There is a wealth of research demonstrating the breadth and depth of the nurse staffing crisis.  The relationship between patient health and adequate levels of nurse staffing is also well-documented.

Below are some of the groundbreaking studies that explore the nurse staffing crisis and its effects on patient care (links are provided, where available).

Nurse Staffing in Hospitals:  Is There a Business Case For Quality?
Jack Needleman, PhD, Peter Buerhaus, PhD, RN, et al, Health Affairs, Jan.-Feb. 2006, 25(1):204-211

• An update to the May 2002 Needleman and Buerhaus research, this study finds that increasing the proportion of RNs without increasing total nursing hours per day could reduce costs and improve patient care by reducing unnecessary deaths and reducing days in the hospital. 

Improving Nurse-to-Patient Staffing Ratios as a Cost-Effective Safety Intervention
Michael Rothberg, et. al, Medical Care, 43(8): 785-791, August, 2005

• This national study found that reducing nurse-to-patient ratios was cost-effective in improving patient outcomes.

Is the Shortage of Hospital Registered Nurses Getting Better or Worse? 
Peter Buerhaus, PhD, RN, et. al. Nursing Economic$, March-April, 2005

• This survey of nurses found that 75 percent of RNs believe the nursing shortage presents a major problem for the quality of their worklife, patient care, and time spent with patients. 

New Signs of a Strengthening US Nurse Labor Market?
Peter Buerhaus, PhD, RN, et. al., Health Affairs Web Exclusive, Nov. 17, 2004

• Despite an increase in employment of 185,000 hospital RNs since 2001, evidence suggests the current shortage has not been eliminated. 

Keeping Patients Safe: Transforming the Work Environment of Nurses
Institute of Medicine, National Academy of Sciences, 2003

• Following up on the 1999 report on patient safety, To Err is Human, the Institute for Medicine calls for improved nurse-to-patient ratios, limits on mandatory overtime, and nurse involvement on every level to protect patients.

Nurse-Staffing Levels and Quality of Care in Hospitals
Jack Needleman, PhD, Peter Buerhaus, PhD, RN, et al, The New England Journal of Medicine, May 30, 2002

• A higher proportion of RNs in the staff mix and a greater number of nursing hours per day are associated with better patient outcomes. 

Health Care at the Crossroads: Strategies for Addressing the Evolving Nursing Crisis
Joint Commission on Accreditation of Healthcare Organizations (JCAHO), 2002

• Recommends transforming the nursing workplace and giving hospitals an incentive to invest in high quality nursing care.  JCAHO found that low staffing levels were a contributing factor in 24% of patient safety errors resulting in injuries or death since 1996. 

Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction
Linda Aiken PhD, RN, Journal of the American Medical Association, October 22, 2002

• For each additional patient over four patients in a nurse’s workload, the risk of death increases by 7 percent for surgical patients.  Patients in hospitals with a 1:8 nurse-to-patient ratio have a 31 percent greater risk of dying than patients in hospitals with 1:4 nurse-to-patient ratios. 

Projected Supply, Demand, and Shortages of Registered Nurses: 2000-2020
Health Resources and Services Administration, HHS, 2002

• Provides data on the deepening RN shortage crisis.  The nursing shortage will spread to 44 states and the District of Columbia by 2020. 

Strengthening Hospital Nursing
Jack Needleman, PhD, Peter Buerhaus, PhD, RN, et al, Health Affairs, Sep.-Oct. 2002, 21(5): 123-132

• Provides policy recommendations for strengthening nursing and improving patient safety.

Nurse Staffing and Patient Outcomes in Hospitals
Jack Needleman, PhD, Peter Buerhaus, PhD, RN, Harvard School of Public Health, 2001

• Commissioned by the Department of Health and Human Services, this comprehensive study found a strong association between RN staffing and patient outcomes, including a 3-6 percent shorter length of hospital stay for patients in hospitals with a high percentage of RNs.