In the Literature: Research You Need to Know


Clinical question: Is decreased nursing staffing and increased patient turnover across various inpatient adult hospital units associated with higher patient mortality?

Background: Studies that have shown an association between lower nurse staffing and higher inpatient mortality have been limited by methodological issues. These limitations include the use of hospital-level administrative data that do not fully capture actual staffing levels and the lack of control for expected nursing requirements for patients.

Study design: Retrospective observational study.

Setting: Forty-three hospital units on both medical and surgical services at a single institution.

Synopsis: The authors examined whether patients who were cared for during shifts that had nursing staffing that was eight hours or more below the staffing target had a higher-than-expected mortality compared with predicted mortality, based on risk-adjusted DRG-related mortality. They also assessed if increased patient turnover during a patient-care shift was associated with a higher-than-expected mortality.

The authors analyzed mortality outcomes of 197,961 patients who were cared for across 176,696 staffed unit-shifts. The risk of death increased with the number of shifts a patient was cared for when the nursing staffing was eight hours below target, with a hazard ratio per below-target shift of 1.02 (95% CI: 1.01 to 1.03). There was also an association between a higher mortality and a greater number of high-turnover shifts, with a hazard ratio of 1.04 (95% CI 1.02 to 1.03).

Bottom line: Patients cared for during shifts with below-target levels of nurse staffing and during shifts with increased patient turnover had an increased mortality.

Citation: Needleman J, Buerhaus P, Pankratz S, Leibson CL, Stevens SR, Harris M. Nurse staffing and inpatient hospital mortality. N Engl J Med. 2011;364(11):1037-1045.

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