ArticleAnnals of intensive care2017
Are high nurse workload/staffing ratios associated with decreased survival in critically ill patients? A cohort study.
Article in Annals of intensive care, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 67 papers, 1 of them a synthesis that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
67 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Case Fatality Rates for Patients with COVID-19 Requiring Invasive Mechanical Ventilation. A Meta-analysis.American journal of respiratory and critical care medicine · 2021Pooled it
- Trial
- Modeling hospital catchment areas in pediatric oncology using an empirically parameterized extended Huff-model.International journal of health geographics · 2026Article
- Article
- A national survey of factors leading to health care worker turnover in Canadian intensive care units.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2026Article
- Investigating the Relationship Between Moral Resilience and Turnover Intention in Nurses.Journal of healthcare leadership · 2026Article
- Professional Self-Perception Among Critical Care Nurses in China: A Nationwide Cross-Sectional Survey.Journal of nursing management · 2026Article
- Comparison of Open Visiting and Restricted Visiting in ICU Chronic Critical Patients: Effects on Negative Emotions and Delirium.International journal of general medicine · 2026Article
- Transport physics-informed reinforcement learning agents deployed in standalone infusion pumps for managing multidrug delivery in critical care.Bioengineering & translational medicine · 2025Article
- Consensus recommendations for the integration of critical care pharmacists on intensive care unit teams: Endorsed by the American Association of Critical-Care Nurses, American College of Clinical Pharmacy, American Society of Health-System Pharmacists, Institute for Safe Medication Practices, and Society of Critical Care Medicine.Journal of the American College of Clinical Pharmacy : JACCP · 2025Article
- Critical Care Nursing Workforce Retention From an Irish Perspective: A National Survey.Nursing in critical care · 2025Article
- Use of Noninvasive vs Invasive Ventilation for Patients Hospitalized With Acute Exacerbation of COPD, 2010 to 2019.American journal of critical care : an official publication, American Association of Critical-Care Nurses · 2025Article
- National survey evaluating the introduction of new and alternative staffing models in intensive care (SEISMIC-R) in the UK.BMJ open · 2025Observational
- Assessing the Nursing Workload in the Cardiothoracic Intensive Care Unit: Comparative Study.Nursing open · 2024Article
- Association between intensive care unit nursing grade and mortality in patients with cardiogenic shock and its cost-effectiveness.Critical care (London, England) · 2024Article
- Unit-to-unit transfer due to shortage of intensive care beds in Sweden 2015-2019 was associated with a lower risk of death but a longer intensive care stay compared to no transfer: a registry study.Journal of intensive care · 2024Article
- "Who Takes Care of Carers?": Experiences of Intensive Care Unit Nurses in the Acute Phase of the COVID-19 Pandemic.Healthcare (Basel, Switzerland) · 2024Article
- Improved staffing policies and practices in healthcare based on a conceptual model.Frontiers in public health · 2024Article
- Optimizing Pharmacist Team-Integration for ICU Patient Management: Rationale, Study Design, and Methods for a Multicentered Exploration of Pharmacist-to-Patient Ratio.Critical care explorations · 2023Article
- Is nurse staffing associated with critical deterioration events on acute and critical care pediatric wards? A literature review.European journal of pediatrics · 2023Review
7 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDespite the central role of nurses in intensive care, a relationship between intensive care nurse workload/staffing ratios and survival has not been clearly established. We determined whether there is a threshold workload/staffing ratio above which the probability of hospital survival is reduced and then modeled the relationship between exposure to inadequate staffing at any stage of a patient's ICU stay and risk-adjusted hospital survival.
methodsRetrospective analysis of prospectively collected data from a cohort of adult patients admitted to two multi-disciplinary Intensive Care Units was performed. The nursing workload [measured using the Therapeutic Intervention Scoring System (TISS-76)] for all patients in the ICU during each day to average number of bedside nurses per shift on that day (workload/nurse) ratio, severity of illness (using Acute Physiology and Chronic Health Evaluation III) and hospital survival were analysed using net-benefit regression methodology and logistic regression.
resultsA total of 894 separate admissions, representing 845 patients, were analysed. Our analysis shows that there was a 95% probability that survival to hospital discharge was more likely to occur when the maximum workload-to-nurse ratio was <40 and a more than 95% chance that death was more likely to occur when the ratio was >52. Patients exposed to a high workload/nurse ratio (≥52) for ≥1 day during their ICU stay had lower risk-adjusted odds of survival to hospital discharge compared to patients never exposed to a high ratio (odds ratio 0.35, 95% CI 0.16-0.79).
conclusionsExposing critically ill patients to high workload/staffing ratios is associated with a substantial reduction in the odds of survival.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.