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What’s New in the Patient Safety World

November 2022

Nurse Staffing Composition and Patient Mortality



We’ve done lots of columns on the impact of nursing staffing levels on patient mortality and other quality outcomes (see list below). A new study from the UK confirms that better nurse staffing ratios are associated with lower inpatient mortality rates. But it also shows that the composition of that nursing staffing is important.


Zaranko et al. (Zaranko 2022) studied inpatient mortality and nursing staffing patterns at three NHS hospitals. On average, an extra 12-hour shift by an RN was associated with a reduction in the odds of a patient death of 9.6%. Moreover, an additional senior RN had 2.2 times the impact of an additional less senior RN. There was no association for healthcare support workers (HCSW’s) or agency workers. The authors suggest that the lack of association for HCSW’s and agency nurses indicates they are not effective substitutes for RN’s who regularly work on the ward.


The authors note that this study is the first to show the differential impacts of RN’s by seniority. They state that their results “demonstrate the value of ensuring and retaining an adequate number of regularly employed RN’s, show the significant value of senior, more experienced nurses who provide team leadership and, ultimately, highlight areas to target when mobilizing extra resources.”


Retention of nurses is an important goal for all healthcare organizations. We put considerable resources into the training of our nurses and then sometimes lose them to other organizations that offer them better pay or better working environments. It is important for hospital administrators to recognize the “return on investment” in retaining our nurses. Particularly during this era where we predict an impending nationwide shortage of nurses, we need to focus on improving working conditions for our nurses to prevent burnout.



Some of our other columns on nursing workload and missed nursing care/care left undone:


November 26, 2013    Missed Care: New Opportunities?

May 9, 2017                Missed Nursing Care and Mortality Risk

March 6, 2018             Nurse Workload and Mortality

May 29, 2018              More on Nursing Workload and Patient Safety

October 2018               Nurse Staffing Legislative Efforts

February 2019             Nurse Staffing, Workload, Missed Care, Mortality

July 2019                    HAI’s and Nurse Staffing

September 1, 2020      NY State and Nurse Staffing Issues

February 9, 2021         Nursing Burnout

August 2021               The New NY State Law on Nursing Staffing

January 2022               Another Striking Nurse Staffing Study






Zaranko B, Sanford NJ, Kelly E, et. Nurse staffing and inpatient mortality in the English National Health Service: a retrospective longitudinal study. BMJ Quality & Safety 2022; Published Online First: 27 September 2022






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