The Impact Of Nurse Staffing Levels On Patient Outcomes: A Multifaceted Case Study

Abstract

Background: Numerous studies have established a clear correlation between staffing levels and patient outcomes concerning specific nurse-sensitive indicators. These studies reveal that lower patient-to-nurse ratios, characterized by fewer patients per nurse, are linked to improved outcomes.

Objectives: To investigate the correlation between nursing staff attributes, including the hours worked by both permanent and temporary staff and nurse hours per patient day, and patient outcomes encompassing pressure ulcers, patient falls, upper gastrointestinal bleeding, pneumonia, sepsis, shock, and deep vein thrombosis.

Design: A case study using retrospective hospital data, at ward level.

Setting: An advanced cardio-respiratory NHS Trust located in England, encompassing a total of two hospitals.

Participants: Every patient, including those categorized as day cases, who received in-patient admission at either hospital within a span of 12 months.

Methods: Data were obtained from the hospitals' corporate information systems. Clinical areas were classified into two groups: lower dependency, which includes general wards, and critical care, encompassing ICU and high dependency units. The association between nurse staffing attributes and patient outcomes was evaluated using either a Poisson or negative binomial regression model, as appropriate. Our aim was to determine if patient outcomes were influenced by nurse hours per patient day, the proportion of permanent nurse hours relative to total hours, and the proportion of permanent nurse hours relative to the combined total of permanent and bank hours.

Results: In the lower dependency category, which includes general wards, a tenuous link was observed between nurse staffing and most of the outcomes. In contrast, the high dependency critical care areas yielded limited significant findings, with a noteworthy reduction in the sepsis rate being the only notable result as the ratio of permanent staff hours increased.

Conclusions: The research showcased the potential of utilizing available hospital data to investigate the connection between nurse staffing and patient outcomes. Nonetheless, the identified associations were feeble and did not consistently reproduce the results of earlier studies.