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Nurse Staffing Effects on Patient Outcomes

Safety-Net and Non-Safety-Net Hospitals

Blegen, Mary A., PhD, RN, FAAN*; Goode, Colleen J., PhD, RN, FAAN; Spetz, Joanne, PhD*; Vaughn, Thomas, PhD; Park, Shin Hye, MS, RN, PhD(c)*

doi: 10.1097/MLR.0b013e318202e129
Original Articles

Background Nurse staffing has been linked to hospital patient outcomes; however, previous results were inconsistent because of variations in measures of staffing and were only rarely specific to types of patient care units.

Objective To determine the relationship between nurse staffing in general and intensive care units and patient outcomes and determine whether safety net status affects this relationship.

Research Design A cross-sectional design used data from hospitals belonging to the University HealthSystem Consortium.

Subjects Data were available for approximately 1.1 million adult patient discharges and staffing for 872 patient care units from 54 hospitals.

Measures Total hours of nursing care [Registered Nurses (RNs), Licensed Practical Nurses, and assistants] determined per inpatient day (TotHPD) and RN skill mix were the measures of staffing; Agency for Healthcare Research and Quality risk-adjusted safety and quality indicators were the outcome measures.

Results TotHPD in general units was associated with lower rates of congestive heart failure mortality (P<0.05), failure to rescue (P<0.10), infections (P<0.01), and prolonged length of stay (P<0.01). RN skill mix in general units was associated with reduced failure to rescue (P<0.01) and infections (P<0.05). TotHPD in intensive care units was associated with fewer infections (P<0.05) and decubitus ulcers (P<0.10). RN skill mix was associated with fewer cases of sepsis (P<0.01) and failure to rescue (P<0.05). Safety-net status was associated with higher rates of congestive heart failure mortality, decubitus ulcers, and failure to rescue.

Conclusions Higher nurse staffing protected patients from poor outcomes; however, hospital safety-net status introduced complexities in this relationship.

*Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA

College of Nursing, University of Colorado at Denver, Denver, CO

Department of Health Management, College of Public Health, University of Iowa, Iowa city, IA

Reprints: Mary A. Blegen, PhD, RN, FAAN, Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA. e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.