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Nurse Staffing Models, Nursing Hours, and Patient Safety Outcomes

Hall, Linda McGillis PhD, RN; Doran, Diane PhD, RN; Pink, George H. PhD

Journal of Nursing Administration: January 2004 - Volume 34 - Issue 1 - pp 41-45

Background Data: Limited research has been conducted examining the effect of nurse staffing models on costs and patient outcomes.

Objective: The objective of this study was to evaluate the effect of different nurse staffing models on costs and the patient outcomes of patient falls, medication errors, wound infections, and urinary tract infections.

Methods: A descriptive correlational study was conducted in all of the 19 teaching hospitals in Ontario, Canada. The sample comprised hospitals and adult medical, surgical, and obstetric inpatients within those hospitals.

Results: The lower the proportion of professional nursing staff employed on a unit, the higher the number of medication errors and wound infections. The less experienced the nurse, the higher the number of wound infections. Nurse staffing models that included a lower proportion of professional nursing staff in the mix used more nursing hours in this study.

Conclusions: The results of this study suggest that a higher proportion of professional nurses in the staff mix (RNs/RPNs) on medical and surgical units in Ontario teaching hospitals are associated with lower rates of medication errors and wound infections. Higher patient complexity was associated with greater patient use of nursing care resources.

The release of the Institute of Medicine (IOM) report on the Adequacy of Nurse Staffing in Hospitals and Nursing Homes in 1996 identified a need for empirical evidence regarding the relationship between the quality of patient care, nurse staffing levels, and nursing staff mix. 1 Numerous research reports have emerged since then, the majority of which provide evidence of the link between nurse staffing and patient safety outcomes.

Authors’ affiliations: Assistant Professor (Dr McGillis Hall); Associate Professor and Associate Dean of Research (Dr Doran); Co-Investigator (Drs McGillis Hall, Doran, Pink); Nursing Effectiveness, Utilization, and Outcomes Research Unit, Faculty of Nursing; Adjunct Senior Scientist (Dr Pink), Institute of Clinical and Evaluative Sciences; University of Toronto, Toronto, Ontario; Associate Professor (Dr Pink), Department of Health Policy & Administration, University of North Carolina at Chapel Hill; New Investigator (Dr McGillis Hall), Canadian Institutes of Health Research, Ottawa, Ontario.

Corresponding author: Dr McGillis Hall, Faculty of Nursing, University of Toronto, 50 St. George St, Toronto, Ontario M5S 3H4 (

Funded by the Canadian Health Services Research Foundation (CHSRF) and Ontario Council of Teaching Hospitals (OCOTH).

© 2004 Lippincott Williams & Wilkins, Inc.