Continuing Medical Education Article—Concise Definitive Review

At the conclusion of this CME activity, participants should be able to measure nurse staffing ratios in their intensive care unit (ICU) and use this information to improve patient outcomes. Determining the right number and characteristics of nurses needed to meet patient needs has been a topic of interest because of limited resources, financial constraints, and the nursing shortage. California was the first state in the United States to mandate nurse-to-patient-ratios in 2004, and other states are considering adopting similar mandates. California’s mandates for staffing were over a variety of hospital nursing settings. However, results from a study 2 yrs after regulation in California indicated that although this mandate did result in an increased licensed nurse staffing, an improvement in patient outcomes was not found in medical–surgical and step-down units. The anticipated decreases in two key nursing-sensitive outcomes, falls or prevalence of hospitalBackground: Studies over the past several decades have shown an association between nurse staffing and patient outcomes. Most of those studies were generated from general acute care units. Critically ill patients demand increased nurse staffing resources and nurses who have specialized knowledge and skills. Appropriate nurse staffing in critical care units may improve the quality of care of critically ill patients. Objectives: To review the literature evaluating the association of nurse staffing with patient outcomes in critical care units and populations. Methods: An annotated review of major nursing and medical literature from 1998 to 2008 was performed to find research studies conducted in intensive care units or critical care populations where nurse staffing and patient outcomes were addressed. Results: Twenty-six studies met inclusion for this review. Most were observational studies in which outcomes were retrieved from existing large databases. There was variation in the measurement of nurse staffing and outcomes. Outcomes most frequently studied were infections, mortality, postoperative complications, and unplanned extubation. Most studies suggested that decreased nurse staffing is associated with adverse outcomes in intensive care unit patients. Conclusions: Findings from this review demonstrate an association of nurse staffing in the intensive care unit with patient outcomes and are consistent with findings in studies of the general acute care population. A better understanding of nurse staffing needs for intensive care unit patients is important to key stakeholders when making decisions about provision of nurse resources. Additional research is necessary to demonstrate the optimal nurse staffing ratios of intensive care units. (Crit Care Med 2010; 38:1521–1528)