Nurse staffing in acute care settings: Research perspectives and practice implications

Background: The research literature linking nurse staffing and outcomes has expanded radically at a time of profound changes in human resources and financial management in hospitals and health care systems. Findings: Reviews of more than 100 peer-reviewed studies as of mid-2007 support an association between lower nurse staffing levels and poorer patient outcomes in acute care settings. Research efforts are increasingly aimed at understanding which outcomes are affected and under what circumstances and at evaluating the impact of staffing from an economic point of view. Minimal staffing levels appear to be a necessary but insufficient condition for safety in acute care hospitals. Conclusions and Implications: In the face of a deepening nursing shortage, many facilities are likely to find that various aspects of staffing, such as coverage, licensure levels, and experience, are lower than those historically in place. Advance planning by staff and supervisors and careful monitoring of outcomes are needed to ensure patient safety. Health care managers and executives need to benchmark staffing levels and nursing-sensitive outcomes in their facilities, carefully analyze recruitment and retention issues, and develop short- and long-term strategies for averting and dealing with the shortfalls in numbers and skill mix of nursing personnel that they will likely face increasingly in the coming decades.