and other health care organizations on
patient care quality, as well as safetyfocused outcomes. To address some
of the inconsistencies and limitations in
existing studies, design issues and
limitations of current methods and
measures were presented.
Meta-analysis; identified 117 studies
and focused on 21 studies conducted
since 2002.
The results of research investigating nurse staffing and the quality of
patient care did not provide a thorough and consistent foundation to
prescribe a solution to improve patient outcomes. The inconsistent
results in the nurse staffing literature are largely due to differing units of
analysis (hospital, patient, and care unit), variability in measures of nurse
staffing, the variety of quality indicators chosen, the difficulty finding
accurate measures of these indicators, and the difficulty creating riskadjustment strategies for the indicators most sensitive to nursing care.
Studies with different design show associations between increased
registered nurse 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-Patient
Ratios as a
Patient Safety
Strategy: A
Systemic Review
Meta-analysis; reviewed 87 articles
and 15 new studies augmented the
two existing reviews on the evidence of
nurse staffing ratios and in-hospital
death.
Clarke SP
(2008) Agency
for Healthcare
Research and
Quality.
Chapter 25.
Pub. No. 080043.
Unruh L (2008)
American
Journal of
Nursing
108:62-71
Shekelle PG
(2013) Archives
of Internal
Medicine,
158:404-409
Researchers have generally found that lower staffing levels are
associated with heightened risks of poor patient outcomes. Associations
are not identified every time they are expected in this area of research.
Other aspects of hospital working conditions beyond staffing, as well
individual nurse and patient characteristics, affect outcomes since
negative outcomes are relatively uncommon even at the extremes of
staffing and do not occur in every circumstance where staffing is low. A
critical mass of studies established that nurse staffing is one of a number
of variables worthy of attention in safety practice and research.
Studies examining the relationship between nurse staffing and patient
outcomes have yielded inconsistent results: there’s variable evidence to
support a link between specific staffing measures and specific patient
outcomes. But they also show that weak results don’t necessarily mean
there’s no relationship but rather may reflect varying methods or
insufficient data.
Nurse staffing ratios have a relationship with reductions in hospitalrelated mortality in most published studies. However, lack of a published
evaluation of an intentional change in registered nurse staffing from some
initial value limits conclusions on increasing nurse staffing ratios as a
patient safety strategy.
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