What happens when nurse staffing is low? Nothing good, a new study finds.

A new study adds evidence to a case nurse managers have been making for years: Lower nurse staffing leads to longer waits and may threaten health care outcomes, Kenneth Michek writes for HealthLeaders Media

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Study details

For the study, published in the Western Journal of Emergency Medicine, researchers reviewed the EHR database at a high-volume, urban public hospital and compared nursing hours per day with average door-to-discharge length of stay, door-to-admission length of stay, and the percentage of patients who left without being seen by a provider.

Between January and December of 2015, more than 100,000 patients were seen at the hospital's ED, during which time nurse staffing levels fluctuated substantially.

Key findings

The researchers found that average door-to-discharge length of stay increased by 28 minutes on days that ranked in the lowest quartile for nursing staffing when compared with days that ranked in the highest quartile, regardless of daily patient volume, occupancy, and ED admission rates.

There was no significant change across quartiles in average door-to-admission length of stay, however.

The researchers also found that an average of nine more patients each day left without being seen by a provider on the lower-staffing days compared to higher-staffing days.


The researchers concluded that lower staffing rates contributed to a statistically significant increase in wait times for patients, which can ultimately impact how many patients are seen each day.

"Suboptimal nurse staffing may impact a number of nursing tasks such as triage, vital signs, phlebotomy, medication administration, procedures, and discharge education," the researchers wrote. "As nursing delays accumulate, this translates into longer wait times, leading to more patients who [leave without being seen by a provider]."

The researchers added that patient safety and patient satisfaction are noticeably impacted by increased wait times and that throughput metrics show an overall decrease in the revenue of facilities. "This analysis is a pivotal step in identifying and ensuring appropriate nurse staffing to optimize ED quality metrics," they wrote (Michek, HealthLeaders Media, 7/20; Ramsey et al., Western Journal of Emergency Medicine, May 2018).

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