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Higher RN Staffing Levels Improve Patient Outcomes, RWJF Study Finds

A new study, published in the current issue of Medical Care, finds that higher staffing levels in both intensive care units and in non-intensive care units improve patient outcomes but not to the same extent in safety net hospitals, which provide care to low-income, uninsured and vulnerable populations and tend to have poorer patient outcomes overall.

Mary Blegen, PhD, RN, FAAN, professor in Community Health Systems and director of the Center for Patient Safety at the University of California San Francisco School of Nursing, is one of the lead investigators of the study, which was funded by the Robert Wood Johnson Foundation's Interdisciplinary Nursing Quality Research Initiative (INQRI).

Blegen led an interdisciplinary team with nurse administrators, health service researchers, and health economists that reviewed data from the University HealthSystem Consortium (UHC), which included details on 1.1 million adult patients cared for in 872 units (285 of them ICUs) in 54 hospitals, and the hours of care that nurses provided to those patients.
The researchers found that while the staffing levels were similar in safety net and non-safety net hospitals, patient outcomes were worse in safety-net hospitals.

In non-safety net hospitals, higher nurse staffing rates and a larger number of registered nurses were associated with:

  • fewer deaths due to congestive health failure;
  • fewer incidents in which nurses did not note or initiate treatment in life-threatening situations (failure to rescue);
  • lower rates of infection, including infection after operations (postoperative sepsis); and
  • fewer patients who were required to stay in the hospital for longer than expected. 

"Higher levels of nursing skill and more nurses providing more hours of care, overall, are correlated with better care - shorter hospital stays, fewer infections and lower rates of failure to rescue," said Blegen. "We suspect that the increase in mortality rates due to congestive heart failure in safety net hospitals are a function of patients' overall health, rather than staffing rates, but more research needs to be done. We also need to know more about how non-RNs affect patient care."
INQRI supports interdisciplinary teams of nurse scholars and scholars from other disciplines to address the gaps in knowledge about the relationship between nursing and health care quality. It is helping to advance the recommendations of the Institute of Medicine's landmark report, "The Future of Nursing: Leading Change, Advancing Health," which include fostering multidisciplinary collaboration and preparing and enabling nurses to lead change.

By requiring research teams to include a nurse scholar and at least one scholar from another health care discipline, INQRI not only fosters interprofessional collaboration, the Initiative also ensures that diverse perspectives are brought to bear in research, according to RWJF. 

To learn more, visit, or follow on Twitter at @INQRIProgram.

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