Nurse-patient ratios: a systematic review on the effects of nurse staffing on patient, nurse employee, and hospital outcomes.
OBJECTIVE
To determine whether the peer-reviewed literature supports specific, minimum nurse-patient ratios for acute care hospitals and whether nurse staffing is associated with patient, nurse employee, or hospital outcomes.


BACKGROUND
Hospital care may be compromised by forces that have increased patient acuity, reduced the ratio of caregivers to patients, and lowered the level of training of these caregivers.


METHODS
We systematically reviewed studies of the effects of nurse staffing on patient, nurse employee, and hospital outcomes published between 1980 and 2003 to determine whether they could guide the setting of minimum licensed nurse-patient ratios in acute care hospitals.


RESULTS
Of 2897 titles and abstracts of interest, 490 articles were retrieved, and 43 met the inclusion criteria. Although all adjusted for case mix and skill mix, only one recent study addressed minimum nurse staffing ratios. Patient outcomes were limited to in-hospital, adverse events. Evidence suggests that richer nurse staffing is associated with lower failure-to-rescue rates, lower inpatient mortality rates, and shorter hospital stays.


CONCLUSIONS
The literature offers no support for specific, minimum nurse-patient ratios for acute care hospitals, especially in the absence of adjustments for skill and patient mix, although total nursing hours and skill mix do appear to affect some important patient outcomes.
Tom Lang Communications, Murphys, CA, USA. tomlangcom@aol.com
Thomas A
TA
Lang
Margaret
M
Hodge
Valerie
V
Olson
Patrick S
PS
Romano
Richard L
RL
Kravitz
D017052:Hospital Mortality; D006801:Humans; D008508:Medication Errors / Q000706:statistics & numerical data; D009723:Nurse-Patient Relations; D009741:Nursing Staff, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D013315:Stress, Psychological / Q000209:etiology; D016896:Treatment Outcome; D016526:Workload / Q000706:statistics & numerical data*