Hospital Nurse Understaffing and Patient Mortality, Readmission, and Length of Stay

Is nurse understaffing during the day shift or evening and night shift, relative to typical ward staffing levels, associated with patient outcomes in acute care hospitals?In this cohort study of 77 289 hospital admissions across 82 wards in Japan, patients exposed to nurse understaffing during the day shift or during the 24-hour period had higher in-hospital mortality and increased readmission rates, whereas evening and night shift understaffing was not associated with these outcomes. Understaffing during the 24-hour period, as well as during the day shift and evening and night shift, was associated with longer hospital stays.These findings suggest that maintaining nurse staffing at or above the ward’s typical level for each shift, particularly during day shifts, is associated with improved patient outcomes.

Corresponding Author: Noriko Morioka, PhD, Department of Epidemiology and Biostatistics, National Institute of Public Health, Minami 2-3-6, Wako, Saitama, Japan (morioka.n.rk@niph.go.jp).

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