The Association of Registered Nurse Staffing Levels and Patient Outcomes

Systematic Review and Meta-Analysis

Bibliographic Data

ID9101952
AuthorsRobert L Kane (0009-0005-8505-6218, University of Minnesota, corresponding author), Tatyana A Shamliyan (0000-0003-3584-2008, University of Minnesota, corresponding author), Christine Mueller (University of Minnesota), Sue Duval (0000-0003-1025-8665, University of Minnesota, corresponding author), Timothy J Wilt (0000-0002-6019-7779, Minneapolis VA Medical Center)
Year2007
Volume45
Issue12
Pages1195-1204
Publication date2007-12-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0b013e3181468ca3
PMID18007170
OpenAlexW2159874007
LanguageEN
Citations received44
References cited86

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, 0.94-0.95) 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). CONCLUSIONS: 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

Confidence interval · Intensive care · Intensive care medicine · Logistic regression · Odds · Odds ratio · Pneumonia · Staffing · Emergency Medicine · Internal Medicine · Medicine · Nursing · Nursing education and management · Nursing Roles and Practices · Sepsis Diagnosis and Treatment