Quality of Patient Care and Nurse Staffing

Nurse staffing had a different effect in different care settings. The addition of one unit of nursing care may vary depending on the baseline rate. For example, ICUs have higher staffing levels than typical hospital units. The effect of an additional nurse hour might be quite dissimilar in that context. We evaluated differences in the association between nurse staffing variables and patient outcomes by the type of hospital units (ICU, surgical, medical, neonatal) and by the type of patients (medical vs. surgical). We found a greater reduction in the relative risk of hospital related mortality (16 percent) in surgical patients for an additional one RN FTE per patient day compared to a reduction of 6 percent in medical patients. Given a higher baseline mortality in surgical patients, the reduction in nurse workload would save six surgical compared to five medical patients per 1,000 hospitalized. Consistent with previous studies, the present meta analysis found consistent evidence that surgical patients would demonstrate a greater cost-benefit from improved nurse staffing. Increasing the care of surgical patients by one RN FTE per patient day would eliminate 16 percent of failure to rescue (26 saved lives per 1,000 hospitalized) compared with 9.2 percent in all patients (medical and surgical). Such consistent and large improvements in patient safety from increasing the RN FTE per patient day ratio in surgical patients and in ICUs suggest heath care administrators can improve quality of care in these categories of patients using optimal staffing ratios.

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