Nurse staffing levels make a difference on patient outcomes: a multisite study in Chinese hospitals

J Nurs Scholarsh. 2012 Sep;44(3):266-73. doi: 10.1111/j.1547-5069.2012.01454.x. Epub 2012 Jun 25.


Purpose: The purpose of this study is to examine the relationship between nurse staffing and patient outcomes in hospitals in mainland China.

Methods: The study was conducted in 181 hospitals across all of the eight economic zones in mainland China using a four-stage sampling design. Two instruments, the China Nurse Survey and the patient satisfaction measurement from the Hospital Consumer Assessment of Healthcare Providers and Systems, were employed in data collection. In this article, 7,802 nurse surveys and 5,430 patient surveys from 600 medical and surgical units were analyzed.

Results: The adjusted joint effects of nurse staffing on patient outcomes from logistic regression analyses showed that more nursing staff per patient had statistically significant positive effects on all necessary nursing care, nurses' reports of quality of care, their confidence on patients' self-care ability on discharge from the hospital, patient adverse events, as well as patients' report of satisfaction. When the nurse-to-patient ratio (total number of nurses on all shifts on the unit divided by total number of patients who stay on the unit) increased to the 0.5-<0.6 category, most patient outcomes were significantly improved, considering hospital and patient factors and nurse skill mix in the logistic regression models.

Conclusions: The findings provide evidence on how inadequate nurse staffing might result in missed but needed nursing care and negative patient outcomes, while better staffing levels could be an effective strategy for improving patient outcomes.

Clinical relevance: We recommend that the nurse-to-patient ratio on medical and surgical units in Chinese hospitals be increased to at least 0.5-0.6 so as to secure patient safety and the quality of health services.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • China
  • Female
  • Health Care Surveys
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Nursing Staff, Hospital / supply & distribution*
  • Outcome Assessment, Health Care*
  • Patient Safety*
  • Patient Satisfaction*
  • Personnel Staffing and Scheduling*