Outcomes sensitive to critical care nurse staffing levels: A systematic review

Rae, Pamela J.L., Pearce, Susie, Greaves, Jane, Dall'Ora, Chiara, Griffiths, Peter and Endacott, Ruth (2021) Outcomes sensitive to critical care nurse staffing levels: A systematic review. Intensive and Critical Care Nursing, 67. p. 103110. ISSN 0964-3397

Endacott et al Systematic Review protocol FINAL.pdf - Accepted Version
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Official URL: https://doi.org/10.1016/j.iccn.2021.103110


To determine associations between variations in registered nurse staffing levels in adult critical care units and outcomes such as patient, nurse, organisational and family outcomes.

We published and adhered to a protocol, stored in an open access repository and searched for quantitative studies written in the English language and held in CINAHL Plus, MEDLINE, PsycINFO, SCOPUS and NDLTD databases up to July 2020.

Three authors independently extracted data and critically appraised papers meeting the inclusion criteria. Results are summarised in tables and discussed in terms of strength of internal validity. A detailed review of the two most commonly measured outcomes, patient mortality and nosocomial infection, is also presented.

Our search returned 7960 titles after duplicates were removed; 55 studies met the inclusion criteria. Studies with strong internal validity report significant associations between lower levels of critical care nurse staffing and increased odds of both patient mortality (1.24–3.50 times greater) and nosocomial infection (3.28–3.60 times greater), increased hospital costs, lower nurse-perceived quality of care and lower family satisfaction. Meta-analysis was not feasible because of the wide variation in how both staffing and outcomes were measured.

A large number of studies including several with high internal validity provide evidence that higher levels of critical care nurse staffing are beneficial to patients, staff and health services. However, inconsistent approaches to measurement and aggregation of staffing levels reported makes it hard to translate findings into recommendation for safe staffing in critical care.

Item Type: Article
Additional Information: Funding information: This paper presents independent research funded by the National Institute for Health Research (Programme Development Grants, Safe staffing in ICU: development and testing of a staffing model, NIHR200100). The views expressed in this publication are those of the author(s) and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care, neither of whom have had involvement in any aspect of the design, data collection, synthesis, interpretation or writing of, this review.
Uncontrolled Keywords: Critical care, Cross infection, Health care, Health workforce, Mortality, Outcome assessment, Registered nurse
Subjects: B700 Nursing
Department: Faculties > Health and Life Sciences > Nursing, Midwifery and Health
Depositing User: Elena Carlaw
Date Deposited: 21 Dec 2021 16:23
Last Modified: 09 Jul 2022 03:31
URI: http://nrl.northumbria.ac.uk/id/eprint/48034

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