Evidence-Based Approach to Appropriate Staffing

Q What is an evidence-based approach to appropriate staffing?

A Sarah A. Delgado, DNP, RN, ACNP, replies:

Nurse staffing shortages are a profound issue in acute and critical care. Randomized controlled trials of nurse staffing levels are ethically and feasibly impossible. Therefore, most research on the impact of staffing comes from cross-sectional or longitudinal observational studies. A consistent finding in large cross-sectional examinations is that a higher number of patients per nurse in acute care hospitals is associated with adverse patient outcomes.^1,2  Individual studies demonstrate a correlation between nurse-to-patient ratios and a higher risk of patient mortality from sepsis and after surgery.^3,4  The association between nurse staffing and patient outcomes is not isolated to the United States, as similar cross-sectional studies conducted in health systems in other countries have had the same results.^5,6  A systematic review of longitudinal studies further confirms...