The association of registered nurse staffing levels and patient outcomes: systematic review and meta-analysis.
OBJECTIVE
To examine the association between registered nurse (RN) staffing and patient outcomes in acute care hospitals.


METHODS
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.


RESULTS
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.
Kane
Robert L
RL
University of Minnesota School of Public Health, Minneapolis, Minnesota 55455, USA. kanex001@umn.edu
Shamliyan
Tatyana A
TA
Mueller
Christine
C
Duval
Sue
S
Wilt
Timothy J
TJ
D000208:Acute Disease / Q000451:nursing*; D017052:Hospital Mortality; D006801:Humans; D015999:Multivariate Analysis; D015401:Nursing Administration Research; D009741:Nursing Staff, Hospital / Q000458:organization & administration* / Q000592:standards; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration* / Q000592:standards; D011787:Quality of Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D016526:Workload