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Nursing ratios linked to patient outcomes


Researchers say they have found more evidence linking patient safety with nursing staffing levels.

Study authors from the department of nursing science at the University of Eastern Finland said they had found “significant associations” between nurse staffing and adverse patient outcomes in hospitals.

It follows previous research that has indicated a higher proportion of registered nurses in the staff skill mix results in better patient outcomes.

The researchers surveyed 535 registered nurses in Finland and 334 in the Netherlands.

The patient-to-nurse ratio was on average 8.74:1 and did not vary significantly between the countries. But there were fewer registered nurses among the Dutch hospital staff than the Finnish staff. In addition, Finnish nurses performed non-nursing and administrative activities more frequently than the Dutch nurses.

The researchers found frequencies of patient falls were related to the patient-to-nurse ratio in both countries. Finnish nurses also reported the occurrence of adverse patient outcomes more frequently.

Writing in the Journal of Clinical Nursing, the authors said: “Compared with the Netherlands, in Finland, nurses appear to have higher workloads, there are higher patient-to-nurse ratios, and these adverse staffing conditions are associated with higher rates of adverse patient outcomes.”

They added: “The findings provide valuable insights into the potential effects of major changes or reductions in nursing staff on the occurrence of adverse patient outcomes in hospital settings.”

In 2009 Nursing Times exclusively revealed research showing the number of nurses per bed was directly linked to mortality rates. The data was collated by healthcare analysts Dr Foster and highlighted in its most recent Hospital Guide, published in November.


Hinno et al. Nursing activities, nurse staffing and adverse patient outcomes as perceived by hospital nurses. Journal of Clinical Nursing


Readers' comments (24)

  • michael stone

    Duh !

    It seems intuitively and logically likely, that patient outcomes are related to both the number of nurses present, and the ability of those nurses, for any particular 'enviroment': in particular, it would be remarkable (to the point of incredulity) if there were not 'minimum levels' which if fallen below would lead to significantly worse outcomes for patients.

    But, this is WITHIN ANY PARTICULAR ENVIROMENT - so how is Finland and The Netherlands, of any great significance to the NHS ?

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  • lets do a research project on how it would look if there were no nursing staff at all in relation to patients!
    Happy New Year - HIC!

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  • No shit sherlock; we'd never have guessed that the registered nurse to patient s ratio would affect outcomes!!

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  • Would love to know how many of these studies have been done!! I most certainly have commented on all of the ones that have been published on this site!!

    Definitely a prize for the NS Sherlock prize!!

    Patients need nurses in the right numbers, trained appropriately, given the support they need from their managers and respected by the medical staff!!

    But quite frankly will this government listen, probably not! Because adding more nurses into the mix means more money to be spent!

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  • I have a better idea. Lets all give up work and engage in a multinational research project to verifying the findings of all the previous research and demand high pay for our highly specialised endeavours!

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  • we seem to be living in an era of investigative research, report writing, debate and little action to the serious detriment of society and its most vulnerable!

    Maybe it is us nurses still at the bediside who are the mugs and we should all jump on this more lucrative bandwagon. Oh, and only publish your findings, don't dare to complain as there is zero tolerance to whistle blowing because it upsets the status quo and may cost those in high places their clip board promenading, paper pushing, coffee drinking, desk hugging, board room and partying job!

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  • What's the point of all this research, when no action is taken. Efficacy v cost, guess which one always wins?

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  • Marjorie Lloyd

    Only when the government (and managers) start actually listening to what the evidence tells them will nursing research be considered to be of any good or benefit.

    Despite nursing research showing these inconsistencies consistently, the people in power are still not listening!

    It is no wonder nurses do not want to do more nursing research if no one is going to listen to them anyway.

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  • John Howes

    Barr, Rhys-Hearne, Aberdeen Formula, Telford... I could go on ad nauseum.

    I have been involved in several exercises in Patient Dependency, going back to 1973! It is a sad reflection that staffing ratios are determined by spreadsheets by PWC, KPMG and the usual subjects who are paid several £million by the NHS.

    Unfortunately Patient Dependency studies are no longer used. See below the search that I have carried out starting in May 2010

    NHS Evidence Health Information Resources

    Search Results from your NHS Evidence Health Information Resources alert named "Nurse/Patient Dependency".
    0 new article was found for your search: Nurse/Patient Dependency

    Search strategy
    1. NURSE/Patient dependency

    Much of the current concern about standards of care could be addressed by a bottom up approach based on clinical judgement, not by what some Financial apparatchik pulls off a spreadsheet!

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  • what happened to common sense and clinical judgement in nursing?

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