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Nurse Staffing and Quality of Care

Shortages of registered nurses are associated with longer patient stays and higher rates of adverse events in U.S. hospitals.

Many people sense that nurse staffing currently is inadequate in U.S. hospitals. To determine whether this impression is valid, researchers analyzed administrative data from hospitals in 11 states and examined associations between nurse staffing and 14 adverse outcomes that might be sensitive to nursing care.

Among medical patients, a higher proportion of nursing care provided by registered nurses (RNs), as opposed to licensed practical nurses, was associated with a significantly shorter mean length of stay and with lower rates of hospital-acquired urinary infection, upper gastrointestinal bleeding, pneumonia, and shock or cardiac arrest. A greater number of RN hours per patient-day was associated with a shorter mean length of stay and with lower rates of urinary infection and GI bleeding. Among surgical patients, there were only 2 significant correlations: A higher proportion of RN care was associated with a lower rate of urinary infection, and a greater number of RN hours was associated with a lower rate of "failure to rescue" (i.e., death of patients caused by potentially treatable hospital complications).

Comment: The authors conclude that more RN staffing is associated with better care in U.S. hospitals. That conclusion rings true to many of us who currently practice in acute care hospitals. However, particularly among surgical patients, many adverse outcomes did not correlate with RN-staffing levels. Moreover, it's possible that higher levels of RN staffing were markers for other unmeasured hospital characteristics that contribute to better quality of care. This issue of the New England Journal of Medicine also includes a review article that discusses dissatisfaction among nurses, nursing shortages, and nursing-staff projections.

— Allan S. Brett, MD

Published in Journal Watch General Medicine May 31, 2002

Citation(s):

Needleman J et al. Nurse-staffing levels and the quality of care in hospitals. N Engl J Med 2002 May 30; 346:1715-22.

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• Medline abstract (Free)

Steinbrook R. Nursing in the crossfire. N Engl J Med 2002 May 30; 346:1757-66.

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• Medline abstract (Free)