Evidence map›Paper›PMID 30514780›Full record

ArticleBMJ quality & safety2019

Nurse staffing, nursing assistants and hospital mortality: retrospective longitudinal cohort study.

Peter Griffiths, Antonello Maruotti, Alejandra Recio Saucedo, Oliver C Redfern, Jane E Ball, Jim Briggs, Chiara Dall'Ora, Paul E Schmidt, Gary B Smith, Missed Care Study Group

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ quality & safety, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 139 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
139citing papers in PubMed, 6 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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.

3 · Its place in the literature

Who cites it

139 citing papers in PubMed, 6 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Trial
  8. Review
  9. Article
  10. Unfallchirurgie (Heidelberg, Germany) · 2026
    Article
  11. Observational
  12. A Triptych of Care: An Anthropological Interpretation of Morning Bed-Baths in Greek Intensive Care.Nursing philosophy : an international journal for healthcare professionals · 2026
    Article
  13. Article
  14. Article
  15. Patient-Count and Perceived Workload Associations With Missed Nursing Care: A Multicenter Repeated-Measures Study.Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing · 2026
    Observational
  16. Article
  17. Observational
  18. Article
  19. Article
  20. Article

79 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors.

Peter GriffithsFaculty of Environmental and Life Sciences, University of Southampton, Southampton, UK peter.griffiths@soton.ac.uk.ORCID 0000-0003-2439-2857
Antonello MaruottiFaculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
Alejandra Recio SaucedoFaculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.ORCID 0000-0003-2823-4573
Oliver C RedfernCentre for Healthcare Modelling and Informatics Portsmouth, University of Portsmouth, Portsmouth, UK.
Jane E BallFaculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
Jim BriggsCentre for Healthcare Modelling and Informatics Portsmouth, University of Portsmouth, Portsmouth, UK.
Chiara Dall'OraFaculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
Paul E SchmidtNational Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, Southampton, UK.ORCID 0000-0001-5856-8262
Gary B SmithFaculty of Health and Social Sciences, University of Bournemouth, Bournemouth, UK.ORCID 0000-0003-2070-8455
Missed Care Study Group

Funding

Department of Health 14/194/21Department of Health HS&DR/13/114/17
6 · The paper itself

Abstract

objectiveTo determine the association between daily levels of registered nurse (RN) and nursing assistant staffing and hospital mortality.

designThis is a retrospective longitudinal observational study using routinely collected data. We used multilevel/hierarchical mixed-effects regression models to explore the association between patient outcomes and daily variation in RN and nursing assistant staffing, measured as hours per patient per day relative to ward mean. Analyses were controlled for ward and patient risk.

participants138 133 adult patients spending >1 days on general wards between 1 April 2012 and 31 March 2015. OUTCOMES: In-hospital deaths.

resultsHospital mortality was 4.1%. The hazard of death was increased by 3% for every day a patient experienced RN staffing below ward mean (adjusted HR (aHR) 1.03, 95% CI 1.01 to 1.05). Relative to ward mean, each additional hour of RN care available over the first 5 days of a patient's stay was associated with 3% reduction in the hazard of death (aHR 0.97, 95% CI 0.94 to 1.0). Days where admissions per RN exceeded 125% of the ward mean were associated with an increased hazard of death (aHR 1.05, 95% CI 1.01 1.09). Although low nursing assistant staffing was associated with increases in mortality, high nursing assistant staffing was also associated with increased mortality.

conclusionLower RN staffing and higher levels of admissions per RN are associated with increased risk of death during an admission to hospital. These findings highlight the possible consequences of reduced nurse staffing and do not give support to policies that encourage the use of nursing assistants to compensate for shortages of RNs.

Indexed as

Hospital MortalityPersonnel Staffing and SchedulingAgedAged, 80 and overDatabases, FactualFemaleHumansLogistic ModelsLongitudinal StudiesMaleMiddle AgedNursing AssistantsNursing Staff, HospitalRetrospective StudiesUnited Kingdomhealth policyhealth services researchmortality (standardized mortality ratios)nursespatient safety

Identifiers

PMID30514780
PMCPMC6716358

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.