The association of registered nurse staffing levels and patient outcomes: systematic review and meta-analysis.

Abstract:

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.

journal_name

Med Care

journal_title

Medical care

authors

Kane RL,Shamliyan TA,Mueller C,Duval S,Wilt TJ

doi

10.1097/MLR.0b013e3181468ca3

subject

Has Abstract

pub_date

2007-12-01 00:00:00

pages

1195-204

issue

12

eissn

0025-7079

issn

1537-1948

pii

00005650-200712000-00011

journal_volume

45

pub_type

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