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      The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: a systematic review and meta-analysis

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          Abstract

          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.

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          The Quality of Care

          Avedis Donabedian (1988)
          Article 0 comments Cited 419 times – based on 0 reviews     Review now
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            Nurse-staffing levels and the quality of care in hospitals.

            Jack Needleman, Peter Buerhaus, Soeren Mattke … (2002)
            It is uncertain whether lower levels of staffing by nurses at hospitals are associated with an increased risk that patients will have complications or die. We used administrative data from 1997 for 799 hospitals in 11 states (covering 5,075,969 discharges of medical patients and 1,104,659 discharges of surgical patients) to examine the relation between the amount of care provided by nurses at the hospital and patients' outcomes. We conducted regression analyses in which we controlled for patients' risk of adverse outcomes, differences in the nursing care needed for each hospital's patients, and other variables. The mean number of hours of nursing care per patient-day was 11.4, of which 7.8 hours were provided by registered nurses, 1.2 hours by licensed practical nurses, and 2.4 hours by nurses' aides. Among medical patients, a higher proportion of hours of care per day provided by registered nurses and a greater absolute number of hours of care per day provided by registered nurses were associated with a shorter length of stay (P=0.01 and P<0.001, respectively) and lower rates of both urinary tract infections (P<0.001 and P=0.003, respectively) and upper gastrointestinal bleeding (P=0.03 and P=0.007, respectively). A higher proportion of hours of care provided by registered nurses was also associated with lower rates of pneumonia (P=0.001), shock or cardiac arrest (P=0.007), and "failure to rescue," which was defined as death from pneumonia, shock or cardiac arrest, upper gastrointestinal bleeding, sepsis, or deep venous thrombosis (P=0.05). Among surgical patients, a higher proportion of care provided by registered nurses was associated with lower rates of urinary tract infections (P=0.04), and a greater number of hours of care per day provided by registered nurses was associated with lower rates of "failure to rescue" (P=0.008). We found no associations between increased levels of staffing by registered nurses and the rate of in-hospital death or between increased staffing by licensed practical nurses or nurses' aides and the rate of adverse outcomes. A higher proportion of hours of nursing care provided by registered nurses and a greater number of hours of care by registered nurses per day are associated with better care for hospitalized patients.
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              The association of registered nurse staffing levels and patient outcomes: systematic review and meta-analysis.

              Robert Kane, Tatyana Shamliyan, Christine Mueller … (2007)
              To examine the association between registered nurse (RN) staffing and patient outcomes in acute care hospitals. 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. 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, 0.94-0.95) 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). 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.
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                Author and article information

                Journal
                Title: European Journal of Cardiovascular Nursing
                Abbreviated Title: European Journal of Cardiovascular Nursing
                Publisher: SAGE Publications
                ISSN (Print): 1474-5151
                ISSN (Electronic): 1873-1953
                Publication date Created: September 15 2017
                Publication date Created: January 2018
                Publication date (Electronic): July 18 2017
                Publication date (Print): January 2018
                Volume: 17
                Issue: 1
                Pages: 6-22
                Affiliations
                [1 ]Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Australia
                [2 ]School of Nursing, Midwifery, Social Work &amp; Social Sciences, University of Salford, UK
                [3 ]Munn Center for Nursing Research, Massachusetts General Hospital, USA
                [4 ]Library, University of Leeds, UK
                [5 ]Department of Public Health and Primary Care, University of Cambridge, UK
                [6 ]School of Nursing and Allied Health, Liverpool John Moores University, UK
                [7 ]Department of Nursing and Human Sciences, Dublin City University, Ireland
                [8 ]School of Nursing &amp; Midwifery, Trinity College Dublin, Ireland
                [9 ]Divison of Epidemiology and Biostatistics, University of Leeds, UK
                [10 ]Research and Development Department, University of Huddersfield and Calderdale and Huddersfield NHS Foundation Trust, UK
                Article
                DOI: 10.1177/1474515117721561
                PubMed ID: 28718658
                SO-VID: 9180311b-b4f9-41be-9bbd-afb482bf8681
                Copyright © © 2018
                License:

                http://journals.sagepub.com/page/policies/text-and-data-mining-license

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