Outcomes of variation in hospital nurse staffing in English hospitals: Cross-sectional analysis of survey data and discharge records

Anne Marie Rafferty, Sean P. Clarke, James Coles, Jane Ball, Philip James, Martin McKee, Linda H. Aiken

Research output: Contribution to journalArticle

Abstract

Context: Despite growing evidence in the US, little evidence has been available to evaluate whether internationally, hospitals in which nurses care for fewer patients have better outcomes in terms of patient survival and nurse retention. Objectives: To examine the effects of hospital-wide nurse staffing levels (patient-to-nurse ratios) on patient mortality, failure to rescue (mortality risk for patients with complicated stays) and nurse job dissatisfaction, burnout and nurse-rated quality of care. Design and setting: Cross-sectional analysis combining nurse survey data with discharge abstracts. Participants: Nurses (N = 3984) and general, orthopaedic, and vascular surgery patients (N = 118 752) in 30 English acute trusts. Results: Patients and nurses in the quartile of hospitals with the most favourable staffing levels (the lowest patient-to-nurse ratios) had consistently better outcomes than those in hospitals with less favourable staffing. Patients in the hospitals with the highest patient to nurse ratios had 26% higher mortality (95% CI: 12-49%); the nurses in those hospitals were approximately twice as likely to be dissatisfied with their jobs, to show high burnout levels, and to report low or deteriorating quality of care on their wards and hospitals. Conclusions: Nurse staffing levels in NHS hospitals appear to have the same impact on patient outcomes and factors influencing nurse retention as have been found in the USA.

Original languageEnglish (US)
Pages (from-to)175-182
Number of pages8
JournalInternational Journal of Nursing Studies
Volume44
Issue number2
DOIs
StatePublished - Feb 2007

Keywords

  • Burnout
  • Failure to rescue
  • Job satisfaction
  • Mortality
  • Nurse staffing
  • Nursing outcomes
  • Patient outcomes
  • Staff outcomes
  • Workforce planning

ASJC Scopus subject areas

  • Nursing(all)

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