Patient outcomes and cost savings associated with hospital safe nurse staffing legislation: an observational study

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...

Celý popis

Uložené v:
Podrobná bibliografia
Vydané v:BMJ open Ročník 11; číslo 12; s. e052899
Hlavní autori: Lasater, Karen B, Aiken, Linda H, Sloane, Douglas, French, Rachel, Martin, Brendan, Alexander, Maryann, McHugh, Matthew D
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: England British Medical Journal Publishing Group 08.12.2021
BMJ Publishing Group LTD
BMJ Publishing Group
Edícia:Original research
Predmet:
ISSN:2044-6055, 2044-6055
On-line prístup:Získať plný text
Tagy: Pridať tag
Žiadne tagy, Buďte prvý, kto otaguje tento záznam!
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.Setting: 87 acute care hospitals in Illinois.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.
AbstractList 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.Setting: 87 acute care hospitals in Illinois.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.
To 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.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.Cross-sectional analysis of multiple data sources including a 2020 survey of nurses linked to patient outcomes data.Setting: 87 acute care hospitals in Illinois.DESIGNCross-sectional analysis of multiple data sources including a 2020 survey of nurses linked to patient outcomes data.Setting: 87 acute care hospitals in Illinois.210 493 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.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.Primary 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.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.Patient-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.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.Patient-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.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.
To 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. Cross-sectional analysis of multiple data sources including a 2020 survey of nurses linked to patient outcomes data. : 87 acute care hospitals in Illinois. 210 493 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. Primary 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. Patient-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. Patient-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.
Objective To 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.Design Cross-sectional analysis of multiple data sources including a 2020 survey of nurses linked to patient outcomes data.Setting: 87 acute care hospitals in Illinois.Participants 210 493 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 measures Primary 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.Results Patient-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.Conclusions Patient-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.
Author Martin, Brendan
French, Rachel
Aiken, Linda H
Sloane, Douglas
McHugh, Matthew D
Lasater, Karen B
Alexander, Maryann
AuthorAffiliation 1 Center for Health Outcomes and Policy Research, School of Nursing , University of Pennsylvania , Philadelphia , Pennsylvania , USA
3 National Council of State Boards of Nursing , Chicago , Illinois , USA
2 Leonard Davis Institute of Health Economics , University of Pennsylvania , Philadelphia , Pennsylvania , USA
AuthorAffiliation_xml – name: 2 Leonard Davis Institute of Health Economics , University of Pennsylvania , Philadelphia , Pennsylvania , USA
– name: 3 National Council of State Boards of Nursing , Chicago , Illinois , USA
– name: 1 Center for Health Outcomes and Policy Research, School of Nursing , University of Pennsylvania , Philadelphia , Pennsylvania , USA
Author_xml – sequence: 1
  givenname: Karen B
  orcidid: 0000-0002-5834-1954
  surname: Lasater
  fullname: Lasater, Karen B
  email: karenbl@nursing.upenn.edu
  organization: Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
– sequence: 2
  givenname: Linda H
  orcidid: 0000-0001-8004-3630
  surname: Aiken
  fullname: Aiken, Linda H
  organization: Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
– sequence: 3
  givenname: Douglas
  surname: Sloane
  fullname: Sloane, Douglas
  organization: Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
– sequence: 4
  givenname: Rachel
  surname: French
  fullname: French, Rachel
  organization: Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
– sequence: 5
  givenname: Brendan
  surname: Martin
  fullname: Martin, Brendan
  organization: National Council of State Boards of Nursing, Chicago, Illinois, USA
– sequence: 6
  givenname: Maryann
  surname: Alexander
  fullname: Alexander, Maryann
  organization: National Council of State Boards of Nursing, Chicago, Illinois, USA
– sequence: 7
  givenname: Matthew D
  orcidid: 0000-0002-1263-0697
  surname: McHugh
  fullname: McHugh, Matthew D
  organization: Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
BackLink https://www.ncbi.nlm.nih.gov/pubmed/34880022$$D View this record in MEDLINE/PubMed
BookMark eNp9kk1v1DAQhi1URD_oL0BCkbhwCbXHH-twQEIVlEqV4NC75Tj2rldJvNjOov57nGYLbQ_1xfbM-z4azcwpOhrDaBF6R_AnQqi4aIdt2NmxBgykxhxk07xCJ4AZqwXm_OjR-xidp7TF5TDecA5v0DFlUmIMcILiL529HXMVpmzCYFOlx64yIeUq6b0f1yWQUjBeZ9tVf3zeVJuQdj7rvgicrcYpJlulrJ0r6qq3a5_6wgzj54KqQpts3N__Z0eeuru36LXTfbLnh_sM3X7_dnv5o775eXV9-fWmbjltci1BGmB65aBbUaG1oFzqTjoN4EBQ0llmpOMrx3HLqAUjjdBCOyk6yRmmZ-h6wXZBb9Uu-kHHOxW0V_eBENdKx-xNb5UUmLUUC9w4YJhRaUECAUkEYY4xKKwvC2s3tYPtTGlY1P0T6NPM6DdqHfaFzDmXM-DjARDD78mmrAafjO17PdowJQWCcEIaDk2Rfngm3YYplu7NKrxqJMGUFNX7xxX9K-VhskXQLAITQ0rROmXK0OY5lAJ9rwhW8yKpwyKpeZHUskjFS595H_Avuy4WV0n-r_klx1-ypt3V
CitedBy_id crossref_primary_10_1097_jnr_0000000000000615
crossref_primary_10_62116_MSJ_2024_33_2_79
crossref_primary_10_1002_wmh3_581
crossref_primary_10_1097_JHM_D_22_00176
crossref_primary_10_1097_JHM_D_22_00170
crossref_primary_10_1097_AS9_0000000000000185
crossref_primary_10_3390_healthcare13010088
crossref_primary_10_1016_j_outlook_2025_102448
crossref_primary_10_1002_nop2_70040
crossref_primary_10_1155_2024_4796716
crossref_primary_10_1097_nmg_0000000000000103
crossref_primary_10_1186_s12913_024_12116_3
crossref_primary_10_1016_j_ijnurstu_2024_104830
crossref_primary_10_1016_j_enfcle_2025_102124
crossref_primary_10_1016_j_enfie_2025_500535
crossref_primary_10_1016_j_outlook_2025_102356
crossref_primary_10_1080_26895269_2025_2456548
crossref_primary_10_3390_nursrep15010012
crossref_primary_10_1001_jamanetworkopen_2025_15376
crossref_primary_10_3390_ijerph21101284
crossref_primary_10_1016_j_iccn_2022_103265
crossref_primary_10_1016_j_labeco_2025_102715
crossref_primary_10_1016_j_gaceta_2024_102376
crossref_primary_10_1155_jonm_3332688
crossref_primary_10_1016_j_healthpol_2022_11_013
crossref_primary_10_2478_sjph_2023_0023
crossref_primary_10_1136_bmj_2024_079987
crossref_primary_10_1016_j_outlook_2024_102346
crossref_primary_10_1155_nuf_2130414
crossref_primary_10_4236_ojn_2025_157036
crossref_primary_10_1097_NNA_0000000000001449
crossref_primary_10_1161_CIRCHEARTFAILURE_122_010456
crossref_primary_10_1097_MLR_0000000000002148
crossref_primary_10_1007_s00520_023_07633_6
crossref_primary_10_1155_2024_2554273
crossref_primary_10_3390_nursrep14040241
crossref_primary_10_1186_s12912_024_01995_w
crossref_primary_10_1186_s12912_024_01766_7
crossref_primary_10_1186_s12913_023_10452_4
crossref_primary_10_1111_jocn_16835
crossref_primary_10_1111_jocn_17804
crossref_primary_10_1097_JHQ_0000000000000483
crossref_primary_10_1016_j_ijnurstu_2025_105146
crossref_primary_10_3390_jcm13164747
crossref_primary_10_1016_j_jss_2024_01_016
crossref_primary_10_1016_j_ijnurstu_2024_104749
crossref_primary_10_1097_NNA_0000000000001611
crossref_primary_10_1093_ejcts_ezae402
crossref_primary_10_1177_09697330241312381
crossref_primary_10_2478_sjph_2023_0009
crossref_primary_10_1097_NNA_0000000000001490
crossref_primary_10_1136_bmjopen_2022_066813
crossref_primary_10_1016_j_enfi_2025_500535
crossref_primary_10_1016_j_outlook_2022_11_007
crossref_primary_10_1097_JPN_0000000000000813
crossref_primary_10_1111_1475_6773_14076
crossref_primary_10_1186_s12913_024_11625_5
crossref_primary_10_1016_j_enfcli_2024_06_004
crossref_primary_10_1097_JPN_0000000000000859
Cites_doi 10.3390/ijerph18020610
10.1097/00005650-199801000-00004
10.1111/j.1468-0009.2011.00658.x
10.1136/bmjqs-2018-008043
10.1111/j.1475-6773.2010.01114.x
10.1001/jamapediatrics.2013.18
10.1097/MLR.0000000000001167
10.1136/bmjqs-2012-001610
10.1097/MLR.0000000000001519
10.1016/S0140-6736(13)62631-8
10.7326/0003-4819-158-5-201303051-00007
10.1001/jama.285.3.297
10.1016/j.ajic.2020.12.002
10.1001/jama.288.16.1987
10.1007/s11606-020-06151-z
10.1111/j.1547-5069.2011.01403.x
10.1016/S2214-109X(21)00209-6
10.1111/j.1532-5415.2012.03990.x
10.1111/j.1365-2834.2012.01411.x
10.1037/0021-9010.69.4.673
10.1097/MLR.0000000000001002
10.1001/jamasurg.2015.4908
10.1136/bmjqs-2019-010534
10.1111/j.1475-6773.2012.01465.x
10.1002/job.4030160308
10.1111/jgs.14367
10.1016/S0140-6736(21)00768-6
10.1111/jan.12483
10.1093/intqhc/mzq067
10.1056/NEJMsa1001025
10.1377/hlthaff.25.1.204
10.1016/j.ijnurstu.2016.03.012
10.1097/MLR.0000000000001464
10.1136/bmjqs-2020-011512
10.1056/NEJMsa012247
10.1136/bmjopen-2019-036264
10.1111/1475-6773.12462
10.1016/j.outlook.2017.12.002
10.1016/j.ajic.2012.02.029
10.1097/MLR.0000000000000456
10.1037//0021-9010.69.4.673
ContentType Journal Article
Copyright Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
2021 Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2021
Copyright_xml – notice: Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
– notice: 2021 Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
– notice: Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2021
DBID 9YT
ACMMV
AAYXX
CITATION
CGR
CUY
CVF
ECM
EIF
NPM
3V.
7RV
7X7
7XB
88E
88G
8FI
8FJ
8FK
ABUWG
AFKRA
AZQEC
BENPR
BTHHO
CCPQU
COVID
DWQXO
FYUFA
GHDGH
GNUQQ
K9-
K9.
KB0
M0R
M0S
M1P
M2M
NAPCQ
PHGZM
PHGZT
PIMPY
PJZUB
PKEHL
PPXIY
PQEST
PQQKQ
PQUKI
PRINS
PSYQQ
Q9U
7X8
5PM
DOA
DOI 10.1136/bmjopen-2021-052899
DatabaseName BMJ Open Access Journals
BMJ Journals:Open Access
CrossRef
Medline
MEDLINE
MEDLINE (Ovid)
MEDLINE
MEDLINE
PubMed
ProQuest Central (Corporate)
Nursing & Allied Health Database
Health & Medical Collection
ProQuest Central (purchase pre-March 2016)
Medical Database (Alumni Edition)
Psychology Database (Alumni)
Hospital Premium Collection
Hospital Premium Collection (Alumni Edition)
ProQuest Central (Alumni) (purchase pre-March 2016)
ProQuest Central (Alumni)
ProQuest Central
ProQuest Central Essentials - QC
ProQuest Central
BMJ Journals
ProQuest One Community College
Coronavirus Research Database
ProQuest Central Korea
Health Research Premium Collection
Health Research Premium Collection (Alumni)
ProQuest Central Student
Consumer Health Database
ProQuest Health & Medical Complete (Alumni)
Nursing & Allied Health Database (Alumni Edition)
Consumer Health Database (ProQuest)
ProQuest Health & Medical Collection
Medical Database
Psychology Database
Nursing & Allied Health Premium
ProQuest One Academic
ProQuest One Academic
Publicly Available Content Database
ProQuest Health & Medical Research Collection
ProQuest One Academic Middle East (New)
ProQuest One Health & Nursing
ProQuest One Academic Eastern Edition (DO NOT USE)
ProQuest One Academic (retired)
ProQuest One Academic UKI Edition
ProQuest Central China
ProQuest One Psychology
ProQuest Central Basic
MEDLINE - Academic
PubMed Central (Full Participant titles)
DOAJ Directory of Open Access Journals
DatabaseTitle CrossRef
MEDLINE
Medline Complete
MEDLINE with Full Text
PubMed
MEDLINE (Ovid)
Publicly Available Content Database
ProQuest One Psychology
ProQuest Central Student
ProQuest One Academic Middle East (New)
ProQuest Central Essentials
ProQuest Health & Medical Complete (Alumni)
ProQuest Central (Alumni Edition)
ProQuest One Community College
ProQuest One Health & Nursing
ProQuest Family Health (Alumni Edition)
ProQuest Central China
ProQuest Central
ProQuest Health & Medical Research Collection
Health Research Premium Collection
Health and Medicine Complete (Alumni Edition)
ProQuest Central Korea
Health & Medical Research Collection
ProQuest Central (New)
ProQuest Medical Library (Alumni)
ProQuest Central Basic
ProQuest Family Health
ProQuest One Academic Eastern Edition
Coronavirus Research Database
ProQuest Nursing & Allied Health Source
ProQuest Hospital Collection
Health Research Premium Collection (Alumni)
ProQuest Psychology Journals (Alumni)
ProQuest Hospital Collection (Alumni)
Nursing & Allied Health Premium
ProQuest Health & Medical Complete
ProQuest Medical Library
ProQuest Psychology Journals
ProQuest One Academic UKI Edition
BMJ Journals
ProQuest Nursing & Allied Health Source (Alumni)
ProQuest One Academic
ProQuest One Academic (New)
ProQuest Central (Alumni)
MEDLINE - Academic
DatabaseTitleList
MEDLINE - Academic
MEDLINE

Publicly Available Content Database
Database_xml – sequence: 1
  dbid: DOA
  name: DOAJ Directory of Open Access Journals
  url: https://www.doaj.org/
  sourceTypes: Open Website
– sequence: 2
  dbid: NPM
  name: PubMed
  url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
  sourceTypes: Index Database
– sequence: 3
  dbid: 7RV
  name: Nursing & Allied Health Database
  url: https://search.proquest.com/nahs
  sourceTypes: Aggregation Database
DeliveryMethod fulltext_linktorsrc
Discipline Medicine
Nursing
EISSN 2044-6055
ExternalDocumentID oai_doaj_org_article_8604b30609f240438e2821281614f442
PMC8655582
34880022
10_1136_bmjopen_2021_052899
bmjopen
Genre Journal Article
Observational Study
Research Support, N.I.H., Extramural
GeographicLocations United States
New York
California
United States--US
Illinois
GeographicLocations_xml – name: United States
– name: New York
– name: California
– name: United States--US
– name: Illinois
GrantInformation_xml – fundername: National Institute of Nursing Research, National Institutes of Health
  grantid: R01NR014855; T32NR007104
– fundername: National Council of State Boards of Nursing
  grantid: N/A
  funderid: http://dx.doi.org/10.13039/100013902
– fundername: NINR NIH HHS
  grantid: T32 NR007104
– fundername: NINR NIH HHS
  grantid: R01 NR014855
– fundername: ;
  grantid: N/A
– fundername: ;
  grantid: R01NR014855; T32NR007104
GroupedDBID ---
4.4
53G
5VS
7RV
7X7
7~R
88E
8FI
8FJ
9YT
ABUWG
ACGFS
ACMMV
ADBBV
AENEX
AFKRA
ALIPV
ALMA_UNASSIGNED_HOLDINGS
AOIJS
AZQEC
BAWUL
BCNDV
BENPR
BKNYI
BPHCQ
BTFSW
BTHHO
CCPQU
DIK
DWQXO
EBS
FYUFA
GNUQQ
GROUPED_DOAJ
GX1
H13
HMCUK
HYE
HZ~
K9-
KQ8
M0R
M1P
M2M
M48
M~E
NAPCQ
O9-
OK1
PGMZT
PHGZT
PIMPY
PQQKQ
PROAC
PSQYO
PSYQQ
RHI
RMJ
RPM
UKHRP
AAYXX
ADRAZ
AFFHD
BVXVI
CITATION
EJD
PHGZM
PJZUB
PPXIY
3V.
CGR
CUY
CVF
ECM
EIF
NPM
RHF
7XB
8FK
COVID
K9.
PKEHL
PQEST
PQUKI
PRINS
Q9U
7X8
5PM
ID FETCH-LOGICAL-b539t-828c24a7f2d736aa6358ad8fa22f2631de4c8f57f50b43e2c8c6a6af86d85403
IEDL.DBID BENPR
ISICitedReferencesCount 63
ISICitedReferencesURI http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=000728888800001&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D
ISSN 2044-6055
IngestDate Fri Oct 03 12:42:26 EDT 2025
Tue Nov 04 01:45:02 EST 2025
Sun Nov 09 10:17:06 EST 2025
Tue Oct 07 07:07:02 EDT 2025
Thu Jan 02 22:54:46 EST 2025
Sat Nov 29 07:08:12 EST 2025
Tue Nov 18 21:53:54 EST 2025
Thu Apr 24 22:50:36 EDT 2025
IsDoiOpenAccess true
IsOpenAccess true
IsPeerReviewed true
IsScholarly true
Issue 12
Keywords health policy
organisation of health services
quality in health care
health & safety
health services administration & management
Language English
License This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
LinkModel DirectLink
MergedId FETCHMERGED-LOGICAL-b539t-828c24a7f2d736aa6358ad8fa22f2631de4c8f57f50b43e2c8c6a6af86d85403
Notes Original research
ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 14
content type line 23
ObjectType-Undefined-3
ORCID 0000-0002-1263-0697
0000-0002-5834-1954
0000-0001-8004-3630
OpenAccessLink https://www.proquest.com/docview/2607981031?pq-origsite=%requestingapplication%
PMID 34880022
PQID 2607981031
PQPubID 2040975
ParticipantIDs doaj_primary_oai_doaj_org_article_8604b30609f240438e2821281614f442
pubmedcentral_primary_oai_pubmedcentral_nih_gov_8655582
proquest_miscellaneous_2615119529
proquest_journals_2607981031
pubmed_primary_34880022
crossref_citationtrail_10_1136_bmjopen_2021_052899
crossref_primary_10_1136_bmjopen_2021_052899
bmj_journals_10_1136_bmjopen_2021_052899
PublicationCentury 2000
PublicationDate 20211208
PublicationDateYYYYMMDD 2021-12-08
PublicationDate_xml – month: 12
  year: 2021
  text: 20211208
  day: 8
PublicationDecade 2020
PublicationPlace England
PublicationPlace_xml – name: England
– name: London
– name: BMA House, Tavistock Square, London, WC1H 9JR
PublicationSeriesTitle Original research
PublicationTitle BMJ open
PublicationTitleAbbrev BMJ Open
PublicationTitleAlternate BMJ Open
PublicationYear 2021
Publisher British Medical Journal Publishing Group
BMJ Publishing Group LTD
BMJ Publishing Group
Publisher_xml – name: British Medical Journal Publishing Group
– name: BMJ Publishing Group LTD
– name: BMJ Publishing Group
References Lasater, Aiken, Sloane (R21) 2021; 59
Schlak, Aiken, Chittams (R37) 2021; 18
Jha, Shlipak, Hosmer (R44) 2001; 285
Griffiths, Maruotti, Recio Saucedo (R2) 2019; 28
Aiken, Sloane, Cimiotti (R5) 2010; 45
Needleman, Buerhaus, Stewart (R26) 2006; 25
McHugh, Brooks Carthon, Sloane (R27) 2012; 90
Sloane, Smith, McHugh (R43) 2018; 56
Li, Jones (R42) 2013; 21
Aiken, Simonetti, Sloane (R34) 2021; 9
Griffiths, Ball, Drennan (R1) 2016; 63
Duffield, Roche, Homer (R41) 2014; 70
Brooks Carthon, Brom, McHugh (R19) 2021; 59
Lasater, Jarrín, Aiken (R29) 2019; 57
Aiken, Clarke, Sloane (R10) 2002; 288
Brooks-Carthon, Kutney-Lee, Sloane (R18) 2011; 43
Elixhauser, Steiner, Harris (R31) 1998; 36
McHugh, Aiken, Sloane (R33) 2021; 397
Krausz, Koslowsky, Shalom (R39) 1995; 16
Lasater, Aiken, Sloane (R32) 2021; 59
Martsolf, Gibson, Benevent (R3) 2016; 51
Shekelle (R4) 2013; 158
McHugh, Shang, Sloane (R8) 2011; 23
Lasater, McHugh (R9) 2016; 64
Carthon, Kutney-Lee, Jarrín (R17) 2012; 60
Rogowski, Staiger, Patrick (R15) 2013; 167
Lasater, McHugh, Rosenbaum (R25) 2021; 30
Needleman, Buerhaus, Mattke (R13) 2002; 346
Lasater, Sloane, McHugh (R22) 2021; 49
Shin, Park, Bae (R36) 2018; 66
Needleman, Buerhaus, Pankratz (R14) 2011; 364
Lasater, McHugh, Rosenbaum (R23) 2021; 36
Aiken, Sloane, Bruyneel (R11) 2014; 383
Silber, Rosenbaum, McHugh (R24) 2016; 151
(R45) 2019
Steel, Ovalle (R40) 1984; 69
Cimiotti, Aiken, Sloane (R7) 2012; 40
Tubbs-Cooley, Cimiotti, Silber (R16) 2013; 22
Lasater, Aiken, Sloane (R20) 2021; 30
McHugh, Rochman, Sloane (R12) 2016; 54
Mark, Harless, Spetz (R28) 2013; 48
McHugh, Aiken, Windsor (R35) 2020; 10
2025101812291942000_11.12.e052899.7
Sloane (2025101812291942000_11.12.e052899.43) 2018; 56
2025101812291942000_11.12.e052899.8
2025101812291942000_11.12.e052899.5
2025101812291942000_11.12.e052899.6
2025101812291942000_11.12.e052899.4
2025101812291942000_11.12.e052899.1
2025101812291942000_11.12.e052899.2
Lasater (2025101812291942000_11.12.e052899.20) 2021; 30
Lasater (2025101812291942000_11.12.e052899.29) 2019; 57
2025101812291942000_11.12.e052899.42
2025101812291942000_11.12.e052899.41
Lasater (2025101812291942000_11.12.e052899.32) 2021; 59
2025101812291942000_11.12.e052899.40
McHugh (2025101812291942000_11.12.e052899.33) 2021; 397
2025101812291942000_11.12.e052899.13
2025101812291942000_11.12.e052899.35
2025101812291942000_11.12.e052899.12
2025101812291942000_11.12.e052899.11
2025101812291942000_11.12.e052899.10
2025101812291942000_11.12.e052899.17
Lasater (2025101812291942000_11.12.e052899.21) 2021; 59
2025101812291942000_11.12.e052899.39
Lasater (2025101812291942000_11.12.e052899.9) 2016; 64
2025101812291942000_11.12.e052899.16
Brooks Carthon (2025101812291942000_11.12.e052899.19) 2021; 59
2025101812291942000_11.12.e052899.38
2025101812291942000_11.12.e052899.36
Lasater (2025101812291942000_11.12.e052899.22) 2021; 49
Brooks-Carthon (2025101812291942000_11.12.e052899.18) 2011; 43
Needleman (2025101812291942000_11.12.e052899.14) 2011; 364
Silber (2025101812291942000_11.12.e052899.24) 2016; 151
Lasater (2025101812291942000_11.12.e052899.23) 2021; 36
Rogowski (2025101812291942000_11.12.e052899.15) 2013; 167
Lasater (2025101812291942000_11.12.e052899.25) 2021; 30
2025101812291942000_11.12.e052899.31
2025101812291942000_11.12.e052899.30
Martsolf (2025101812291942000_11.12.e052899.3) 2016; 51
2025101812291942000_11.12.e052899.46
2025101812291942000_11.12.e052899.45
Schlak (2025101812291942000_11.12.e052899.37) 2021; 18
2025101812291942000_11.12.e052899.44
2025101812291942000_11.12.e052899.28
2025101812291942000_11.12.e052899.27
2025101812291942000_11.12.e052899.26
2025101812291942000_11.12.e052899.47
Aiken (2025101812291942000_11.12.e052899.34) 2021; 9
References_xml – volume: 18
  start-page: 610
  year: 2021
  ident: R37
  article-title: Leveraging the work environment to minimize the negative impact of nurse burnout on patient outcomes
  publication-title: Int J Environ Res Public Health
  doi: 10.3390/ijerph18020610
– volume: 36
  start-page: 8
  year: 1998
  ident: R31
  article-title: Comorbidity measures for use with administrative data
  publication-title: Med Care
  doi: 10.1097/00005650-199801000-00004
– volume: 90
  start-page: 160
  year: 2012
  ident: R27
  article-title: Impact of nurse staffing mandates on safety-net hospitals: lessons from California
  publication-title: Milbank Q
  doi: 10.1111/j.1468-0009.2011.00658.x
– volume: 28
  start-page: 609
  year: 2019
  ident: R2
  article-title: Nurse staffing, nursing assistants and hospital mortality: retrospective longitudinal cohort study
  publication-title: BMJ Qual Saf
  doi: 10.1136/bmjqs-2018-008043
– volume: 45
  start-page: 904
  year: 2010
  ident: R5
  article-title: Implications of the California nurse staffing mandate for other states
  publication-title: Health Serv Res
  doi: 10.1111/j.1475-6773.2010.01114.x
– volume: 167
  start-page: 444
  year: 2013
  ident: R15
  article-title: Nurse staffing and NICU infection rates
  publication-title: JAMA Pediatr
  doi: 10.1001/jamapediatrics.2013.18
– volume: 57
  start-page: 742
  year: 2019
  ident: R29
  article-title: A methodology for studying organizational performance
  publication-title: Med Care
  doi: 10.1097/MLR.0000000000001167
– volume: 22
  start-page: 735
  year: 2013
  ident: R16
  article-title: An observational study of nurse staffing ratios and hospital readmission among children admitted for common conditions
  publication-title: BMJ Qual Saf
  doi: 10.1136/bmjqs-2012-001610
– volume: 59
  start-page: 444
  year: 2021
  ident: R32
  article-title: Is Hospital nurse staffing legislation in the public's interest?: an observational study in New York state
  publication-title: Med Care
  doi: 10.1097/MLR.0000000000001519
– volume: 383
  start-page: 1824
  year: 2014
  ident: R11
  article-title: Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study
  publication-title: Lancet
  doi: 10.1016/S0140-6736(13)62631-8
– volume: 158
  start-page: 404
  year: 2013
  ident: R4
  article-title: Nurse-patient ratios as a patient safety strategy: a systematic review
  publication-title: Ann Intern Med
  doi: 10.7326/0003-4819-158-5-201303051-00007
– volume: 285
  start-page: 297
  year: 2001
  ident: R44
  article-title: Racial differences in mortality among men hospitalized in the Veterans Affairs health care system
  publication-title: JAMA
  doi: 10.1001/jama.285.3.297
– volume: 49
  year: 2021
  ident: R22
  article-title: Evaluation of hospital nurse-to-patient staffing ratios and sepsis bundles on patient outcomes
  publication-title: Am J Infect Control
  doi: 10.1016/j.ajic.2020.12.002
– volume: 288
  start-page: 1987
  year: 2002
  ident: R10
  article-title: Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction
  publication-title: JAMA
  doi: 10.1001/jama.288.16.1987
– volume: 36
  start-page: 84
  year: 2021
  ident: R23
  article-title: Evaluating the costs and outcomes of hospital nursing resources: a matched cohort study of patients with common medical conditions
  publication-title: J Gen Intern Med
  doi: 10.1007/s11606-020-06151-z
– volume: 43
  start-page: 301
  year: 2011
  ident: R18
  article-title: Quality of care and patient satisfaction in hospitals with high concentrations of black patients
  publication-title: J Nurs Scholarsh
  doi: 10.1111/j.1547-5069.2011.01403.x
– volume: 9
  start-page: e1145
  year: 2021
  ident: R34
  article-title: Hospital nurse staffing and patient outcomes in Chile: a multilevel cross-sectional study
  publication-title: Lancet Glob Health
  doi: 10.1016/S2214-109X(21)00209-6
– year: 2019
  ident: R45
  article-title: National Council of state boards of nursing
  publication-title: NCLEX Examination Statistics in NCSBN Research Brief
– volume: 60
  start-page: 1078
  year: 2012
  ident: R17
  article-title: Nurse staffing and postsurgical outcomes in black adults
  publication-title: J Am Geriatr Soc
  doi: 10.1111/j.1532-5415.2012.03990.x
– volume: 21
  start-page: 405
  year: 2013
  ident: R42
  article-title: A literature review of nursing turnover costs
  publication-title: J Nurs Manag
  doi: 10.1111/j.1365-2834.2012.01411.x
– volume: 69
  start-page: 673
  year: 1984
  ident: R40
  article-title: A review and meta-analysis of research on the relationship between behavioral intentions and employee turnover
  publication-title: J Appl Psychol
  doi: 10.1037/0021-9010.69.4.673
– volume: 56
  start-page: 1001
  year: 2018
  ident: R43
  article-title: Effect of changes in hospital nursing resources on improvements in patient safety and quality of care: a panel study
  publication-title: Med Care
  doi: 10.1097/MLR.0000000000001002
– volume: 151
  start-page: 527
  year: 2016
  ident: R24
  article-title: Comparison of the value of nursing work environments in hospitals across different levels of patient risk
  publication-title: JAMA Surg
  doi: 10.1001/jamasurg.2015.4908
– volume: 30
  start-page: 46-55
  year: 2021
  ident: R25
  article-title: Valuing Hospital investments in nursing: multistate matched-cohort study of surgical patients
  publication-title: BMJ Qual Saf
  doi: 10.1136/bmjqs-2019-010534
– volume: 48
  start-page: 435
  year: 2013
  ident: R28
  article-title: California's minimum nurse staffing legislation: results from a natural experiment
  publication-title: Health Serv Res
  doi: 10.1111/j.1475-6773.2012.01465.x
– volume: 59
  year: 2021
  ident: R21
  article-title: Is Hospital nurse staffing legislation in the public's interest?: an observational study in New York state
  publication-title: Med Care
  doi: 10.1097/MLR.0000000000001519
– volume: 16
  start-page: 277
  year: 1995
  ident: R39
  article-title: Predictors of intentions to leave the ward, the hospital, and the nursing profession: a longitudinal study
  publication-title: J Organ Behav
  doi: 10.1002/job.4030160308
– volume: 64
  start-page: 2593
  year: 2016
  ident: R9
  article-title: Reducing hospital readmission disparities of older black and white adults after elective joint replacement: the role of nurse staffing
  publication-title: J Am Geriatr Soc
  doi: 10.1111/jgs.14367
– volume: 397
  start-page: 1905
  year: 2021
  ident: R33
  article-title: Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals
  publication-title: The Lancet
  doi: 10.1016/S0140-6736(21)00768-6
– volume: 70
  start-page: 2703
  year: 2014
  ident: R41
  article-title: A comparative review of nurse turnover rates and costs across countries
  publication-title: J Adv Nurs
  doi: 10.1111/jan.12483
– volume: 23
  start-page: 44
  year: 2011
  ident: R8
  article-title: Risk factors for hospital-acquired 'poor glycemic control': a case-control study
  publication-title: Int J Qual Health Care
  doi: 10.1093/intqhc/mzq067
– volume: 364
  start-page: 1037
  year: 2011
  ident: R14
  article-title: Nurse staffing and inpatient hospital mortality
  publication-title: N Engl J Med Overseas Ed
  doi: 10.1056/NEJMsa1001025
– volume: 25
  start-page: 204
  year: 2006
  ident: R26
  article-title: Nurse staffing in hospitals: is there a business case for quality?
  publication-title: Health Aff
  doi: 10.1377/hlthaff.25.1.204
– volume: 63
  start-page: 213
  year: 2016
  ident: R1
  article-title: Nurse staffing and patient outcomes: strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for health and care excellence safe staffing Guideline development
  publication-title: Int J Nurs Stud
  doi: 10.1016/j.ijnurstu.2016.03.012
– volume: 59
  start-page: 169
  year: 2021
  ident: R19
  article-title: Better nurse staffing is associated with survival for Black patients and diminishes racial disparities in survival after in-hospital cardiac arrests
  publication-title: Med Care
  doi: 10.1097/MLR.0000000000001464
– volume: 30
  start-page: 639-647
  year: 2021
  ident: R20
  article-title: Chronic Hospital nurse understaffing meets COVID-19: an observational study
  publication-title: BMJ Qual Saf
  doi: 10.1136/bmjqs-2020-011512
– volume: 346
  start-page: 1715
  year: 2002
  ident: R13
  article-title: Nurse-staffing levels and the quality of care in hospitals
  publication-title: N Engl J Med
  doi: 10.1056/NEJMsa012247
– volume: 10
  year: 2020
  ident: R35
  article-title: Case for hospital nurse-to-patient ratio legislation in Queensland, Australia, hospitals: an observational study
  publication-title: BMJ Open
  doi: 10.1136/bmjopen-2019-036264
– volume: 51
  start-page: 2221
  year: 2016
  ident: R3
  article-title: An examination of hospital nurse staffing and patient experience with care: differences between cross-sectional and longitudinal estimates
  publication-title: Health Serv Res
  doi: 10.1111/1475-6773.12462
– volume: 66
  start-page: 273
  year: 2018
  ident: R36
  article-title: Nurse staffing and nurse outcomes: a systematic review and meta-analysis
  publication-title: Nurs Outlook
  doi: 10.1016/j.outlook.2017.12.002
– volume: 40
  start-page: 486
  year: 2012
  ident: R7
  article-title: Nurse staffing, burnout, and health care-associated infection
  publication-title: Am J Infect Control
  doi: 10.1016/j.ajic.2012.02.029
– volume: 54
  start-page: 74
  year: 2016
  ident: R12
  article-title: Better nurse staffing and nurse work environments associated with increased survival of in-hospital cardiac arrest patients
  publication-title: Med Care
  doi: 10.1097/MLR.0000000000000456
– ident: 2025101812291942000_11.12.e052899.1
  doi: 10.1016/j.ijnurstu.2016.03.012
– volume: 49
  year: 2021
  ident: 2025101812291942000_11.12.e052899.22
  article-title: Evaluation of hospital nurse-to-patient staffing ratios and sepsis bundles on patient outcomes
  publication-title: Am J Infect Control
  doi: 10.1016/j.ajic.2020.12.002
– volume: 57
  start-page: 742
  year: 2019
  ident: 2025101812291942000_11.12.e052899.29
  article-title: A methodology for studying organizational performance
  publication-title: Med Care
  doi: 10.1097/MLR.0000000000001167
– ident: 2025101812291942000_11.12.e052899.46
– volume: 151
  start-page: 527
  year: 2016
  ident: 2025101812291942000_11.12.e052899.24
  article-title: Comparison of the value of nursing work environments in hospitals across different levels of patient risk
  publication-title: JAMA Surg
  doi: 10.1001/jamasurg.2015.4908
– ident: 2025101812291942000_11.12.e052899.7
  doi: 10.1016/j.ajic.2012.02.029
– volume: 64
  start-page: 2593
  year: 2016
  ident: 2025101812291942000_11.12.e052899.9
  article-title: Reducing hospital readmission disparities of older black and white adults after elective joint replacement: the role of nurse staffing
  publication-title: J Am Geriatr Soc
  doi: 10.1111/jgs.14367
– ident: 2025101812291942000_11.12.e052899.16
  doi: 10.1136/bmjqs-2012-001610
– ident: 2025101812291942000_11.12.e052899.41
  doi: 10.1111/jan.12483
– ident: 2025101812291942000_11.12.e052899.11
  doi: 10.1016/S0140-6736(13)62631-8
– volume: 59
  year: 2021
  ident: 2025101812291942000_11.12.e052899.21
  article-title: Is Hospital nurse staffing legislation in the public's interest?: an observational study in New York state
  publication-title: Med Care
  doi: 10.1097/MLR.0000000000001519
– ident: 2025101812291942000_11.12.e052899.40
  doi: 10.1037//0021-9010.69.4.673
– ident: 2025101812291942000_11.12.e052899.13
  doi: 10.1056/NEJMsa012247
– volume: 43
  start-page: 301
  year: 2011
  ident: 2025101812291942000_11.12.e052899.18
  article-title: Quality of care and patient satisfaction in hospitals with high concentrations of black patients
  publication-title: J Nurs Scholarsh
– ident: 2025101812291942000_11.12.e052899.6
– volume: 30
  start-page: 46-55
  year: 2021
  ident: 2025101812291942000_11.12.e052899.25
  article-title: Valuing Hospital investments in nursing: multistate matched-cohort study of surgical patients
  publication-title: BMJ Qual Saf
  doi: 10.1136/bmjqs-2019-010534
– volume: 51
  start-page: 2221
  year: 2016
  ident: 2025101812291942000_11.12.e052899.3
  article-title: An examination of hospital nurse staffing and patient experience with care: differences between cross-sectional and longitudinal estimates
  publication-title: Health Serv Res
  doi: 10.1111/1475-6773.12462
– ident: 2025101812291942000_11.12.e052899.17
  doi: 10.1111/j.1532-5415.2012.03990.x
– volume: 397
  start-page: 1905
  year: 2021
  ident: 2025101812291942000_11.12.e052899.33
  article-title: Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals
  publication-title: The Lancet
  doi: 10.1016/S0140-6736(21)00768-6
– ident: 2025101812291942000_11.12.e052899.5
  doi: 10.1111/j.1475-6773.2010.01114.x
– volume: 364
  start-page: 1037
  year: 2011
  ident: 2025101812291942000_11.12.e052899.14
  article-title: Nurse staffing and inpatient hospital mortality
  publication-title: N Engl J Med Overseas Ed
  doi: 10.1056/NEJMsa1001025
– ident: 2025101812291942000_11.12.e052899.30
– ident: 2025101812291942000_11.12.e052899.8
  doi: 10.1093/intqhc/mzq067
– ident: 2025101812291942000_11.12.e052899.27
  doi: 10.1111/j.1468-0009.2011.00658.x
– ident: 2025101812291942000_11.12.e052899.42
  doi: 10.1111/j.1365-2834.2012.01411.x
– ident: 2025101812291942000_11.12.e052899.47
– ident: 2025101812291942000_11.12.e052899.35
  doi: 10.1136/bmjopen-2019-036264
– volume: 30
  start-page: 639-647
  year: 2021
  ident: 2025101812291942000_11.12.e052899.20
  article-title: Chronic Hospital nurse understaffing meets COVID-19: an observational study
  publication-title: BMJ Qual Saf
  doi: 10.1136/bmjqs-2020-011512
– volume: 59
  start-page: 169
  year: 2021
  ident: 2025101812291942000_11.12.e052899.19
  article-title: Better nurse staffing is associated with survival for Black patients and diminishes racial disparities in survival after in-hospital cardiac arrests
  publication-title: Med Care
  doi: 10.1097/MLR.0000000000001464
– ident: 2025101812291942000_11.12.e052899.45
– ident: 2025101812291942000_11.12.e052899.31
  doi: 10.1097/00005650-199801000-00004
– volume: 59
  start-page: 444
  year: 2021
  ident: 2025101812291942000_11.12.e052899.32
  article-title: Is Hospital nurse staffing legislation in the public's interest?: an observational study in New York state
  publication-title: Med Care
  doi: 10.1097/MLR.0000000000001519
– ident: 2025101812291942000_11.12.e052899.36
  doi: 10.1016/j.outlook.2017.12.002
– volume: 18
  start-page: 610
  year: 2021
  ident: 2025101812291942000_11.12.e052899.37
  article-title: Leveraging the work environment to minimize the negative impact of nurse burnout on patient outcomes
  publication-title: Int J Environ Res Public Health
  doi: 10.3390/ijerph18020610
– ident: 2025101812291942000_11.12.e052899.44
  doi: 10.1001/jama.285.3.297
– ident: 2025101812291942000_11.12.e052899.12
  doi: 10.1097/MLR.0000000000000456
– volume: 36
  start-page: 84
  year: 2021
  ident: 2025101812291942000_11.12.e052899.23
  article-title: Evaluating the costs and outcomes of hospital nursing resources: a matched cohort study of patients with common medical conditions
  publication-title: J Gen Intern Med
  doi: 10.1007/s11606-020-06151-z
– ident: 2025101812291942000_11.12.e052899.4
  doi: 10.7326/0003-4819-158-5-201303051-00007
– ident: 2025101812291942000_11.12.e052899.38
– ident: 2025101812291942000_11.12.e052899.28
  doi: 10.1111/j.1475-6773.2012.01465.x
– ident: 2025101812291942000_11.12.e052899.39
  doi: 10.1002/job.4030160308
– volume: 56
  start-page: 1001
  year: 2018
  ident: 2025101812291942000_11.12.e052899.43
  article-title: Effect of changes in hospital nursing resources on improvements in patient safety and quality of care: a panel study
  publication-title: Med Care
  doi: 10.1097/MLR.0000000000001002
– volume: 167
  start-page: 444
  year: 2013
  ident: 2025101812291942000_11.12.e052899.15
  article-title: Nurse staffing and NICU infection rates
  publication-title: JAMA Pediatr
  doi: 10.1001/jamapediatrics.2013.18
– ident: 2025101812291942000_11.12.e052899.10
  doi: 10.1001/jama.288.16.1987
– volume: 9
  start-page: e1145
  year: 2021
  ident: 2025101812291942000_11.12.e052899.34
  article-title: Hospital nurse staffing and patient outcomes in Chile: a multilevel cross-sectional study
  publication-title: Lancet Glob Health
  doi: 10.1016/S2214-109X(21)00209-6
– ident: 2025101812291942000_11.12.e052899.26
  doi: 10.1377/hlthaff.25.1.204
– ident: 2025101812291942000_11.12.e052899.2
  doi: 10.1136/bmjqs-2018-008043
SSID ssj0000459552
Score 2.5298655
Snippet ObjectiveTo evaluate variation in Illinois hospital nurse staffing ratios and to determine whether higher nurse workloads are associated with mortality and...
To evaluate variation in Illinois hospital nurse staffing ratios and to determine whether higher nurse workloads are associated with mortality and length of...
Objective To evaluate variation in Illinois hospital nurse staffing ratios and to determine whether higher nurse workloads are associated with mortality and...
SourceID doaj
pubmedcentral
proquest
pubmed
crossref
bmj
SourceType Open Website
Open Access Repository
Aggregation Database
Index Database
Enrichment Source
Publisher
StartPage e052899
SubjectTerms Aged
Clinical outcomes
Cost control
Cost Savings
Cross-Sectional Studies
Data collection
health & safety
health policy
health services administration & management
Hospitals
Humans
Legislation
Length of stay
Medicare
Mortality
Nurses
Nursing
Nursing Staff, Hospital
Observational studies
organisation of health services
Patients
Personnel Staffing and Scheduling
quality in health care
Quality of Health Care
Ratios
Response rates
Sepsis
United States
Workforce
Workforce planning
Workloads
SummonAdditionalLinks – databaseName: BMJ Journals
  dbid: RMJ
  link: http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1Lb9QwEB61BapeeJQCgYKMxIED203sPBxugKgQolWFKtRb5PjRLmqTapPl9zPjOIFFqEKcIjljy48ZeV7-BuAVBW-4isVM1rkkA8WgSJGxkqraCqO19lmV374Ux8fy7Kw82QA-voWpr75T2agD_A4vGgijqennSTJP-NzGGRkIB-Sa3oRbZNsQJ389-jz5VVBFKTNfaIfHaTpDbT0LYEOJyMfhkTc4WtF-sB3YFsTFMdXP3USCtRvKA_n_Tfv8M4nyt1vp8N7_rOc-3A06KHs3MM0D2LDNLmwfhSj7LtwJLoSHsDwZYFdZu-pxXNsx1Rim265nnSJXBDaE87WGkU-XXYRCJEjgLPM5Igw1UOeQml3a80U3ZN-9xaFYW09OYepBULd7cHr48fTDp1mo0jCrM1H29A5d81QVjptC5EqhBiOVkU5x7nguEmNTLV1WuCyuU2G5ljpXuXIyNxLVRfEItpq2sU-AOZGWdWYoVot6jlClkYnOuKVIq5RJHMFr3MYqCFlXeftF5FXY44oOtRp2NAI-nmGlA9g51dy4vLnTm6nT9YD1cTP5e2KOiZSAun1DuzyvgtxXMo_TGs2yuHScgIykRRuXopeoFrk05RHsj6z1a2FoYxalpAIcEbycfqPcUzBHNbZdEU1CIeCM4zweD5w4zWTk5wiKNR5dm-r6n2Zx4bHF6Z1yJvnTf9_qZ7DjpYlSfOQ-bPXLlX0Ot_WPftEtX3jh_AlzHDaL
  priority: 102
  providerName: BMJ Publishing Group Ltd
– databaseName: DOAJ Directory of Open Access Journals
  dbid: DOA
  link: http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwrV1LT9wwELYQqlAvFZQ-QqEyEoceuiLxKw63UhX10CIOqOIWOX6UrSBBmyy_vzOOCbtVRS-92uPI8czYM57xN4QcYfCGmZzPdKM0OigOVAqdFWEaz521NmZV_vhWnp_rq6vqYqXUF-aEjfDA48Ida5WLBuzavAoMkWC0BycBwz9wrgQh4u4LVs-KMxX3YCErKVmCGSq4Om5uf2E9KpAKBv6zRD8DjhNoXTuQIm7_34zNP3MmVw6hs23yIlmP9NM46x2y4duXZOt7io_vksXFCJNKu-UAouR7alpHbdcPtDd4dQANiR_eUbyDpdepcAgQBE9jTgcFizEEoKY3_ue8H7PlTuBTtGumS1wcgdC0r8jl2ZfLz19nqarCrJG8GvDduGXClIG5kitjwOLQxulgGAtM8cJ5YXWQZZB5I7hnVltllAlaOQ3mHX9NNtuu9W8JDVxUjXQYWwW7hJvK6cJK5jEyqnWRZ-QDrG-dlKKvo7_BVZ1YUSMr6pEVGWEPTKhtAifHGhk3Tw_6OA26G7E5niY_Re5OpAisHRtA3OokbvW_xC0j-w-y8fhj4BOWlcaCGRk5nLpBTzH4YlrfLZGmwJCtZDCPN6MoTTPhuIuCMZWRck3I1qa63tPOryMWOL4rlprt_Y9_e0eeR-3AZB29TzaHxdIfkGf2fpj3i_dRwX4DwcEmzA
  priority: 102
  providerName: Directory of Open Access Journals
Title Patient outcomes and cost savings associated with hospital safe nurse staffing legislation: an observational study
URI https://bmjopen.bmj.com/content/11/12/e052899.full
https://www.ncbi.nlm.nih.gov/pubmed/34880022
https://www.proquest.com/docview/2607981031
https://www.proquest.com/docview/2615119529
https://pubmed.ncbi.nlm.nih.gov/PMC8655582
https://doaj.org/article/8604b30609f240438e2821281614f442
Volume 11
WOSCitedRecordID wos000728888800001&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D
hasFullText 1
inHoldings 1
isFullTextHit
isPrint
journalDatabaseRights – providerCode: PRVADZ
  databaseName: BMJ Journals
  customDbUrl:
  eissn: 2044-6055
  dateEnd: 99991231
  omitProxy: false
  ssIdentifier: ssj0000459552
  issn: 2044-6055
  databaseCode: RMJ
  dateStart: 20110101
  isFulltext: true
  titleUrlDefault: http://www.bmj.com/thebmj
  providerName: BMJ Publishing Group Ltd
– providerCode: PRVAON
  databaseName: DOAJ Directory of Open Access Journals
  customDbUrl:
  eissn: 2044-6055
  dateEnd: 99991231
  omitProxy: false
  ssIdentifier: ssj0000459552
  issn: 2044-6055
  databaseCode: DOA
  dateStart: 20110101
  isFulltext: true
  titleUrlDefault: https://www.doaj.org/
  providerName: Directory of Open Access Journals
– providerCode: PRVHPJ
  databaseName: ROAD: Directory of Open Access Scholarly Resources
  customDbUrl:
  eissn: 2044-6055
  dateEnd: 99991231
  omitProxy: false
  ssIdentifier: ssj0000459552
  issn: 2044-6055
  databaseCode: M~E
  dateStart: 20110101
  isFulltext: true
  titleUrlDefault: https://road.issn.org
  providerName: ISSN International Centre
– providerCode: PRVPQU
  databaseName: Consumer Health Database (ProQuest)
  customDbUrl:
  eissn: 2044-6055
  dateEnd: 99991231
  omitProxy: false
  ssIdentifier: ssj0000459552
  issn: 2044-6055
  databaseCode: M0R
  dateStart: 20110101
  isFulltext: true
  titleUrlDefault: https://search.proquest.com/familyhealth
  providerName: ProQuest
– providerCode: PRVPQU
  databaseName: Health & Medical Collection
  customDbUrl:
  eissn: 2044-6055
  dateEnd: 99991231
  omitProxy: false
  ssIdentifier: ssj0000459552
  issn: 2044-6055
  databaseCode: 7X7
  dateStart: 20110101
  isFulltext: true
  titleUrlDefault: https://search.proquest.com/healthcomplete
  providerName: ProQuest
– providerCode: PRVPQU
  databaseName: Nursing & Allied Health Database
  customDbUrl:
  eissn: 2044-6055
  dateEnd: 99991231
  omitProxy: false
  ssIdentifier: ssj0000459552
  issn: 2044-6055
  databaseCode: 7RV
  dateStart: 20110101
  isFulltext: true
  titleUrlDefault: https://search.proquest.com/nahs
  providerName: ProQuest
– providerCode: PRVPQU
  databaseName: ProQuest Central
  customDbUrl:
  eissn: 2044-6055
  dateEnd: 99991231
  omitProxy: false
  ssIdentifier: ssj0000459552
  issn: 2044-6055
  databaseCode: BENPR
  dateStart: 20110101
  isFulltext: true
  titleUrlDefault: https://www.proquest.com/central
  providerName: ProQuest
– providerCode: PRVPQU
  databaseName: Psychology Database
  customDbUrl:
  eissn: 2044-6055
  dateEnd: 99991231
  omitProxy: false
  ssIdentifier: ssj0000459552
  issn: 2044-6055
  databaseCode: M2M
  dateStart: 20110101
  isFulltext: true
  titleUrlDefault: https://www.proquest.com/psychology
  providerName: ProQuest
– providerCode: PRVPQU
  databaseName: Publicly Available Content Database
  customDbUrl:
  eissn: 2044-6055
  dateEnd: 99991231
  omitProxy: false
  ssIdentifier: ssj0000459552
  issn: 2044-6055
  databaseCode: PIMPY
  dateStart: 20110101
  isFulltext: true
  titleUrlDefault: http://search.proquest.com/publiccontent
  providerName: ProQuest
link http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpR1db9Mw0GIdQrzwPQiMykg88EC11M6HwwtiaBMgUkXVNJWnyPHHVjSS0aT8fu4cN6MI9YUXK7HPkZO7s-8rd4S8RucNkyGfiCoRqKBoYClUViJZGa6VUi6q8vxrOpuJxSIrvMGt9WGVmz3RbdS6UWgjPwK5O80EFiV4f_1zglWj0LvqS2jskX3MVBaNyP7xyayYD1YWEFiyOGY-3dCUJ0fVj-9Ylwqog4EeHaO-AccK9G4dTC5__7-Ezr9jJ_84jE7v_-9rPCD3vBhKP_R085DcMvUjcif3jvbHZFX0-VZps-7gwaalstZUNW1HW4k2COjwiDWaojGXXvoKJABgDXXBIRRET2sBml6Zi2Xbh929g0fRphqswTgDc9w-IWenJ2cfP018eYZJFfOswx_QFYtkaplOeSIliC5CamElY5YlfKpNpISNUxuHVcQNU0IlMpFWJFqAnMgPyKhuavOMUMujrIo1OmlBwOEy02KqYmbQxSrgYwXkDSCo9NzVlk5x4UnpcVkiLsselwFhGyyWymc5x2IbV7snvR0mXfdJPnaDHyN5DKCYodt1NKuL0jN8KZIwqkAfCzPLMIORMKDcotsS5CEbRSwghxsCuXmxG-oIyKthGBgevTiyNs0aYabo-40ZrONpT4vDSjhuxyCVBSTdotKtpW6P1MtLl1Qcf1COBXu-e1kvyF3HOBjPIw7JqFutzUtyW_3qlu1qTPbS-Tm2i9S1Yuz5cexMHdDmIV7nLIeR4nNefIO7ef7lN9sZQXw
linkProvider ProQuest
linkToHtml http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMw1V1Zb9QwEB6VgoAX7iNQwEgg8dBVd-0cDhJCXFWrblcVWlV9sxwf7aKSlE0WxI_iPzKTqyxC-9YHXh07spNv7vEMwAsK3nA9FAOZxZIMFIskRcZKqDMnrDGmzqo8HCeTiTw6Sg_W4Fd3F4bSKjueWDNqWxjykW-h3p2kkpoSvD37NqCuURRd7VpoNLDYcz9_oMlWvtn9iP_3Jefbn6YfdgZtV4FBFom0onvThoc68dwmItYaJa7UVnrNueexGFkXGumjxEfDLBSOG2liHWsvYytRvRH42ktwGdn4iDLIks-HvUsHtaM0inhb22gk4q3s6xdqgoVQ5Gi0R2TcoAzD0SUpWDcL-JeG-3ei5h-Sb_vmf_bNbsGNVsVm7xqauA1rLr8DV_fbJIK7MD9oasmyYlHhOVzJdG6ZKcqKlZr8KzjQgtZZRo5qdtJ2V8EJ3rE68YWhWu09zman7nhWNimFr_FVrMh6TzetoPq992B6EQe-D-t5kbuHwLwI0yyyFIBG5U3o1MqRibij8LHEfxPAK8SDajlHqWqjTMSqhY4i6KgGOgHwDjTKtBXcqZHI6epFm_2is6aAyerp7wmN_VSqPl4PFPNj1TIzJeNhmKGtOUw9p-pM0qHhTiFZ1PV8GPIANjo8nh_sHIwBPO8fIzOjCJXOXbGgOSOKa0cc9_GggX6_E0GiBjXOAJIlolja6vKTfHZSF0yny9eR5I9Wb-sZXNuZ7o_VeHey9xiu1zRLeUtyA9ar-cI9gSvmezUr509rsmegLphkfgM8V5QW
linkToPdf http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMw1V1Lb9QwEB6VgiouvAuBAkYCiQOrzdp5OEgIAWVF1bJaoQr1Fjl-tItKUjZZED-Nf8dM4k1ZhPbWA1fHjuzkm_d4BuApBW-4CsVAFokkA8UgSZGxEqnCCqO1brMqPx-kk4k8OsqmG_BreReG0iqXPLFl1KbS5CMfot6dZpKaEgydT4uY7o5fn30bUAcpirQu22l0ENm3P3-g-Va_2tvFf_2M8_H7w3cfBr7DwKCIRdbQHWrNI5U6blKRKIXSVyojneLc8USMjI20dHHq4rCIhOVa6kQlysnESFR1BL72ElxOKTZIWYPhp969g5pSFsfc1zkaiWRYfP1CDbEQlhwN-JgMHZRnOLoiEdvGAf_Sdv9O2vxDCo6v_8ff7wZc86o3e9PRyk3YsOUt2Prokwtuw3za1Zhl1aLBM9maqdIwXdUNqxX5XXDAg9kaRg5sduK7ruAEZ1mbEMNQ3XYOZ7NTezyru1TDl_gqVhW9B5xWUF3fO3B4EQfehs2yKu09YE5EWREbCkyjUidUZuRIx9xSWFnifwrgOWIj9xylzltjTSS5h1FOMMo7GAXAlwDKta_sTg1GTtcvetEvOusKm6yf_paQ2U-lquTtQDU_zj2Ty2USRgXaoGHmOFVtkhYNegrVog7ooogHsLPE5vnBzoEZwJP-MTI5ilyp0lYLmjOieHfMcR93OzLodyJIBKEmGkC6QiArW119Us5O2kLqdCk7lvz--m09hi2klPxgb7L_AK625EvpTHIHNpv5wj6EK_p7M6vnj1oOwCC_YIr5DYU3nLM
openUrl ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Patient+outcomes+and+cost+savings+associated+with+hospital+safe+nurse+staffing+legislation%3A+an+observational+study&rft.jtitle=BMJ+open&rft.au=Lasater%2C+Karen+B&rft.au=Aiken%2C+Linda+H&rft.au=Sloane%2C+Douglas&rft.au=French%2C+Rachel&rft.series=Original+research&rft.date=2021-12-08&rft.pub=BMJ+Publishing+Group&rft.eissn=2044-6055&rft.volume=11&rft.issue=12&rft_id=info:doi/10.1136%2Fbmjopen-2021-052899&rft_id=info%3Apmid%2F34880022&rft.externalDocID=PMC8655582
thumbnail_l http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=2044-6055&client=summon
thumbnail_m http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=2044-6055&client=summon
thumbnail_s http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=2044-6055&client=summon