Outcomes of Variation in Hospital Nurse Staffing

Table of Contents


On the moment of the conducting of their study, Rafferty et al. (2007) stated that despite the fact that there was growing evidence in the United States, little evidence was obtainable to assess whether at the international level, hospitals, where nurses provide care for fewer patients, demonstrate more significant outcomes within the scope of patients survival and nurses retention. It seems apparent that the contribution of this article is substantial as it broadens the framework of evidence-based findings on the topic of insufficient and adequate staffing. The study aims to investigate the impact of “hospital-wide nurse staffing levels (patient-to-nurse ratios) on patients mortality…, failure to rescue and nurse job satisfaction, burnout, and nurse-rated quality of care” (Rafferty et al., 2007, p. 175). The research question may be formulated as follows – what is the relationship between nurses’ shifting and health outcomes?

The study of Marzuki et al. (2013) states that the nursing shortage is to be considered as an international issue, and there is a consent that the identification of drawbacks and possibilities for the improvement of work environments in hospitals is important to support significant health outcomes. The mentioned research aims to discuss the stuffing, as well as resource adequacy, in NPE and the relationship with POs (Marzuki et al., 2013). So as the study above, the one of Marzuki et al. (2013) may be perceived as a notable investigation in the framework of nursing as it provides evidence from the three university hospitals in Malaysia, which shows that the issue is relevant worldwide – not only for the developed countries. The research question is as follows – do adequate staffing and resources contribute to positive patient/nurse outcomes.

Articles and PICOT Question

The above articles have a direct relation to the PICOT question – it seems reasonable to claim that they both address the issue of insufficient/adequate staff within the given scope. They provide solid evidence regarding how appropriate staffing may contribute to health outcomes, as well as a substantial amount of data obtained and investigated. The PICOT question can be answered by appealing to the related crucial findings of these studies. The correlation rates and coherent assumptions will serve as a foundation for addressing the PICOT question.

It should be admitted that comparison groups of the articles – to an exact extent – are broader than one given in the PICOT question (patients with chronic diseases). Nevertheless, these studies provide the audience with the opportunity with a certain projection of the findings, if to take into account the significant reliability, generalizability, and validity. Their scope and qualitative approach allow making specific and precise suggestions and conclusions.

Method of Study

Rafferty et al. (2007) obtained “nurse and patient data from thirty English hospital trusts” (p. 176). These data were collected from three primary sources. Data regarding hospitals’ structures were obtained from administrative databases. Then, nurses who practice in hospitals that take part participated in surveys so that information on patient-to-nurse ratios, staffing appropriacy, work environment, and quality of care measures could be obtained. Patients outcomes came from nurse surveying, as well as discharge abstracts. This information was integrated in order to discuss the impact of staffing and a number of other hospitals’ working environment aspects on different healthcare outcomes. Descriptive statistics were utilized in order to show the peculiarities of the participants within the sample. Then, logistic regression methods were appealed to so that the influence of “nurse staffing on the patient outcomes (mortality and FTR), two nurse-reported job outcomes, and two nurse ratings of quality of care” was assessed (Rafferty et al., 2007, p. 178). Nurses’ staffing was recorded as “a categorical variable grouping institutions into quartiles” (Rafferty et al., 2007, p. 178).

The study of Marzuki et al. (2013) is a descriptive correlational investigation that was conducted in order to discuss the relationship between “staffing and resource adequacy and the incidence of adverse events” (p. 59). Three hundred ninety-five staff nurses took part in this research from three Malaysian university hospitals for two months. A stratified random sampling approach was utilized, which involved staff nurses from eight departments. The Practice Environment Scale of the Nursing Work Index was utilized in order to discuss the staff and resource adequacy in NPE and the relationship with adverse impacts.

It might be assumed that both studies appeal to the best practices of qualitative research, appealing to reliable mathematic models and approaches. However, it should be noted that these studies also appeal to some qualitative metrics to an insignificant extent. Then, the study of Rafferty et al. (2007) seems to be broader than the one of Marzuki et al. (2013) as the former involved more participants and cooperated with more healthcare establishments. Moreover, the investigation of Rafferty et al. (2007) includes more variables that were taken into account while providing quantitative calculations.

The benefit of the research of Rafferty et al. (2007) is that it considers a plethora of variabilities, which contributes to the article’s reliability. The main limitation here is that the researchers seem to demonstrate an over-appealing to the related evidence within the US scope – in the meaning of abandoning the study’s significance to the US nursing scholarly dimension. The advantage of Marzuki et al. (2013) is that it indicates that the issue of nurse staffing and resource adequacy is essential worldwide – even in developing countries. The primary limitation is that the investigation was conducted within university hospitals but not the state or private ones.

Results of Study

Rafferty et al. (2007) report that the participants involved in better staffing levels had more significant health outcomes than participants involved in the worse ones. Nurses in notable healthcare establishments demonstrated high rates of job satisfaction, low burnout indicators, and high-quality care. Marzuki et al. (2013) found that appropriate staffing and resources are a vital issue in the framework of working environments and positive healthcare outcomes for both nurses and patients.

Both studies demonstrate strong evidence regarding the problem of proper staffing and resources – these pieces of evidence might be taken into account while designing funding and healthcare establishments’ management policies.

Outcomes Comparison

It was expected that insufficient staff results in insignificant patient outcomes and quality of health and that it is reasonable for any healthcare establishment.

The outcomes of the chosen articles seem to be absolutely in line with the anticipated results, which indicates the appropriacy of the initial suggestion – it is essential to provide good working conditions so that patients could receive care only of the highest quality.


Marzuki, M., Wichaikhum, O., & Nantsupawat, R. (2013). Unfavorable staffing and resources adequacy impact on patient outcomes and quality of care in the three university hospitals in Malaysia. Open Journal of Nursing, 3, 58–63.

Rafferty, A. M., Clarke, S. P., Coles, J., Ball, J., James, P., McKee, M., & Aiken, L. H. (2007). Outcomes of variation in hospital nurse staffing in English hospitals: Cross-sectional analysis of survey data and discharge records. International Journal of Nursing Studies, 44(2), 175–182. Web.

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