Evidence map›Paper›PMID 31483509›Full record

SynthesisJournal of advanced nursing2019

A quantitative systematic review of the association between nurse skill mix and nursing-sensitive patient outcomes in the acute care setting.

Diane E Twigg, Yvonne Kutzer, Elisabeth Jacob, Karla Seaman

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Journal of advanced nursing, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
27citing papers in PubMed, 5 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

27 citing papers in PubMed, 5 syntheses or guidelines pooled it.

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  16. Skill mix versus flexibility: Decoding nurse staffing impacts on critical access hospitals.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2025
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

4 authors.

Diane E TwiggSchool of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia.ORCID http://orcid.org/0000-0002-4694-4555
Yvonne KutzerSchool of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia.ORCID https://orcid.org/0000-0003-3568-5030
Elisabeth JacobSchool of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia.ORCID https://orcid.org/0000-0002-3506-8422
Karla SeamanSchool of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia.ORCID http://orcid.org/0000-0003-4611-9616

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsTo examine the association between nurse skill mix (the proportion of total hours provided by Registered Nurses) and patient outcomes in acute care hospitals.

designA quantitative systematic review included studies published in English between January 2000 - September 2018. DATA SOURCES: Cochrane Library, CINAHL Plus with Full Text, MEDLINE, Scopus, Web of Science and Joanna Briggs Institute were searched. Observational and experimental study designs were included. Mix-methods designs were included if the quantitative component met the criteria. REVIEW

methodsThe Systematic Review guidelines of the Joanna Briggs Institute and its critical appraisal instrument were used. An inverse association was determined when seventy-five percent or more of studies with significant results found this association.

resultsSixty-three articles were included. Twelve patient outcomes were inversely associated with nursing skill mix (i.e., higher nursing skill mix was significantly associated with improved patient outcomes). These were length of stay; ulcer, gastritis and upper gastrointestinal bleeds; acute myocardial infarction; restraint use; failure-to-rescue; pneumonia; sepsis; urinary tract infection; mortality/30-day mortality; pressure injury; infections and shock/cardiac arrest/heart failure.

conclusionNursing skill mix affected 12 patient outcomes. However, further investigation using experimental or longitudinal study designs are required to establish causal relationships. Consensus on the definition of skill mix is required to enable more robust evaluation of the impact of changes in skill mix on patient outcomes. IMPACT: Skill mix is perhaps more important than the number of nurses in reducing adverse patient outcomes such as mortality and failure to rescue, albeit the optimal staffing profile remains elusive in workforce planning.

Indexed as

Clinical CompetenceNurse-Patient RelationsTreatment OutcomeHumansNursing Staff, Hospitalnursesnursing outcomesoutcome assessmentoutcomes (health care)outcomes researchpatient outcome assessmentreviewskill mixsystematic reviewtreatment outcome

Identifiers

PMID31483509
PMCPMC6899638

What OpenQuestion holds

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LicenceCC BY
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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.