1. Fitzpatrick, Melissa A. RN, MSN, FAAN, Editor-in-Chief

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Who would disagree that lower nurse-to-patient ratios lead to better clinical outcomes and higher nurse satisfaction? Intuitively, nurses have always known the positive correlation between adequate staffing, care quality, and staff morale. Yet historically, nursing hasn't taken an evidence-based approach to validating those intuitions with data and proving the impact that nurses make on outcomes.


Traditionally, nurses have used their passion and persuasiveness to secure adequate staffing, often doing so without data to justify the need. We've consistently ensured the availability of additional nurses to provide care by making an emotional plea and a convincing case that "it's unsafe"-but that was before the current nursing shortage.


Backed by fact

Today, even with a compelling argument, nurse leaders often fail to procure the additional staffing required to meet patient needs. Without data, it becomes increasingly difficult to make our case.


Recent research arms nursing with the evidence to help articulate and validate our concerns. A study by researchers at the University of Pennsylvania, Philadelphia, and Children's Hospital of Philadelphia, and published in the Journal of the American Medical Association (JAMA), reports findings from a survey of more than 10,000 staff RNs in 168 hospitals and outcomes for more than 232,000 surgical patients. Researchers found that RN staffing levels significantly affected preventable hospital deaths and complications among the patients in the sample. Patient mortality risk rose 7% for every additional patient added to the nurse's average workload.


The difference between 4-to-6 and 4-to-8 patients per nurse was accompanied by a 14% and 31% increase in mortality, respectively. 1 If applied nationally, these results indicate up to 20,000 preventable deaths annually.


The study also reveals that workload directly impacts nurse retention rates. The addition of 1 patient per nurse to a staffing pattern increased the odds of RN burnout by 23% and the odds of job dissatisfaction by 15%. Almost half of the nurses who reported high levels of burnout and dissatisfaction intended to leave their jobs within the next year. 2


From instinct to evidence

It's essential that we apply these evidence-based results to our organizations. They support our demands for appropriate staffing and move us to a specific, data-rich discussion of the quality and quantity of resources that best meet future patient and family needs.




1. Aiken, L., Clarke S., Sloane, D., et al.: "Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction," JAMA. 288( 16): October 23/30, 2002. [Context Link]


2. Ibid. [Context Link]