Nursing-sensitive indicators for nursing care: A systematic review (1997-2017).
Beratiye Oner, Ferhat D Zengul, Nurettin Oner and 3 others
PMID 34482649WHAT IT FOUND
Across 39 studies, higher patient-to-nurse ratios consistently linked to increased mortality and failure to rescue.
However, findings for nurse education and experience were mixed. The sheer variety of staffing definitions used makes comparing results across hospitals difficult.
Key findings
01The ratio of patients to Registered Nurses showed a significant positive relationship with mortality and failure to rescue.
02Higher proportions of Registered Nurses were associated with lower rates of nosocomial infections, mortality, pressure ulcers, and medication errors.
03Nurse education levels showed mixed results, with some studies finding no significant link to mortality while others found an inverse relationship.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review only included English-language studies from 1997 to 2017, potentially missing relevant research in other languages or older/newer periods. Most studies (74%) were conducted in the USA, limiting generalizability to healthcare systems in other countries. The wide variety of definitions used for nurse staffing variables across the 39 studies makes it difficult to compare findings or draw precise conclusions about specific staffing thresholds. The review excluded studies focused on specific nursing fields (like pediatrics or psychiatry) or specific diseases, so it does not address outcomes in those specialized areas.
Declared interests
The authors reported no conflicts of interest. The study was funded by the Scientific and Technological Research Council of Turkey.
The easy way to misread this
Do not assume that increasing nurse education levels alone will reduce mortality or improve patient outcomes. The review found mixed and inconsistent results for nurse education, whereas the relationship between patient-to-RN ratios and adverse outcomes was more consistent.