Systematic review: Association between the patient-nurse ratio and nurse outcomes in acute care hospitals

Abstract

Aims: To evaluate and summarize current evidence on the relationship between the patient-nurse ratio staffing method and nurse employee outcomes.

Background: Evidence-based decision-making linking nurse staffing with staff-related outcomes is a much needed research area. Although multiple studies have investigated this phenomenon, the evidence is mixed and fragmented.

Evaluation: A systematic literature search was conducted using PubMed, Embase, Web of Science, Cinahl, Cochrane Library and the ERIC databases. Thirty studies were identified, analysing eight selected key nurse outcomes.

Key issue(s): Future research should focus on unit-level data, incorporate other methodologies and aim for comparability between different types of clinical settings as well as different health care systems.

Conclusion: A relationship between the patient-nurse ratio and specific staff-related outcomes is confirmed by various studies. However, apart from the patient-nurse ratio other variables have to be taken into consideration to ensure quality of care (e.g., skill mix, the work environment and patient acuity).

Implications for nursing management: Hospital management should pursue the access and use of reliable data so that the validity and generalizability of evidence-based research can be assessed, which in turn can be converted into policy guidelines.

Keywords: health care; nurse outcome; patient-nurse ratio; staffing; work environment.