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Research papers on Nurse staffing and patient outcomes

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  1. Dexamethasone in Hospitalized Patients with Covid-19

    The RECOVERY Collaborative Group · 2020 · New England Journal of Medicine · 10,119 citations

    BACKGROUND: Coronavirus disease 2019 (Covid-19) is associated with diffuse lung damage. Glucocorticoids may modulate inflammation-mediated lung injury and thereby reduce progression to respiratory failure and death. METHODS: In this controlled, open-label trial comparing a range of possible treatments in patients who were hospitalized with Covid-19, we randomly assigned patients to receive oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days or to receive usual care alone. The primary outcome was 28-day mortality. Here, we report the final results of this assessment. RESULTS: A total of 2104 patients were assigned to receive dexamethasone and 4321 to receive usu

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

    Linda H. Aiken · 2002 · JAMA · 5,208 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

  3. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators

    Alfred F. Connors, Neal V. Dawson, Norman A. Desbiens, et al. · 1995 · JAMA · 2,779 citations

    OBJECTIVES: To improve end-of-life decision making and reduce the frequency of a mechanically supported, painful, and prolonged process of dying. DESIGN: A 2-year prospective observational study (phase I) with 4301 patients followed by a 2-year controlled clinical trial (phase II) with 4804 patients and their physicians randomized by specialty group to the intervention group (n = 2652) or control group (n = 2152). SETTING: Five teaching hospitals in the United States. PATIENTS: A total of 9105 adults hospitalized with one or more of nine life-threatening diagnoses; an overall 6-month mortality rate of 47%. INTERVENTION: Physicians in the intervention group received estimates of the likelihoo

  4. Nurse-Staffing Levels and the Quality of Care in Hospitals

    Jack Needleman, Peter I. Buerhaus, Soeren Mattke, et al. · 2002 · New England Journal of Medicine · 2,265 citations

    BACKGROUND: 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. METHODS: 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. RESULTS: The mean number of hours of nursing care per patien

  6. Educational Levels of Hospital Nurses and Surgical Patient Mortality

    Linda H. Aiken · 2003 · JAMA · 1,736 citations

    CONTEXT: Growing evidence suggests that nurse staffing affects the quality of care in hospitals, but little is known about whether the educational composition of registered nurses (RNs) in hospitals is related to patient outcomes. OBJECTIVE: To examine whether the proportion of hospital RNs educated at the baccalaureate level or higher is associated with risk-adjusted mortality and failure to rescue (deaths in surgical patients with serious complications). DESIGN, SETTING, AND POPULATION: Cross-sectional analyses of outcomes data for 232 342 general, orthopedic, and vascular surgery patients discharged from 168 nonfederal adult general Pennsylvania hospitals between April 1, 1998, and Novemb

  7. The Association of Registered Nurse Staffing Levels and Patient Outcomes: Systematic Review and Meta-Analysis

    R. Kane, T. Shamliyan, C. Mueller, et al. · 2007 · Medical Care · 1,189 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

  8. Nurse Staffing and Inpatient Hospital Mortality

    Jack Needleman, Peter I. Buerhaus, V. Shane Pankratz, et al. · 2011 · New England Journal of Medicine · 936 citations

    BACKGROUND: Cross-sectional studies of hospital-level administrative data have shown an association between lower levels of staffing of registered nurses (RNs) and increased patient mortality. However, such studies have been criticized because they have not shown a direct link between the level of staffing and individual patient experiences and have not included sufficient statistical controls. METHODS: We used data from a large tertiary academic medical center involving 197,961 admissions and 176,696 nursing shifts of 8 hours each in 43 hospital units to examine the association between mortality and patient exposure to nursing shifts during which staffing by RNs was 8 hours or more below th

  9. Effects of Nurse Staffing and Nurse Education on Patient Deaths in Hospitals With Different Nurse Work Environments

    Linda H. Aiken, Jeannie P. Cimiotti, Douglas M. Sloane, et al. · 2011 · Medical Care · 818 citations

    CONTEXT: Better hospital nurse staffing, more educated nurses, and improved nurse work environments have been shown to be associated with lower hospital mortality. Little is known about whether and under what conditions each type of investment works better to improve outcomes. OBJECTIVE: To determine the conditions under which the impact of hospital nurse staffing, nurse education, and work environment are associated with patient outcomes. DESIGN, SETTING, AND PARTICIPANTS: Outcomes of 665 hospitals in 4 large states were studied through linked data from hospital discharge abstracts for 1,262,120 general, orthopedic, and vascular surgery patients, a random sample of 39,038 hospital staff nur

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

    Ashraf Elmdni · 2025 · Nursing in Critical Care · 431 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.

  11. 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

    M. McHugh, L. Aiken, D. Sloane, et al. · 2021 · Lancet (London, England) · 373 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

  12. Nurse Staffing and Patient Outcomes

    Grif Alspach · 2003 · Critical Care Nurse · 102 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

  13. 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 · 90 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

  15. Evaluation of Hospital Nurse-to-Patient Staffing Ratios and Sepsis Bundles on Patient Outcomes

    K. Lasater, D. Sloane, M. McHugh, et al. · 2020 · American journal of infection control · 67 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

  17. Minimum nurse-to-patient Ratios Improve Staffing, Patient Outcomes.

    K. Rosenberg · 2021 · The 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.

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

    M. Beltempo, Sharina Patel, Robert W. Platt, et al. · 2023 · Archives of Disease in Childhood · 7 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

  19. 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 · 6 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

  20. 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, Seonhee Kim · 2023 · Healthcare · 6 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

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

    Pernilla Dillner, Katarina 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

  23. 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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