Topic 3 DQ 2 –

Writing –

Topic 3 DQ 2 –

Please respond with a paragraph to the following question, add citations and references:


Aiken LH, Clarke SP, Cheung RB, Sloane DM, Silber JH. Educational levels of hospital nurses and surgical patient mortality. JAMA. 2003;290(12):1617–1623. [PMC free article] [PubMed]


Better hospital nurse staffing, more educated nurses, and improved nurse work environments have been shown to be associated with lower hospital mortality. Little is known about whether and under what conditions each type of investment works better to improve outcomes.

Strength: This article discusses improved staffing equals lower patient mortality.

Weakness: No information regarding the ways or cost to improve nursing environments or staffing.


Cook, A., Gaynor, M., Stephens Jr, M., & Taylor, L. (2012). The effect of a hospital nurse staffing mandate on patient health outcomes: Evidence from California’s minimum staffing regulation. Journal Of Health Economics, 31(2), 340-348. doi:10.1016/j.jhealeco.2012.01.005


Evaluating the impact of California Assembly Bill 394, which mandated maximum levels of patients per nurse in the hospital setting. When the law was passed, some hospitals already met the requirements, while others did not. Thus changes in staffing ratios from the pre- to post-mandate periods are driven in part by the legislation. To find persuasive evidence that AB394 had the intended effect of decreasing patient/nurse ratios in hospitals that previously did not meet mandated standards. However, these improvements in staffing ratios do not appear to be associated with relative improvements in measured patient safety in affected hospitals.

Strength: Discusses the safe staffing ratios the California bill enacted.

Weakness: Study did not show real improvements in patient safety.


Janita P. C., C., Suzanne H. S., L., K. C., C., Eric L. S., C., Matthew D., M., Danny W. K., T., & Lee, D. F. (2015). A longitudinal examination of the association between nurse staffing levels, the practice environment and nurse-sensitive patient outcomes in hospitals. BMC Health Services Research, 15538-545. doi:10.1186/s12913-015-1198-0


The level of patient safety and outcomes accomplished depends on the quality of care provided. Previous studies found that nurse-to-patient ratio, practice environment, and nursing education were significant predictors of patient outcomes. However, the outcomes measured in previous studies were mainly inpatient mortality and failure-to-rescue rates. Few nurse-sensitive patient outcomes have been measured that quantify nurses’ contribution to patient care. Selecting appropriate outcomes that reflect the clinically relevant effect of nursing care is important.

Strength: Discusses multiple areas that affect patient outcomes including nurse/patient ratios.

Weakness: Does not go in depth regarding nurse sensitive patient outcomes.


Sung-Heui, B. (2016). CNE SERIES. The Centers for Medicare & Medicaid Services Reimbursement Policy and Nursing-Sensitive Adverse Patient Outcomes. Nursing Economic$, 34


The Centers for Medicare & Medicaid Services (CMS) implemented a new policy for Medicare in 2008 to reduce preventable adverse outcomes in hospitals. The new CMS reimbursement policy incentivizes the prevention of avoidable adverse patient outcomes by eliminating reimbursement for treatment of those outcomes in hospitals (Department of Health and Human Services, 2009). Intended consequences of the new CMS policy include appropriate changes in care processes to foster better quality of care so that hospitals can prevent adverse outcomes.

Strength: Studies and stats show different adverse outcomes of hospitalized patients.

Weakness: Does not go in depth about nurse/patient ratios related to preventable adverse patient outcomes.


You, L., Aiken, L. H., Sloane, D. M., Liu, K., He, G., Hu, Y., & … Sermeus, W. (2013). Hospital nursing, care quality, and patient satisfaction: Cross-sectional surveys of nurses and patients in hospitals in China and Europe. International Journal Of Nursing Studies, 50(2), 154-161. doi:10.1016/j.ijnurstu.2012.05.003


This study provides a comprehensive evaluation of nurse resources in Chinese hospitals and the link between nurse resources and nurse and patient outcomes. Survey data were used from 9688 nurses and 5786 patients in 181 Chinese hospitals to estimate associations between nurse workforce characteristics and nurse and patient outcomes in China. Nurse and patient assessments in China were compared with a similar study in Europe.

Strength: This study shows the nursing shortage/burnout and nurse/patient ratios affect nursing worldwide.

Weakness: Does not discuss how mandating safe nurse/patient ratios will help patient outcomes.


West, E., Barron, D. N., Harrison, D., Rafferty, A. M., Rowan, K., & Sanderson, C. (2014). Nurse staffing, medical staffing and mortality in Intensive Care: An observational study. International Journal Of Nursing Studies, 51(5), 781-794. doi:10.1016/j.ijnurstu.2014.02.007


To investigate whether the size of the workforce (nurses, doctors and support staff) has an impact on the survival chances of critically ill patients both in the intensive care unit (ICU) and in the hospital. Investigations of intensive care outcomes suggest that some of the variation in patient survival rates might be related to staffing levels and workload, but the evidence is still equivocal.

Strength: This study shows that the unsafe nurse/patient ratios spread across all departments and specialties of nursing.

Weakness: Shows some evidence that leans toward patient outcomes and nursing ratios but no concrete evidence.