Case for hospital nurse-to-patient ratio legislation in Queensland, Australia, hospitals: an observational study

Abstract

ObjectivesTo determine whether there was variation in nurse staffing across hospitals in Queensland prior to implementation of nurse-to-patient ratio legislation targeting medical-surgical wards, and if so, the extent to which nurse staffing variation was associated with poor outcomes for patients and nurses.DesignAnalysis of cross-sectional data derived from nurse surveys linked with admitted patient outcomes data.SettingPublic hospitals in Queensland.Participants4372 medical-surgical nurses and 146 456 patients in 68 public hospitals.Main outcome measures30-day mortality, quality and safety indicators, nurse outcomes including emotional exhaustion and job dissatisfaction.ResultsMedical-surgical nurse-to-patient ratios before implementation of ratio legislation varied significantly across hospitals (mean 5.52 patients per nurse; SD=2.03). After accounting for patient characteristics and hospital size, each additional patient per nurse was associated with 12% higher odds of 30-day mortality (OR=1.12; 95% CI 1.01 to 1.26). Each additional patient per nurse was associated with poorer outcomes for nurses including 15% higher odds of emotional exhaustion (OR=1.15; 95% CI 1.07 to 1.23) and 14% higher odds of job dissatisfaction (OR=1.14; 95% CI 1.02 to 1.28), as well as higher odds of concerns about quality of care (OR=1.12; 95% CI 1.01 to 1.25) and patient safety (OR=1.32; 95% CI 1.11 to 1.57).ConclusionsBefore ratios were implemented, nurse staffing varied considerably across Queensland hospital medical-surgical wards and higher nurse workloads were associated with patient mortality, low quality of care, nurse emotional exhaustion and job dissatisfaction. The considerable variation across hospitals and the link with outcomes suggests that taking action to improve staffing levels was prudent.

Chronic hospital nurse understaffing meets COVID-19: an observational study

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Nurse staffing and inpatient mortality in the English National Health Service: a retrospective longitudinal study

“…Identifying strategies to optimise the staffing of these teams is a priority for health service providers and policymakers. A growing body of research suggests that a richer nursing skill-mix, greater education levels and higher nurse-to-patient ratios are associated with better patient outcomes, increased staff well-being, decreased healthcare spending and improved workforce retention 1–11. Patient outcomes that have been examined include mortality,8 11–17 missed care13 18 19 and nurse-driven outcomes like pressure injuries, falls and medication errors 14 17 20–22.…”

Evaluation of hospital nurse-to-patient staffing ratios and sepsis bundles on patient outcomes

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