1. Kennedy, Maureen Shawn MA, RN

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Hospitalized patients are at risk for complications when nurse staffing levels and the ratios of RNs to LPNs and nurses' aides are low, according to a report from the Agency for Healthcare Quality and Research summarizing many of the studies completed to date. Hospitalized patients today are more acutely ill than those in years past, but at the same time the nursing workforce is aging and fewer young people are considering nursing as a career. Hospitals now have an average vacancy rate of 13%; by 2020 the rate is projected to increase to 29%.


The largest study examined in the report, which looked at medical records of 6.1 million patients treated at 799 hospitals during 1993, found that higher levels of RN staffing were associated with lower rates of hospital-acquired pneumonia, urinary tract infections (UTIs), failure to rescue, shock or cardiac arrest, upper gastrointestinal bleeding, and longer hospital stays. More staffing at all levels of nursing was associated with decreases in some adverse outcomes.


In addition to the obvious suffering they cause in patients-and stress in nurses-adverse outcomes related to inadequate nurse staffing are expensive for hospitals. In fact, the costs related to such outcomes are so high that a hospital's profits are not actually reduced when nurse staffing levels are increased to prevent them.


The report tells us that patients in hospitals with low nurse staffing are at higher risk for adverse outcomes. It also points out that "research findings indicating what minimal nurse staffing ratios should be" are not available. Tools for more accurately measuring nurse staffing, patient acuity, and other variables are needed to better define how they combine to affect patient outcomes. And the ANA is working on a meta-review of all of the available nurse staffing and outcomes research, according to Katherine Kany, of the ANA's Department of Nursing Practice and Policy. The report's authors do note, however, that the current findings can be used to show how the "quality of care is changing and how it is linked to the contributions of nurses." To access the full report, go to


-Fran Mennick, BSN, RN