Observational studyBMJ quality & safety2021
Chronic hospital nurse understaffing meets COVID-19: an observational study.
Observational study in BMJ quality & safety, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 145 papers, 4 of them syntheses that pooled 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.
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
145 citing papers in PubMed, 4 syntheses or guidelines pooled it, 302 citations in OpenAlex.
- Impacts for health and care workers of Covid-19 and other public health emergencies of international concern: living systematic review, meta-analysis and policy recommendations.Human resources for health · 2024Pooled it
- Caregivers' experiences and perspectives on caring for the elderly during the COVID-19 pandemic: A qualitative systematic review.Journal of nursing management · 2022Pooled it
- Influencing Factors of Nurses' Well-Being in Critical Care During Pandemic Era: A Systematic Review.Public health nursing (Boston, Mass.)Pooled it
- Guideline
- Optimising Treatment Expectations Using a Video-Based Intervention in Orthopaedic Surgery: Results From a Randomised Controlled Trial.European journal of pain (London, England) · 2025Trial
- Classification of Emergency Diagnosis-Sensitive Conditions Among Medicare Beneficiaries.JAMA network open · 2026Article
- Clinician Distress in the Care of Seriously Ill Hospitalized Patients: A Mixed Methods Integration of Qualitative Findings and a Quantitative Typology.Research square · 2026Article
- Evaluating the Resilience of ICU Nurse Staffing Standard Operating Procedures Under Demand Variability: A Discrete Event Simulation Study Using MIMIC-IV.Healthcare (Basel, Switzerland) · 2026Article
- Impact of Quiet Quitting and Nursing Work Environment on Quality of Care and Patient Safety: A Cross-Sectional Study Among Nurses in Greece.Healthcare (Basel, Switzerland) · 2026Article
- Safe Minimum Nurse Staffing Requirements for Hospitals: Evidence From Pennsylvania.Medical care · 2026Observational
- Hospital-Level Nurse Communication and 30-Day Readmission in United States Acute Care Hospitals: A Cross-Sectional Centers for Medicare and Medicaid Services Hospital Compare Analysis.Nursing reports (Pavia, Italy) · 2026Article
- Implications for Virtual Nursing Role Development in Acute Nursing Care: 24-Hour Time-and-Motion Study.JMIR nursing · 2026Article
- Work environment of nurses and technicians in Brazilian Intensive Care Units during the COVID-19 pandemic: a multicenter cross-sectional study.BMC health services research · 2026Article
- The Impact of Nurse Staffing and Education on 30-Day Mortality Among Patients Hospitalized for Acute Kidney Injury.Research in nursing & health · 2026Article
- Employee Net Promoter Score Links Nursing Satisfaction to Quality of Care Before and During the COVID-19 Pandemic.Journal of nursing management · 2026Article
- Examining the Relationship Between Hospital Nurses' Structural Empowerment, Missed Nursing Care and Quality of Care: A Cross-Sectional Study.Journal of clinical nursing · 2026Article
- The Impact of Nursing Resources on Chronic Wound Management: A Cross-Sectional Analysis.Journal of clinical nursing · 2026Observational
- Modeling the disruptive impact of the COVID-19 pandemic on nurses' supply and wages.Frontiers in epidemiology · 2026Article
- Virtual Nursing for the Care of Hospitalized Patients.JAMA network open · 2025Article
- Poor Patient Care Outcomes and Nurse Job Outcomes Associated With Unfavorable Intensive Care Unit and Emergency Department Nurse Work Environments: Implications for Critical Care Medicine.Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2025Article
85 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
8 authors at 1 institution in 1 country.
Funding
Abstract
introductionEfforts to enact nurse staffing legislation often lack timely, local evidence about how specific policies could directly impact the public's health. Despite numerous studies indicating better staffing is associated with more favourable patient outcomes, only one US state (California) sets patient-to-nurse staffing standards. To inform staffing legislation actively under consideration in two other US states (New York, Illinois), we sought to determine whether staffing varies across hospitals and the consequences for patient outcomes. Coincidentally, data collection occurred just prior to the COVID-19 outbreak; thus, these data also provide a real-time example of the public health implications of chronic hospital nurse understaffing.
methodsSurvey data from nurses and patients in 254 hospitals in New York and Illinois between December 2019 and February 2020 document associations of nurse staffing with care quality, patient experiences and nurse burnout.
resultsMean staffing in medical-surgical units varied from 3.3 to 9.7 patients per nurse, with the worst mean staffing in New York City. Over half the nurses in both states experienced high burnout. Half gave their hospitals unfavourable safety grades and two-thirds would not definitely recommend their hospitals. One-third of patients rated their hospitals less than excellent and would not definitely recommend it to others. After adjusting for confounding factors, each additional patient per nurse increased odds of nurses and per cent of patients giving unfavourable reports; ORs ranged from 1.15 to 1.52 for nurses on medical-surgical units and from 1.32 to 3.63 for nurses on intensive care units.
conclusionsHospital nurses were burned out and working in understaffed conditions in the weeks prior to the first wave of COVID-19 cases, posing risks to the public's health. Such risks could be addressed by safe nurse staffing policies currently under consideration.
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What OpenQuestion holds
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.