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Nursing Hours & Patient Outcomes

Clients will often inquire if staffing ratios impact outcomes and request that MHO investigate the relationship between nursing hours and patient outcomes: Does more staff mean better care?

The ratio of nurses to patients is important for inpatient psychiatric units to provide the best care to patients and the best working environment for staff. Safe-staffing ratios are developed to support the types of patients and goals of the program. Nursing research has consistently supported the association between staffing levels and risk management. Staffing below target levels tends to be associated with higher mortality, higher rates of specific infections, and more patient falls.

But is there a relationship between staffing and clinical outcomes or patient satisfaction for psychiatric units?

One theory is that as nursing hours per patient day increase, there is a direct increase in positive outcomes and decrease in negative outcomes. However, our data for inpatient psychiatric units do not support this relationship.

For adult units, no specific relationships between nursing hours and outcomes or satisfaction were found. However for geriatric units, one counterintuitive relationship was notable. Patient satisfaction decreased as nursing hours increased.

Why don’t more nursing hours lead to better outcomes?

Though we don’t see consistent relationships between higher nursing hours per patient day and better outcomes in this data, that doesn’t mean there isn’t a relationship of some kind. This just demonstrates satisfaction and clinical outcomes are complex phenomenon influenced by a variety of staffing factors beyond staffing ratios, and can be difficult to quantify.

Timely review of outcomes and satisfaction measures will help determine if the nursing staff is effective in meeting patient needs. For inpatient psychiatric units safe-staffing thresholds are important, but once that level is met, improved patient outcomes likely wouldn’t follow simply by adding more staff. In fact, the relationship seen for geriatric units between higher nursing hours per patient day and lower satisfaction illustrates that there isn’t an inherent benefit to higher staffing ratios.

Our data suggest there are many factors that influence clinical outcomes and satisfaction and more staff does not necessarily mean better outcomes.


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