Many articles have been written about the relationship between low nursing staffing levels and a variety of adverse events and patient mortality. Many have been criticized because of the methodologies or data sources used. A new study (Needleman 2011) uses an improved methodology and corrects for many of the concerns of previous studies and concludes that both low nursing staffing levels and that higher than normal nursing workloads also correlate with increased patient mortality rates.
The authors looked at data from a large academic medical center that, in general, had relatively good nurse staffing rates. They were able to quantify nurse staffing on a shift-to-shift and unit-by-unit basis and match this to both patient census and workload (as measured by patient turnover rates). They demonstrated a significant correlation between patient mortality rates and patient exposure to 3 or more shifts with below-target nursing staffing or 3 or more shifts with high patient turnover.
This study, in conjunction with the numerous prior studies, should leave little doubt about the importance of matching nursing staffing levels to the needs of patients (both census and acuity).
Needleman J, Buerhaus P, Pankratz VS, et al. Nurse Staffing and Inpatient Hospital Mortality. N Engl J Med 2011; 364:1037-104