Nurse staffing and patient care quality and safety (Patient Safety and Quality: An Evidence-Based Handbook for Nurses)

Summary

The importance of nurse staffing to the delivery of high-quality patient care was a principal finding in the landmark report of the Institute of Medicine’s (IOM) Committee on the Adequacy of Nurse Staffing in Hospitals and Nursing Homes: “Nursing is a critical factor in determining the quality of care in hospitals and the nature of patient outcomes”. Nurse staffing is a crucial health policy issue on which there is a great deal of consensus on an abstract level (that nurses are an important component of the health care delivery system and that nurse staffing has impacts on safety), much less agreement on exactly what research data have and have not established, and active disagreement about the appropriate policy directions to protect public safety.

Researchers have generally found that lower staffing levels are associated with heightened risks of poor patient outcomes. Staffing levels, particularly those related to nurse workload, also appear related to occupational health issues (like back injuries and needlestick injuries) and psychological states and experiences (like burnout) that may represent precursors for nurse turnover from specific jobs as well as the profession.

This chapter from the Patient Safety and Quality: An Evidence-based Handbook for Nurses summarises and discusses the state of the science examining the impact of nurse staffing in hospitals and other health care organisations on patient care quality, as well as safety-focused outcomes. To address some of the inconsistencies and limitations in existing studies, design issues and limitations of current methods and measures will be presented. The chapter concludes with a discussion of implications for future research, the management of patient care and public policy.