Observational studyBMJ open2021
Patient outcomes and cost savings associated with hospital safe nurse staffing legislation: an observational study.
Observational study in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 2 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
45 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- From Evidence to Strategic Insight: Preliminary Model Development and Validation for Exploring Potential Changes and Enhancing Nursing Work Performance.Journal of nursing management · 2026Pooled it
- Contribution of Clinical Nurses to Hospital Efficiency and Economic Sustainability: A Systematic Review.Journal of nursing management · 2025Pooled it
- Nurses' Perceptions of Individualized Care for Older Adults in the Post-COVID-19 Era: The Role of Ethical Workplace Climate.Healthcare (Basel, Switzerland) · 2026Article
- Nursing students' perspectives on implicit rationing of nursing care: Cross-sectional and cross-cultural analysis.International journal of nursing studies advances · 2026Article
- Timely hospital discharge in TAVI patients: towards a patient-centered care pathway.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Review
- The illusion of improved nurse staffing levels in South Korea during COVID-19: a statistical artifact of policy changes and declining patient volume.BMC nursing · 2026Article
- Nursing Workload and Optimal Staffing in Medical and Surgical Wards: A Time-Motion Study Using a Patient Classification System.Journal of nursing management · 2026Observational
- Longitudinal Analysis and Predictive Modeling of Nursing-Sensitive Quality Indicators in Hemodialysis.Journal of nursing management · 2026Article
- The Impact of Nursing Resources on Chronic Wound Management: A Cross-Sectional Analysis.Journal of clinical nursing · 2026Observational
- Nurse Staffing and Patient Outcomes: A Call to Action for Chronic Wound Care Policy Reform.Advances in wound care · 2025Article
- Promoting public health with blunt instruments: Evidence from vaccine mandates.Labour economics · 2025Article
- Hospital Ownership Type Correlated With Investments in Nursing Services: Evidence From Illinois.Medical care · 2025Article
- Pediatric Intensive Care Nurse Staffing Measures and Patient Outcomes During the COVID-19 Pandemic.JAMA network open · 2025Observational
- 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 · 2025Article
- Exploring critical care nurses' experiences of redeployment to general medical-surgical wards for covering staff shortages: A qualitative research study.Nursing in critical care · 2025Article
- Billing models for measuring nursing care in inpatient and outpatient settings: a scoping review.BMC health services research · 2025Article
- Impact of Nurse Staffing Levels on Patient Fall Rates: A Retrospective Cross-Sectional Study in General Wards in Japan.Healthcare (Basel, Switzerland) · 2025Article
- Influence of Nursing Time and Staffing on Medication Errors: A Cross-Sectional Analysis of Administrative Data.Nursing reports (Pavia, Italy) · 2025Article
- Unlocking the Power of Inclusive Leadership: The Moderating Role of Climate for Inclusion on Job Satisfaction and Perceived Care Quality.Journal of healthcare leadership · 2025Article
- Understanding the medical challenges for the diagnosis and treatment of bilateral pitting oedema in children: a qualitative study.PLOS global public health · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
Abstract
objectiveTo evaluate variation in Illinois hospital nurse staffing ratios and to determine whether higher nurse workloads are associated with mortality and length of stay for patients, and cost outcomes for hospitals.
designCross-sectional analysis of multiple data sources including a 2020 survey of nurses linked to patient outcomes data.
participants210 493 Medicare patients, 65 years and older, who were hospitalised in a study hospital. 1391 registered nurses employed in direct patient care on a medical-surgical unit in a study hospital.
main outcome measuresPrimary outcomes were 30-day mortality and length of stay. Deaths avoided and cost savings to hospitals were predicted based on results from regression estimates if hospitals were to have staffed at a 4:1 ratio during the study period. Cost savings were computed from reductions in lengths of stay using cost-to-charge ratios.
resultsPatient-to-nurse staffing ratios on medical-surgical units ranged from 4.2 to 7.6 (mean=5.4; SD=0.7). After adjusting for hospital and patient characteristics, the odds of 30-day mortality for each patient increased by 16% for each additional patient in the average nurse's workload (95% CI 1.04 to 1.28; p=0.006). The odds of staying in the hospital a day longer at all intervals increased by 5% for each additional patient in the nurse's workload (95% CI 1.00 to 1.09, p=0.041). If study hospitals staffed at a 4:1 ratio during the 1-year study period, more than 1595 deaths would have been avoided and hospitals would have collectively saved over $117 million.
conclusionsPatient-to-nurse staffing ratios vary considerably across Illinois hospitals. If nurses in Illinois hospital medical-surgical units cared for no more than four patients each, thousands of deaths could be avoided, and patients would experience shorter lengths of stay, resulting in cost-savings for hospitals.
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Registered trials
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