Evidence map›Paper›PMID 42060836›Full record

Observational studyMedical care2026

Safe Minimum Nurse Staffing Requirements for Hospitals: Evidence From Pennsylvania.

K Jane Muir, Linda H Aiken, Heather Brom, Vaneh Hovsepian, Karen B Lasater, Matthew D McHugh

Abstract readObservational Study
In one paragraph

Observational study in Medical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–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

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

K Jane MuirCenter for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA.ORCID 0000-0003-0815-1340
Linda H AikenCenter for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA.
Heather BromCenter for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA.
Vaneh HovsepianUniversity of Massachusetts Dartmouth, College of Nursing and Health Sciences, Dartmouth, MA.
Karen B LasaterCenter for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA.
Matthew D McHughCenter for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA.

Funding

The Impact of Changes in Nursing Systems and Models of Care on Patient Outcomes: A Panel StudyR01NR014855 · NINR · UNIVERSITY OF PENNSYLVANIA · PI Matthew D. McHugh · 2014 to 2026
$7.5M
Identifying Nursing Models of Care to Improve Emergency Department Patient OutcomesK01NR021419 · NINR · UNIVERSITY OF PENNSYLVANIA · PI Kathryn Jane Muir · 2025 to 2026
$337k
NINR NIH HHS K01 NR021419NINR NIH HHS R01 NR014855
6 · The paper itself

Abstract

backgroundThe Pennsylvania legislature is considering limiting the number of patients nurses care for to promote safe care.

objectiveTo determine whether variation in nurse workloads is associated with adverse consequences for patients, nurses, and hospital costs in Pennsylvania.

methodsObservational study of 547,689 medical and surgical patients and 2782 direct care nurses in 132 Pennsylvania hospitals. The independent variable was medical-surgical nurse staffing ratios. Patient outcomes included 30-day mortality, 30-day readmissions, and length of stay. Nurse outcomes included burnout, job dissatisfaction, intent to leave, and evaluations of hospital management and patient care. Hospital outcomes were HCAHPS Star Ratings and cost offsets associated with better staffing.

resultsHospital nurse staffing ranged from 3 to 9 patients per nurse (average 5.9). Each additional patient per nurse was associated with higher odds of 30-day mortality (AOR: 1.08, 95% CI: 1.03, 1.13, P <0.001), longer length of stay (IRR: 1.02, 95% CI: 1.00, 1.04, P <0.05) and higher odds of readmission (AOR: 1.04, 95% CI: 1.01, 1.07, P <0.05). Worse staffing was associated with higher odds of nurse burnout, job dissatisfaction, and intent to leave, and lower patient satisfaction. Cost savings from patient outcomes and nurse retention were projected to offset costs of additional nurses needed for hospitals to meet a minimum safe nurse staffing level proposed in legislation.

conclusionsLarge differences across Pennsylvania hospitals in the amount of nursing care patients receive are associated with negative consequences. A state policy establishing minimum safe nurse staffing requirements in hospitals is in the public's interest.

Indexed as

Nursing Staff, HospitalPatient SafetyPersonnel Staffing and SchedulingAdultBurnout, ProfessionalFemaleHospital MortalityHumansJob SatisfactionLength of StayMaleMiddle AgedPatient ReadmissionPennsylvaniaWorkloadhospitalnursestaffing

Identifiers

PMID42060836
PMCPMC13245930

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LicenceCC BY-NC-ND
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Registered trials

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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.