Nurse Staffing and Patient Outcomes: Bridging Research into Evidenced-Based Practice

This paper describes innovative research that quantified relationships between nurse staffing and nurse-sensitive patient outcomes. Building on existing studies, the research added controls for patient workload, analyzed data at a daily-level of detail and employed rigorous multi-site data control. A key finding in the study was that staffing to effectively meet patient workload demands mitigated negative patient outcomes. The study also identified clinical indicators predictive of risk for negative outcomes and implications of staffing skill mix and characteristics. Background A growing body of research suggests a relationship between nurse staffing and nursesensitive patient outcomes, but beyond inferences that higher staffing relates to more favorable outcomes, these findings haven’t been successful at suggesting effective staffing levels or practices. Most published studies compared aggregated staffing and outcome measures compiled at the hospital or service level over extended time periods. Results, if found, focused on outcomes in well-staffed settings versus staffing-challenged settings. Further, most studies relied on staff-to-patient ratios and did not control for patient workload differences. A better model was needed to transcend staffing-to-outcomes research into evidenced-based practice. Building on existing nurse staffing to outcomes research that has used retrospective aggregate staffing and outcome measures, the QuadraMed study was designed to measure daily staffing and outcomes to quantify the effects of short term staffing fluctuations on patient outcomes. Further, beyond using staff-to-patient ratios as a control, patient workload was utilized to accurately quantify and compare nurse staffing levels. Study Design The basic study design was to track patient outcomes and nurse staffing on a daily basis to enable detailed comparisons of nurse staffing to outcomes. Patient characteristics and nursing unit staffing demographics were also tracked to determine influence on patient outcomes. A standardized measure of daily patient workload was tracked to provide comprehensive study control. To facilitate the outcomes study, QuadraMed approached clients willing to track outcomes and staffing demographics using standardized definitions. Patient outcomes were tracked on a patient-specific, daily basis. The common use of a standardized patient acuity system