1. Page, Jan Stapleton BSN, RN

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Lang et al1 have presented a thorough literature review, looking at patient outcomes as they relate to nurse staffing. This issue holds great significance for nurses, especially for those who live and work in the state of California where the minimum staffing ratio has taken effect. Many key researchers have been working diligently, trying to prove, or disprove, the need for California's new mandate. While their efforts are noteworthy, many are missing the mark.


This mandate is based on the presumption that the more nurses there are, the safer the patients are. The data do not support this presumption. While staffing ratios are certainly a concern, they are not exclusive in affecting patient outcomes, staff satisfaction, or hospital goals. If positive patient outcomes, staff satisfaction, and positive hospital outcomes are the goals, then the data must include all factors affecting these issues. Research needs to focus on how nurses deliver care, rather than how many patients a nurse delivers care to.


By only considering nurse-patient ratios, researchers are not going to find the data they need. Nursing care delivery models should be researched further to establish safe practice guidelines. Care delivery needs to be designed to maximize the potential of each nurse and to appropriately utilize the nursing resources available. Many care delivery models utilize differentiated practice, utilizing the more educated nurses for critical thinking across the continuum, and the less educated nurses for the task-driven roles.


The study conducted by Aiken et al2 revealed that the more educated the nurse, the better the patient outcomes. Thus, it is of vital importance to place the more educated nurses in positions where they can critically think, allowing these nurses to deal with the complexity of care. This will result in safe, appropriate care, excellent patient outcomes, satisfied nurses, as well as productive hospital outcomes.


The work nurses face today is too complex for any one person, or discipline, to handle effectively. Well-coordinated, interdisciplinary care is what keeps the patients safe. It is the coordination of all roles associated with each patient that will have the greatest impact on patient outcomes. With the appropriate roles working together, the patients will have their needs met, nurses will feel more satisfied about their contribution to a team, and hospitals will meet their goals.


Gow et al found that a care coordination delivery model "addresses the needs of complex patients, enhances the quality and consistency of care within a cost-effective frame-work."3(p109) Halm et al4 show that coordination and interdisciplinary collaboration show an increased positive patient outcomes, increased job satisfaction of all roles, and increased retention of nurses. Using a differentiated nursing practice approach with well-educated, articulate nurses placed in the position to coordinate interdisciplinary care is the answer to the staffing issues facing nursing today.




1. Lang TA, Hodge M, Olson V, Romano PS, Kravitz RL. A systematic review on the effects of nurse staffing on patient, nurse employee, and hospital outcomes. J Nurs Adm. 2004;34(7/8):326-337. [Context Link]


2. Aiken LH, Clarke SP, Cheung RB, Sloane DM, Silber JH. Educational levels of hospital nurses and surgical patient mortality. J Am Med Assoc. 2003;290(12):1617-1623. [Context Link]


3. Gow P, Berg S, Smith D, Ross D. Care co-ordination improves quality-of-care at South Auckland health. Qual Clin Pract. 1999;19:107-110. [Context Link]


4. Halm MA, Goering M, Smith M. Interdisciplinary rounds. Impact on patients, families, and staff. Clin Nurse Spec. 2003;17(3):133-142. [Context Link]