Evidence shows an association between better hospital nurse staffing and improved patient outcomes. In 2016, Queensland, Australia, implemented minimum nurse-to-patient ratios on adult medical-surgical units in select public hospitals. Researchers conducted a prospective panel study to assess the effects of this policy on staffing levels and patient outcomes and whether there is an association between them.
The authors used nurse-reported data to measure nurse staffing levels and standardized patient data to assess outcomes at two time points: before and two years after the implementation of nurse-to-patient ratios. They compared two types of hospitals: those in which the ratios were implemented (intervention hospitals) and those that discharged similar patients but were not subject to the ratios (comparison hospitals). The researchers included 231,902 patients assessed at baseline and 257,253 assessed after the policy was implemented.
After implementation of the ratios, 30-day mortality rates weren't significantly higher than they were at baseline in the comparison hospitals but were significantly lower in the implementation hospitals. Readmissions increased in the comparison hospitals but not in the intervention hospitals. Length of stay decreased in both comparison and intervention hospitals, but the decrease was greater in the intervention hospitals. At baseline, 30 of the 36 hospitals in this analysis had more than 4.5 patients per nurse; after implementation, only 21 hospitals did. Staffing improvements of one fewer patient per nurse, according to the researchers, led to improvements in mortality, readmissions, and length of stay. Fewer readmissions and shorter lengths of stay resulted in significant cost savings-twice the cost of the additional staffing needed to comply with the new policy.
The authors note that the hospitals studied weren't selected at random, nor were they assigned randomly to intervention and comparison groups. In addition, there weren't enough medical-surgical nurses in some hospitals to reliably estimate average nurse staffing on medical-surgical units.