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Low Nurse Staffing Ratios, Patient Safety, and Nurse Burnout

Higher patient-to-nurse ratios led to higher patient mortality and to lower job satisfaction among Pennsylvania nurses.

Hospital nurse shortages and recent California legislation that mandates specific patient-to-nurse ratios stimulated this complex study of the relation between patient outcomes in orthopedic, vascular, and general surgery wards and patient-to-nurse ratios in 168 nonfederal Pennsylvania hospitals. Surveys of nurses in the same hospitals were completed concurrently. Within the 168 hospitals, researchers assessed 232,342 patient outcomes and the job satisfaction and burnout rates among 10,184 nurses.

Eighty percent of hospitals had patient-to-nurse ratios from 5:1 to 7:1. Most patients and nurses came from high-tech hospitals (as defined by open-heart surgery capability); 23% of surveyed patient records showed major complications, and 2% of patients died within 30 days after admission. Forty-three percent of nurses had high burnout scores and low job-satisfaction scores. There were significant associations between patient-to-nurse ratio and both likelihood of burnout and risk for surgical mortality; each increase of 1 patient in the staffing ratio increased likelihood of nurse burnout by 23% and risk for patient mortality by 7%. The authors calculated that an increase (worsening) in patient-to-nurse ratios from 4:1 to 8:1 would result in 5 excess deaths per 1000 patients.

Comment: The California legislation specifies staffing ratios of 5 to 6 patients per nurse, which are lower (better) than that of approximately half of the Pennsylvania hospitals studied. The data clearly show that staffing ratios matter, both for patient outcomes and for nurse satisfaction. The current and impending nursing shortage is real and important and requires innovative solutions.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine November 8, 2002

Citation(s):

Aiken LH et al. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA 2002 Oct 23/30; 288:1987-93.

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