title: The impact of nurses on patient morbidity and mortality - the need for a policy change in response to the nursing shortage.
abstract: BACKGROUND
  Workforce projections indicate that by 2012 there will be a shortfall of 61,000 registered nurses in Australia. There is a growing body of evidence that links registered nurse staffing to better patient outcomes.
  
  
  OBJECTIVE
  This article provides a comprehensive review of the research linking nurse staffing to patient outcomes at a time of growing shortages, highlighting that a policy response based on substituting registered nurses with lower skilled workers may have adverse effects on patient outcomes.
  
  
  METHODS
  An electronic search of articles published in English using the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Journals @ OVID and Medline was undertaken.
  
  
  RESULTS
  Robust evidence exists nationally and internationally that links nurse staffing to patient outcomes. Recent meta-analyses have found that there was a 3-12% reduction in adverse outcomes and a 16% reduction in the risk of mortality in surgical patients with higher registered nurse staffing. Evidence confirms that improvements in nurse staffing is a cost-effective investment for the health system but this is not fully appreciated by health policy advisors.
  
  
  CONCLUSIONS
  An appropriate policy response demands that the evidence that patient safety is linked to nurse staffing be recognised. Policy makers must ensure there are sufficient registered nurses to guarantee patient safety.
authors.affiliation: School of Nursing, Midwifery and Postgraduate Medicine, Edith Cowan University, Joondalup, WA 6027, Australia.
authors.forename: Di
authors.initials: D
authors.lastname: Twigg
authors.forename: Christine
authors.initials: C
authors.lastname: Duffield
authors.forename: Peter L
authors.initials: PL
authors.lastname: Thompson
authors.forename: Pat
authors.initials: P
authors.lastname: Rapley
mesh_terms: D001315:Australia; D017052:Hospital Mortality; D006801:Humans; D007407:Interviews as Topic; D009017:Morbidity; D024802:Nurse's Role; D009726:Nurses / Q000600:supply & distribution*; D016134:Organizational Policy; D010361:Patients; D011050:Policy Making