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Effect of Nurse Staffing on Patient Outcomes in Acute Care Hospitals

Friday, 17 July 2009: 8:30 AM

Karen H. Frith, PhD1
Faye Anderson, DNS1
Fan Tseng, PhD2
Nancy Gerilyn Hoyt, BSN, MN3
Kim Moore, RN, MSN, NEA-BC4
Kathleen Sanford, DBA, RN, FACHE5
Barbara Caspers, MS, BSN5
1College of Nursing, University of Alabama in Huntsville, Huntsville, AL
2College of Business Administration, University of Alabama in Huntsville, Huntsville, AL
3Administration, Mercy Regional Medical Center, Durango, CO
4Nursing Administration, Saint Elizabeth Regional Medical Center, Lincoln, NE
5National Office, CATHOLIC HEALTH INITIATIVES, Denver, CO

Learning Objective 1: identify factors that affect patient safety in medical-surgical units of acute care hospitals.

Learning Objective 2: discuss implications of research findings for the practice of nursing administration including budgeting, staffing, and tracking patient outcomes.

Purpose: People expect error-free care when admitted to hospitals, yet each year preventable injuries and deaths occur (Institute of Medicine, 2000). Nurse staffing is an important aspect in healthcare delivery and should be examined as a factor in patient outcomes. Therefore, the purpose of the research was to determine the predictive relationships between nurse staffing and patient outcomes in hospitals. Two hypotheses were examined: higher nurse staffing is significantly, negatively related to length of stay, adverse events and mortality, controlling for patient factors as covariates; and higher percentages of RNs and LPNs are significantly, negatively related to length of stay, adverse events and mortality, controlling for patient factors as covariates.

Methods: A quantitative, cross-sectional method was used, and a sample of 35,000 patients from 11 medical-surgical units was drawn. Data were extracted from administrative databases from a 2-year period. Patient-level and unit-level data were analyzed using hierarchical linear modeling in HLM 6.06.

Results: Findings from the study showed nurse staffing is predictive of patient length of stay (LOS) and adverse events when controlling for patient age and complication index. The predictive model showed that for every 0.6 hour increase in RN hours, there would be a 10.3% decrease in LOS. Likewise, with every 1% increase in the proportion of RNs, there would be a 3% decrease in LOS. Staffing was related to adverse events: for every 1% increase in the proportion of RNs, there was a 3% decrease in adverse events. Mortality was not predicted by nurse staffing.

Conclusion: The results of this study, along with others reported in the literature, show evidence of relationships between staffing and patient outcomes. Nurse administrators should consider research findings when making budgeting and staffing decisions.

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