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Nurse Staffing and Healthcare Outcomes: A Systematic Review of the International Research Evidence

Lankshear, Annette J. PhD; Sheldon, Trevor A. DSc; Maynard, Alan BPhil

Original Article

The relationship between quality of care and the cost of the nursing workforce is of concern to policymakers. This study assesses the evidence for a relationship between the nursing workforce and patient outcomes in the acute sector through a systematic review of international research produced since 1990 involving acute hospitals and adjusting for case mix. Twenty-two large studies of variable quality were included. They strongly suggest that higher nurse staffing and richer skill mix (especially of registered nurses) are associated with improved patient outcomes, although the effect size cannot be estimated reliably. The association appears to show diminishing marginal returns.

Department of Health Sciences, University of York, York, England.

Corresponding author: Annette J. Lankshear, PhD, Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington Road, York YO10 4LG, England (e-mail:

The authors acknowledge the support of the following who contributed to searching for, and analysis of, the papers in the review: Karen Smith, BSc; Catherine Hewitt, MSc; Professor Martin Bland, PhD. This review was carried out on behalf of the Chief Nursing Officer of England and funded by the Department of Health Policy Research Program and the NHS Service Delivery and Organisation (SDO) R&D Program.

© 2005 Lippincott Williams & Wilkins, Inc.