Association of registered nurse and nursing support staffing with inpatient hospital mortality.
Open accessAbstract
Background: The association of nursing staffing with patient outcomes has primarily been studied by comparing high to low staffed hospitals, raising concern other factors may account for observed differences. We examine the association of inpatient mortality with patients’ cumulative exposure to shifts with low registered nurse (RN) staffing, low nursing support staffing and high patient turnover. Methods: Cumulative counts of exposure to shifts with low staffing and high patient turnover were used as time-varying covariates in survival analysis of data from a three-campus US academic medical centre for 2007–2012. Staffing below 75% of annual median unit staffing for each staff category and shift type was characterised as low. High patient turnover per day was defined as admissions, discharges and transfers 1 SD above unit annual daily averages. Results: Models included cumulative counts of patient exposure to shifts with low RN staffing, low nursing support staffing, both concurrently and high patient turnover. The HR for exposure to shifts with low RN staffing only was 1.027 (95% CI 1.002 to 1.053, p<0.001), low nursing support only, 1.030 (95% CI 1.017 to 1.042, p<0.001) and shifts with both low, 1.025 (95% CI 1.008 to 1.043, p=0.035). For a model examining cumulative exposure over the second to fifth days of an admission, the HR for exposure to shifts with low RN staffing only was 1.048 (95% CI 0.998 to 1.100, p=0.061), low nursing support only, 1.032 (95% CI 1.008 to 1.057, p<0.01) and for shifts with both low,1.136 (95% CI 1.089 to 1.185, p<0.001). No relationship was observed for high patient turnover and mortality. Conclusion: Low RN and nursing support staffing were associated with increased mortality. The results should encourage hospital leadership to assure both adequate RN and nursing support staffing.
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- Authors
- Needleman, J., Liu, J., Shang, J., Larson, E. L., & Stone, P. W.
- Affiliations
- University of California, Los Angeles (US)
- Columbia University (US)
- Corresponding author
- Needleman, Jack
- Venue
- BMJ Quality & Safety
- Publisher
- BMJ
- Published
- 2019-08-07
- Volume
- 29
- Issue
- 1
- Pages
- 10-18
- ISSN
- 1475-3898 (ISSN-L)
- 2044-5415
- 2044-5423
- OpenAlex
- W2968400206
- Cited by
- 115
- References
- 31
- Citations by year
- 2026: 8 · 2025: 18 · 2024: 17 · 2023: 17 · 2022: 20 · 2021: 18 · 2020: 15 · 2019: 2
- FWCI
- 25.91
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ Quality & Safety (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Institute of Nursing Research (NINR R01 NR010822)
- Topics
- Health Sciences › Nursing › Research and Theory › Nursing education and management
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Health Sciences › Health Professions › Emergency Medical Services › Healthcare Operations and Scheduling Optimization
- Keywords
- registered nurse staffing, in-hospital mortality, patient turnover, cumulative exposure, time-varying covariates, hospital quality, academic medical centers
- MeSH terms
- Academic Medical Centers, Adult, Age Factors, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Nursing Staff, Hospital, Patient Discharge, Personnel Staffing and Scheduling, Sex Factors, Time Factors, United States, Comorbidity, Proportional Hazards Models, Hospital Mortality
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