The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: a systematic review and meta-analysis

Driscoll, Andrea; Grant, Maria J.; Carroll, Diane L.; Dalton, Sally; Deaton, Christi; Jones, Ian; Lehwaldt, Daniela; McKee, Gábrielle; Munyombwe, Theresa; Astin, Felicity

doi:10.1177/1474515117721561

Cited by 230 publications

(199 citation statements)

References 37 publications

(105 reference statements)

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“…Any relationship between the remainder of the patient outcomes and skill mix was inconclusive. These outcomes were falls and falls injury, deep vein thrombosis, central nervous system complications, pulmonary failure/pulmonary embolism, medication error (in contrast to Driscoll et al ()), physiologic/metabolic derangement, and pain control. Five patient outcomes were excluded as not being suitable as only one study investigated each outcome.…”

Section: Discussionmentioning

confidence: 97%

A quantitative systematic review of the association between nurse skill mix and nursing‐sensitive patient outcomes in the acute care setting

Twigg

Kutzer

Jacob

et al. 2019

Journal of Advanced Nursing

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AimsTo examine the association between nurse skill mix (the proportion of total hours provided by Registered Nurses) and patient outcomes in acute care hospitals.DesignA quantitative systematic review included studies published in English between January 2000 – September 2018.Data sourcesCochrane Library, CINAHL Plus with Full Text, MEDLINE, Scopus, Web of Science and Joanna Briggs Institute were searched. Observational and experimental study designs were included. Mix‐methods designs were included if the quantitative component met the criteria.Review methodsThe Systematic Review guidelines of the Joanna Briggs Institute and its critical appraisal instrument were used. An inverse association was determined when seventy‐five percent or more of studies with significant results found this association.ResultsSixty‐three articles were included. Twelve patient outcomes were inversely associated with nursing skill mix (i.e., higher nursing skill mix was significantly associated with improved patient outcomes). These were length of stay; ulcer, gastritis and upper gastrointestinal bleeds; acute myocardial infarction; restraint use; failure‐to‐rescue; pneumonia; sepsis; urinary tract infection; mortality/30‐day mortality; pressure injury; infections and shock/cardiac arrest/heart failure.ConclusionNursing skill mix affected 12 patient outcomes. However, further investigation using experimental or longitudinal study designs are required to establish causal relationships. Consensus on the definition of skill mix is required to enable more robust evaluation of the impact of changes in skill mix on patient outcomes.ImpactSkill mix is perhaps more important than the number of nurses in reducing adverse patient outcomes such as mortality and failure to rescue, albeit the optimal staffing profile remains elusive in workforce planning.

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Section: Discussionmentioning

confidence: 97%

A quantitative systematic review of the association between nurse skill mix and nursing‐sensitive patient outcomes in the acute care setting

Twigg

Kutzer

Jacob

et al. 2019

Journal of Advanced Nursing

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“…Moreover, studies have also shown that sufficient nursing resources improve the effectiveness of nursing care, which may reduce the incidence of immobility complications. For example, a meta‐analysis showed that higher staffing levels were associated with reduced incidence of pressure ulcers, infections and pneumonia (Driscoll et al, ). Likewise, a 2007 systematic review reported an association between increased nurse staffing and decreased likelihoods of patient complications and hospital‐related mortality in ICUs (Kane, Shamliyan, Mueller, Duval, & Wilt, ).…”

Section: Introductionmentioning

confidence: 99%

Nursing resources and major immobility complications among bedridden patients: A multicenter descriptive study in China

et al. 2019

J Nurs Manag

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Background Being bedridden, which is a common clinical phenomenon, causes a series of complications related to immobilization. Effective management of immobility complications requires a reasonable allocation of nursing resources. Unit‐level evidence about the relationship between nursing resources and immobility complications is lacking. Objectives To gain insight into nursing resources in China and explore the relationship between nursing resources and the incidence of major immobility complications among bedridden patients. The major immobility complications included in our study were pressure ulcers, deep vein thrombosis, pneumonia and urinary tract infection. Design A nationwide, multicenter, cross‐sectional survey. Setting From November 2015 to June 2016, 18 hospitals (six tertiary and 12 secondary) from six provinces and cities in different geographic regions (eastern, southern, western, northern and central) in China participated in our study. Participant Intensive care units, internal medicine and surgery wards with high proportions of bedridden patients were chosen as investigation sites. Of the total of 23,637 available patients in the selected wards, 19,530 were recruited. Methods Data on nursing resources and ward characteristics were collected mainly by questionnaire. The incidence of major immobility complications among bedridden patients was measured by trained investigators. Data on patient characteristics were collected from the patient record system of each hospital. Multilevel regression analysis was used to estimate the impact of nursing resources on the incidence of major immobility complications, adjusting for patient and ward characteristics. Results The study included 23,637 patients in 213 wards, and 19,530 were recruited. The incidence of the four complications was 0.77% (pressure ulcers), 0.82% (deep vein thrombosis), 3.39% (pneumonia) and 0.86% (urinary tract infection), and the overall incidence of major immobility complications was 5.41%. The incidence of major immobility complications was higher in wards not attaining the target bed‐to‐nurse ratios than in those that met these criteria (β = 0.44, 95% confidence interval [CI]: 0.02–0.87; OR = 1.553, 95% CI: 1.002–2.387). The incidence of major immobility complications was negatively associated with the proportion of nurses with intermediate or senior job titles (β = −2.12, 95% CI: −3.78 to −0.45; OR = 0.120, 95% CI: 0.023–0.638). However, the incidence of major immobility complications was unexpectedly positively associated with the proportion of nurses with a bachelor's degree or higher (β = 1.06, 95% CI: 0.31–1.81; OR = 2.886, 95% CI: 1.363–6.110). Conclusions Sufficient nurse staffing and higher professional titles of nurses might contribute to reducing the incidence of major immobility complications. Nurse experience was not related to the incidence of major immobility complications. However, the association between nurse education level and the incidence of major immobility complications requires further investigation....

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“…Safe and effective staffing indicates that the health care service has "the right number of staff, with the right skills, in the right place and at the right time" (Borneo, Helm, & Russell, 2017, p. P.4). Higher levels of nurse staffing in acute care settings are linked to reduced patient mortality and infections as well as restraint use (Driscoll et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Nurse staffing models in medical‐surgical units of acute care settings: A cross‐sectional study

Assaye

Wiechula

Schultz

et al. 2019

Int J of Nursing Practice

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Background: Nurse staffing models have been developed across different countries to address nursing shortages and improve quality of nursing care. However, there is no published study that describes nurse staffing models in Ethiopian hospitals. Aims:To describe the existing staffing models for nursing practice in acute care units of two hospitals (one public and one private) in Ethiopia. Methods:A cross-sectional study was conducted from July to December 2018. A self-administered questionnaire was used to collect data such as shift patterns, hours worked, and number of patients cared for per shift. Unit-level data on nurse staffing were collected using a checklist developed specifically for this study.Results: Fifty-nine percent (59.9%) of participants reported that they worked six or seven days per week. On average, they worked 50 hours per week and 12% working over 60 hours per week. The number of patients they provided care for during their last shift ranged from four to 45 with an average of 13 patients. Conclusion:This study demonstrates that nurses working in acute care settings in Ethiopia are typically working more than 40 hours per week and caring for many patients per shift, which has the potential to impact patient safety. K E Y W O R D Sacute care, Ethiopia, medical-surgical, nurse staffing, nursing, staffing models SUMMARY STATEMENTWhat is already known about this topic?• Nurse staffing is a critical factor affecting patient safety and nurse workforce outcomes.• There are different staffing models in which staff are assigned to give care for patients in different healthcare settings but much of the research is from high-income countries.What this paper adds?• This paper describes nurse staffing in acute care settings in Ethiopia, a low-income country. The number of patients for whom nurses provide care per shift, and the number of hours nurses provide care per week, is very high compared with other settings.• Nurses work very long hours, often more than 50 hours per week.• Many nurses routinely work or seven days per week and on average nurses care for 13 patients per shift

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The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: a systematic review and meta-analysis

Abstract: ABSTRACT:Background: Nurses are pivotal in the provision of high quality care in acute hospitals.

Cited by 230 publications

References 37 publications

A quantitative systematic review of the association between nurse skill mix and nursing‐sensitive patient outcomes in the acute care setting

A quantitative systematic review of the association between nurse skill mix and nursing‐sensitive patient outcomes in the acute care setting

Nursing resources and major immobility complications among bedridden patients: A multicenter descriptive study in China

Nurse staffing models in medical‐surgical units of acute care settings: A cross‐sectional study

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