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The Association of Shift-Level Nurse Staffing With Adverse Patient Events

Patrician, Patricia A. PhD, RN, FAAN; Loan, Lori PhD, RNC; McCarthy, Mary PhD, RN; Fridman, Moshe PhD; Donaldson, Nancy DNSc, RN, FAAN; Bingham, Mona PhD, RN; Brosch, Laura R. PhD, RN

Journal of Nursing Administration: February 2011 - Volume 41 - Issue 2 - p 64-70
doi: 10.1097/NNA.0b013e31820594bf

Objective: The objective of this study was to demonstrate the association between nurse staffing and adverse events at the shift level.

Background: Despite a growing body of research linking nurse staffing and patient outcomes, the relationship of staffing to patient falls and medication errors remains equivocal, possibly due to dependence on aggregated data.

Methods: Thirteen military hospitals participated in creating a longitudinal nursing outcomes database to monitor nurse staffing, patient falls and medication errors, and other outcomes. Unit types were analyzed separately to stratify patient and nurse staffing characteristics. Bayesian hierarchical logistic regression modeling was used to examine associations between staffing and adverse events.

Results: RN skill mix, total nursing care hours, and experience, measured by a proxy variable, were associated with shift-level adverse events.

Conclusions: Consideration must be given to nurse staffing and experience levels on every shift.

Supplemental Digital Content is available in the text.

Authors' Affiliations: Associate Professor and Donna Brown Banton Endowed Professor (Dr Patrician), University of Alabama at Birmingham, School of Nursing; Nursing Research Consultant to the Army Surgeon General (Dr Loan), Chief, Nursing Research Service (Dr McCarthy), Madigan Army Medical Center, Tacoma, Washington; Statistician (Dr Fridman), AMF Consulting, Inc, Los Angeles, California; Clinical Professor, Director, Center for Research and Innovation in Patient Care, and Associate Dean for Practice (Dr Donaldson), University of California, San Francisco, School of Nursing; Chief, Nursing Research Service (Dr Bingham), Brooke Army Medical Center, Ft Sam Houston, Texas; Director, Office of Research Protections (ORP) and ORP Human Research Protection Office (Dr Brosch), Headquarters, US Army Medical Research and Materiel Command, Fort Detrick, Frederick, Maryland.

Corresponding author: Dr Patrician, University of Alabama at Birmingham, NB324, 1530 3rd Ave S, Birmingham, AL 35294-1210 (

Funding: This project was funded by the TriService Nursing Research Program, Uniformed Services University of the Health Sciences (grant N03-P07); however, the information or content and conclusions do not necessarily represent the official position or policy of, nor should any official endorsement be inferred by, the TriService Nursing Research Program, Uniformed Services University of the Health Sciences, the Department of Defense, or the US Government.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

© 2011 Lippincott Williams & Wilkins, Inc.