Evidence Table. Major Integrative Reviews of the Staffing-Outcomes Literature

StudyMethodsOutcomes Associated With StaffingOutcomes for Which Data Considered Limited or Mixed
Seago 20012516 studies dealing with staffing-safety outcomes relationships, 1990–2000

Grading of design and outcome measures
NPR:
Length of stay
Nosocomial infections (UTI, postoperative infections, pneumonia)
Pressure ulcers
NPR:
Mortality
Unplanned readmissions
Failure to rescue

Skill mix:
Negative patient outcomes
Hickam 20033826 studies examining nurse workload/staffing ratios and safety outcomes, 1980– 2002 (22 published 1996 or later)

Grading of design appropriateness and execution
Workload and skill mix:
Nonfatal adverse events

Workload:
Medication errors
Mortality

Recognition of errors

Probability that errors will affect outcomes
Lang 20042743 studies examining effects of nurse staffing on patient, nurse, and hospital outcomes, 1980-2003, excluding studies of ICUs and long-term care facilities

General comments on methods limitations for all studies; grading of effect sizes
Patient outcomes:
Failure to rescue
Mortality
Shock in medical patients; gastrointestinal hemorrhage

Nurse outcomes:
Nurse needlestick injuries
Burnout

Institutional outcomes:
Documentation quality
Extended length of stay
Patient outcomes:
Pneumonia
UTIs
Falls
Nosocomial infections
Medication errors
Pressure ulcers
Patient satisfaction
Morbidity
Adverse drug events
Intravenous errors
Cardiac arrests
Patient injuries

Nurse outcomes:
Nurse job satisfaction
Absenteeism

Institutional outcomes:
Assaults on psychiatric units
Hospital financial outcomes
Kane 20073094 studies examining associations of nurse-to- patient and hours per patient-day on patient outcomes in hospital practice from the United States and Canada, 1987- 2005

Formal meta-analysis (calculation of pooled effect sizes across studies and subpopulations) incorporating evaluation of methodological quality
RN NPR:
Hospital-related mortality
Failure to rescue+
Medical complications
Unplanned extubation*
Pulmonary failure*+
Hospital-acquired pneumonia*
Bloodstream infections+
Cardiopulmonary resuscitation*+
Extended length of stay

* Evidence of a stronger effect or more consistent evidence in ICUs

+ Evidence of a stronger effect or more consistent evidence in surgical patients

HPPD (all staff types)
Mortality
Shock
Upper gastrointestinal bleeding
Nosocomial infection
Extended length of stay
RN HPPD:
Limited support

LPN and UAP NPR and HPPD:
Trend toward association of +worse outcomes with higher use/levels

NPR: Nurse-to-patient ratios

ICU: Intensive care unit

RN: Registered nurse

LPN: Licensed practical nurse

UAP: Unlicensed assistive personnel

HPPD: Hours of care per patient-day

UTI: Urinary tract infection

From: Chapter 25, Nurse Staffing and Patient Care Quality and Safety

Cover of Patient Safety and Quality
Patient Safety and Quality: An Evidence-Based Handbook for Nurses.
Hughes RG, editor.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.