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Patient infections 15% 'more likely' when nurse staffing low, study finds


Hospital patients on units with too few registered nurses are at increased risk of getting healthcare-associated infections, researchers in the US have found.

According to their analysis, patients on a unit with not enough registered nurses on both the day and night shift were 15% more likely to develop a urinary tract infection, bloodstream infection or pneumonia two days later, compared to those with adequate nurse staffing.

“Our study shows that hospital administrators should ensure adequate nurse staffing to provide the safest patient care”

Jingjing Shang

Likewise, they found that patients on units with shortages of nursing support staff on both shifts were 11% more likely to develop one of these infections over the next two days.

The study, conducted by the Columbia University School of Nursing, concluded that nurse understaffing was associated with increased risk of healthcare-associated infections.

The findings build on a growing body of research across the world showing a link between nurse staffing levels and patient outcomes.

For the purposes of the study, units were considered to be understaffed when levels were 80% below what they would be a standard day or night, defined as the median shift staffing.

The study – published in the Journal of Nursing Administration – was conducted by looking at data from more than 100,000 patients cared for at three hospitals in a US city between 2007 and 2012.

jing jing shang

jing jing shang

Jingjing Shang

It found that on 15% of patient days, one shift was understaffed with registered nurses, and 6.2% were short of registered nurses on both day and night shifts.

On units that were understaffed, nurses experienced “excessive workloads”, said the study paper, stating: “These heavy workloads may compromise infection prevention practices and surveillance activities for early recognition of signs and symptoms of infection.”

In addition, it highlighted how continuous understaffing would “undermine nurses’ wellbeing, cause job-related stress, and negatively affect patient care”. 

The authors called on nurse leaders to find “effective solutions” to sure hospitals were staffed with enough nurses in order to provide safe and effective care.

Lead author Jingjing Shang, associate professor at Columbia Nursing, said: “As they often serve as co-ordinators within multidisciplinary health care teams, nurses play a critical role in preventing healthcare-associated infections, which is a top priority for improving quality of care and reducing hospital costs.

“Being at the forefront of infection control and prevention is a unique responsibility and opportunity for nurses, and our study shows that hospital administrators should ensure adequate nurse staffing to provide the safest patient care,” she added.

“This could be achieved through better nurse recruitment and retention practices, together with methods of managing burnout and fatigue,” noted Dr Shang, who is herself a registered nurse.

columbia university school of nursing cropped

columbia university school of nursing cropped

Source: Frank Oudeman

Columbia University School of Nursing


Readers' comments (2)

  • Same year after year, decade after decade, government after government. Pathetic,!nothing will ever change no matter how many studies are done,

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  • Karen S - Totally right. Maybe Hancock's heart is in the right place, but whether it is or not, he's not going to change anything: as a politician, he's either unable to move the mountain, or is cynically talking empty words; who knows? One more thought: just as the poor are always with us, us nurses are always with the poor. Because we too are poor. But at least we can be poor anywhere.

    I think Gemma Mitchell has got the numbers wrong. She says that in the Columbia University study, "... units were considered to be understaffed when levels were 80% below what they would be a [SIC] standard day or night, defined as the median shift staffing." So wards were not considered understaffed until they were operating with only 20% of a standard shift. I find it inconceivable that wards could be deemed well staffed until numbers fell to A FIFTH of normal. I find Mitchell's work to be littered with typos, bad grammar, and here what may be factual inaccuracy. She probably means when wards have 80% of standard shift numbers. I have a low opinion of the editing of this publication.

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