Systematic review: Association between the patient–nurse ratio and nurse outcomes in acute care hospitals

Abstract

Aims To evaluate and summarize current evidence on the relationship between the patient–nurse ratio staffing method and nurse employee outcomes. Background Evidence‐based decision‐making linking nurse staffing with staff‐related outcomes is a much needed research area. Although multiple studies have investigated this phenomenon, the evidence is mixed and fragmented. Evaluation A systematic literature search was conducted using PubMed, Embase, Web of Science, Cinahl, Cochrane Library and the ERIC databases. Thirty studies were identified, analysing eight selected key nurse outcomes. Key issue(s) Future research should focus on unit‐level data, incorporate other methodologies and aim for comparability between different types of clinical settings as well as different health care systems. Conclusion A relationship between the patient–nurse ratio and specific staff‐related outcomes is confirmed by various studies. However, apart from the patient–nurse ratio other variables have to be taken into consideration to ensure quality of care (e.g., skill mix, the work environment and patient acuity). Implications for Nursing Management Hospital management should pursue the access and use of reliable data so that the validity and generalizability of evidence‐based research can be assessed, which in turn can be converted into policy guidelines.

Predicting patient acuity according to their main problem

“…Likewise, a recent systematic review identifies the need for refining workload measurements based on "weighted patients according to their care loads" (Wynendaele, Willems, & Trybou, 2019).…”

“…Likewise, a recent systematic review identifies the need for refining workload measurements based on “ weighted patients according to their care loads ” (Wynendaele, Willems, & Trybou, ). In this study, the MP weights seem to be clinically meaningful, ranking problems such as post‐ICU syndrome or risk of multiorgan failure first.…”

Nurse managers' perceptions of nurse staffing and nursing care quality: A cross‐sectional study

“…This is consistent with other studies, to the extent that the nursing shortage is associated with increased rates of AEs, such as health care‐associated infections, falls and pressure ulcers, leading to increased length of hospital stay, readmission and mortality rates. In addition, it has impact on the efficiency, effectiveness and quality of care, increasing costs for patients, health professionals, health system and society in general (Aiken et al, ; Amiri & Solankallio‐Vahteri, ; Griffiths et al, ; Kim & Kim, ; Smeds‐Alenius, Tishelman, Lindqvist, Runesdotter, & McHugh, ; Wynendaele, Willems, & Trybou, ).…”

“…A more adequate nurse staffing (in number and competencies) enhances nurses' ability to meet patients' needs, given that a higher response capacity reduces the AEs occurrence and increases the quality of nursing care (Wynendaele et al, ). Adequate nurse staffing increases the perceived patient centredness among nurses which in turn improves the outcomes of care (Jarrar, Rahman, Minai, Abumadini, & Larbi, ).…”

“…Finally, the limitation associated with subjective data, resulting from the self‐reporting of the nurse managers, is also identified. However, it should be noted that empirical evidence suggests that nurses' perception of quality of care and patient safety might be used as an indicator of overall hospital quality and safety, given that they possess a broader view of the care provided by multiple professionals (Smeds‐Alenius et al, ; Wynendaele et al, ).…”