Effects of Nurse Staffing and Nurse Education on Patient Deaths in Hospitals With Different Nurse Work Environments

Among the hospital nursing staff factors that have been shown to improve patient outcomes and reduce mortality are lower nurse-patient ratios, higher proportion of baccalaureate-prepared nurses and better nurse work environments (those in which doctors and nurses have good working relationships, and nurses are involved in hospital affairs and quality improvement for patient care).

These researchers sought to measure under which circumstances those three particular nursing investments yield the best outcomes. They used data from 665 hospitals in California, Pennsylvania, Florida and New Jersey; surveyed 39,038 nurses; and analyzed data on 1.3 million patients. They modeled the effects of various nursing factors on mortality and failure-to-rescue rates.

By decreasing nurse workload by one patient per nurse, the odds on deaths and failure-to-rescue were decreased by 10 percent in hospitals with the best work environments, but almost nil in hospitals with poor work environments. A 10 percent increase in the number of baccalaureate-prepared nurses decreased the odds on patients dying by 4 percent in all hospitals, regardless of their work environments.

In summary, the authors write: “Getting better value for investments in hospital nursing requires better staffing in the context of a good nurse work environment, and a more educated nurse workforce.”