Nurse Staffing and Patient Care Quality and Safety

Abstract

From a research tradition in which nurse staffing factors were primarily background variables, the study of nurse staffing and patient outcomes has emerged as a legitimate and strategically crucial field of inquiry. However, despite significant growth in the number and sophistication of studies responding to public policy and provider demand for these findings, results have been inconsistent. This chapter highlights the methodologic challenges inherent in this area of inquiry and explicates how the diversity in measures and units of analyses confound literature synthesis. In the face of myriad pressures to adopt a position for or against mandated nurse-to-patient ratios, the state of the young science does not permit precision in prescribing safe ratios. In fact, it may be concluded that further research is crucial to tease out the nuances in the staffing-outcomes equation. It is essential to advancing the field that future studies replicate, extend, and refine the current body of knowledge, making explicit how characteristics of the workforce, now barely considered (for example, years of experience or professional certification), in addition to the “dose” of the nurse, are linked to processes of care that ultimately result in clinical outcomes (both desirable and adverse). Until then, selected better practices have been noted, with the potential to contribute to pragmatic efforts to improve patient care quality and safety in hospitals.