The Relationship Between Nurse Staffing and Patient Outcomes

Sasichay-Akkadechanunt, Thitinut; Scalzi, Cynthia C.; Jawad, Abbas F.

doi:10.1097/00005110-200309000-00008

Cited by 125 publications

(93 citation statements)

References 16 publications

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“…A systematic review of research confirming the relationship between low nurse staffing levels and adverse patient outcomes found 101 studies published up to 2006, mainly from the USA (Kane et al, 2007). Major studies have continued to be undertaken in countries around the world including Australia (Twigg et al, 2011), China (You et al, 2013), England (Rafferty et al, 2007), Thailand (Sasichay-Akkadechanunt et al, 2003) and across 12…”

Section: Introductionmentioning

confidence: 99%

Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development

Griffiths

Ball

Drennan

et al. 2016

International Journal of Nursing Studies

218

216

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What is already known? A number of high quality reviews establish an association between lower registered nurse staffing levels, increased mortality rates and other adverse outcomes  Careful analysis of this evidence suggests that it is consistent with a causal relationship  Translation of this evidence into practice is disputedWhat this paper adds  This paper summarises and extends a recent systematic review on nurse staffing and outcomes undertaken for England's National Institute for Health and Care Excellence  Methodological limitations mean that existing studies may not give unbiased estimates of the benefits from increased nurse staffing, with over and underestimation of benefit both possible, which makes it difficult to directly translate evidence into guidance for practice. We identify avenues for progressing this important research so that future studies might be better able to provide the evidence needed to inform policy and practice, and provide a checklist to aid future study development AbstractA large and increasing number of studies have reported a relationship between low nurse staffing levels and adverse outcomes, including higher mortality rates. Despite the evidence being extensive in size, and having been sometimes described as "compelling" and "overwhelming", there are limitations that existing studies have not yet been able to address. One result of these weaknesses can be observed in the guidelines on safe staffing in acute hospital wards issued by the influential body that sets standards for the National Health Service in England, the National Institute for Health and Care Excellence (NICE), which concluded there is insufficient good quality evidence available to fully inform practice.In this paper we explore this apparent contradiction. After summarising the evidence review that informed the NICE guideline on safe staffing and related evidence, we move on to discussing the complex challenges that arise when attempting to apply this evidence to practice. Among these, we introduce the concept of endogeneity, a form of bias in the estimation of causal effects. Although current evidence is broadly consistent with a cause and effect relationship, endogeneity means that estimates of the size of effect, essential for building an economic case, may be biased and in some cases qualitatively wrong. We expand on three limitations that are likely to lead to endogeneity in many previous studies: omitted variables, which refers to the absence of control for variables such as medical staffing and patient case mix; simultaneity, which occurs when the outcome can influence the level of staffing just as staffing influences outcome; and common-method variance, which may be present when both outcomes and staffing levels variables are derived from the same survey.Thus while current evidence is important and has influenced policy because it illustrates the potential risks and benefits associated with changes in nurse staffing, it may not provide operational solutions. We conclude by posing a ser...

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Section: Introductionmentioning

confidence: 99%

Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development

Griffiths

Ball

Drennan

et al. 2016

International Journal of Nursing Studies

218

216

View full text Add to dashboard Cite

show abstract

“…Thus, these studies demonstrate the possibility that a hospital with a cohesive multidisciplinary team focused on early diagnosis and treatment of complications has a positive influence on postoperative results [164][165][166] . Additionally, there is evidence that hospitals with higher volume of procedures have lower perioperative mortality than hospitals with lower volume of surgeries, even after adjusting for other variables 167 .…”

Section: Choosing the Hospitalmentioning

confidence: 75%

“…Other studies have already shown lower perioperative mortality in hospitals with more nurses per bed and in ICUs with daily visits of expert intensivists, which reflect effective systems of communication and probably higher probability of prompt recognition of complications [164][165][166] . Thus, these studies demonstrate the possibility that a hospital with a cohesive multidisciplinary team focused on early diagnosis and treatment of complications has a positive influence on postoperative results [164][165][166] .…”

Section: Choosing the Hospitalmentioning

confidence: 85%

II Diretriz de Avaliação Perioperatória da Sociedade Brasileira de Cardiologia

Feitosa¹,

Marques²,

Caramelli³

et al. 2011

Arq. Bras. Cardiol.

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“…Two other studies found conflicting results on the influence of RNs' experience on patient mortality. Tourangeau et al 22 reported that for each additional average year of clinical nursing experience, there were 4 to 6 fewer deaths within 30 days among every 1000 acute medical patients discharged, whereas Sasichay-Akkadechanunt and colleagues 23 found no relationship between the number of years of experience as an RN and patient mortality.…”

Section: Nurses' Comments To Study On Nurse Education and Patient Mormentioning

confidence: 99%

Nurse Education and Patient Mortality: Sorting Fact From Fury

Alspach¹

2014

Critical Care Nurse

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The Relationship Between Nurse Staffing and Patient Outcomes

Cited by 125 publications

References 16 publications

Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development

Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development

II Diretriz de Avaliação Perioperatória da Sociedade Brasileira de Cardiologia

Nurse Education and Patient Mortality: Sorting Fact From Fury

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