Andrea Driscoll1, Maria J Grant2, Diane Carroll3, Sally Dalton4, Christi Deaton5, Ian Jones6, Daniela Lehwaldt7, Gabrielle McKee8, Theresa Munyombwe9, Felicity Astin10. 1. 1 Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Australia. 2. 2 School of Nursing, Midwifery, Social Work & Social Sciences, University of Salford, UK. 3. 3 Munn Center for Nursing Research, Massachusetts General Hospital, USA. 4. 4 Library, University of Leeds, UK. 5. 5 Department of Public Health and Primary Care, University of Cambridge, UK. 6. 6 School of Nursing and Allied Health, Liverpool John Moores University, UK. 7. 7 Department of Nursing and Human Sciences, Dublin City University, Ireland. 8. 8 School of Nursing & Midwifery, Trinity College Dublin, Ireland. 9. 9 Divison of Epidemiology and Biostatistics, University of Leeds, UK. 10. 10 Research and Development Department, University of Huddersfield and Calderdale and Huddersfield NHS Foundation Trust, UK.
Abstract
BACKGROUND: 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. AIM: To undertake a systematic review and meta-analysis examining the association between nurse staffing levels and nurse-sensitive patient outcomes in acute specialist units. METHODS: Nine electronic databases were searched for English articles published between 2006 and 2017. The primary outcomes were nurse-sensitive patient outcomes. RESULTS: Of 3429 unique articles identified, 35 met the inclusion criteria. All were cross-sectional and the majority utilised large administrative databases. Higher staffing levels were associated with reduced mortality, medication errors, ulcers, restraint use, infections, pneumonia, higher aspirin use and a greater number of patients receiving percutaneous coronary intervention within 90 minutes. A meta-analysis involving 175,755 patients, from six studies, admitted to the intensive care unit and/or cardiac/cardiothoracic units showed that a higher nurse staffing level decreased the risk of inhospital mortality by 14% (0.86, 95% confidence interval 0.79-0.94). However, the meta-analysis also showed high heterogeneity (I2=86%). CONCLUSION: Nurse-to-patient ratios influence many patient outcomes, most markedly inhospital mortality. More studies need to be conducted on the association of nurse-to-patient ratios with nurse-sensitive patient outcomes to offset the paucity and weaknesses of research in this area. This would provide further evidence for recommendations of optimal nurse-to-patient ratios in acute specialist units.
BACKGROUND: 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. AIM: To undertake a systematic review and meta-analysis examining the association between nurse staffing levels and nurse-sensitive patient outcomes in acute specialist units. METHODS: Nine electronic databases were searched for English articles published between 2006 and 2017. The primary outcomes were nurse-sensitive patient outcomes. RESULTS: Of 3429 unique articles identified, 35 met the inclusion criteria. All were cross-sectional and the majority utilised large administrative databases. Higher staffing levels were associated with reduced mortality, medication errors, ulcers, restraint use, infections, pneumonia, higher aspirin use and a greater number of patients receiving percutaneous coronary intervention within 90 minutes. A meta-analysis involving 175,755 patients, from six studies, admitted to the intensive care unit and/or cardiac/cardiothoracic units showed that a higher nurse staffing level decreased the risk of inhospital mortality by 14% (0.86, 95% confidence interval 0.79-0.94). However, the meta-analysis also showed high heterogeneity (I2=86%). CONCLUSION: Nurse-to-patient ratios influence many patient outcomes, most markedly inhospital mortality. More studies need to be conducted on the association of nurse-to-patient ratios with nurse-sensitive patient outcomes to offset the paucity and weaknesses of research in this area. This would provide further evidence for recommendations of optimal nurse-to-patient ratios in acute specialist units.
Authors: Clemens Grimm; Steffen Dickel; Alexandra Sachkova; Maria Popp; Martin Golinksi; Falk Fichtner; Peter Kranke; Christian Seeber; Sven Laudi; Sebastian Voigt-Radloff; Onnen Moerer Journal: Cureus Date: 2021-06-19