“Hospital Nurse Staffing and Patient Mortality” by Halm et al.


The article chosen for critical analysis is Halm et al, 2005, ‘Hospital Nurse Staffing and Patient Mortality, Emotional Exhaustion, and Job Dissatisfaction’, from the Clinical Nurse Specialist.

Summary of the Article

The article is based on an in-house study at United Hospital in St. Paul Minnesota, similar to the study by Dr. Linda Aitken and colleagues in 2002, to evaluate the correlation between nurse staffing and patient mortality and failure-to-rescue rates and nurse outcomes. The literature review suggested that there was a positive relationship between higher nurse-to-patient ratios and patient outcomes, while there remained gaps in the literature with regard to the relationship between nurse-to-patient ratios and emotional exhaustion or job dissatisfaction.

The sample size for the study consisted of 2,709 patients and 140 registered nurses. A cross-sectional, correlational research design was used to investigate the relationship between nurse staffing levels and patient and nurse outcomes. The data warehouse of the hospital was used to extract patient data. Nurses who provide care in the identified clinical areas of general surgery, orthopedic surgical, and critical care units were requested to participate in the survey and the number that volunteered was 140. Staffing levels were identified at the concerned units. Death records purchased from the State of Minnesota were used for the study.

Logistic regression was the statistical means employed to predict mortality and failure-to-rescue (death following complications within 30 days) based on staffing and other predictive characteristics. Logistic regression was also employed to evaluate the relationship between nurse clinical specialty and job dissatisfaction and emotional exhaustion.

No significant relationship was found between nursing staff levels and patient mortality. There was also no significant relationship between staffing ratios and failure-to-rescue. Moderate emotional exhaustion was found in low-level nurse staffing, but no job dissatisfaction.

As such the findings of this study are in contrast to the Linda Aitken study in 2002.

Critical Analysis

The title is succinct and addresses the issue of relation to the subject of study. The research questions which the study aims to answer are verifiable through quantitative means and are based on the hypothesis that there is a relationship between patient outcomes and nurse outcomes with the staffing levels of nurses. However, the study has chosen only to look at nursing levels’ relationship to mortality and failure-to-rescue within 30 days as the means to arrive at the correlation between nursing levels and patient outcomes. Factors that also impact patient outcomes involve the length of stay in the hospital and patient satisfaction and the study fails to take these factors into consideration.

The cross-sectional, correlational research design is satisfactory for the purposes of the study. The patient sample size of 2079 is also adequate for the study. The sample size of 140 nurses looks satisfactory initially, but when it is realized that only 42% of the nursing staff volunteered there is a feeling of inadequacy in assessing the true picture of nursing outcome in the chosen areas of the hospital. Furthermore, there arises the question of the qualification and skill levels of the nursing staff involved. In case the nursing staff involved is more qualified and skilled and not representative of a cross-section of nursing staff involved, then the findings of the study will be limited and have less application universally.

The use of the 22-item Human Services Survey from the Maslach Burnout Inventory Manual is adequate for measuring exhaustion, and data extraction methods are satisfactory. In a similar vein, adequate administrative sanctions have been received for the study, and the ethical considerations are satisfactory.

Suitable statistical means through logistic regression have been employed to analyze the data collected and well represented in tables. Furthermore, the findings from the analysis and tables have been well explained to get a proper understanding of the findings.

However, the findings that there is no significant relationship between staffing levels and patient mortality and failure-to-rescue is a little surprising, as it is not in keeping with the Aitken, 2002 study nor the literature reviewed. The reason for this becomes clear when going through the limitations.

The authors themselves admit that the hospital has a “strong nursing collective bargaining unit that collaborates with the hospital to develop agreed-upon variable staffing plans for each nursing unit”, and that “nursing leadership fills those shifts with overtime, agency, or casual staff”. Thus high levels of nursing staff are maintained and the findings are a result of these high levels of nursing staff, which has ensued from the strong collective bargaining. This is further confirmed by the high job satisfaction levels as shown by the study.

This being the case the implications of this study are limited to the strengths of collective bargaining to maintain high levels of nursing staff to patient ratios, which have a positive impact on the mortality and failure-to-rescue figures in patient outcomes. This is the knowledge that this study provides, and as such does not really answer the aims of the study in terms that can be acceptable for all hospital environments (Halm et al, 2005).

Literary References

Halm, M., Peterson, M., Kandals, M. B., Sabo, J. Blalock, M., Braden, R., Gryczman, A., Krisko-Hagel, K., Larson, D., Lemay, D., Sisler, B., Strom, L. & Topham, D. (2005). Hospital Nurse Staffing and Patient Mortality, Emotional Exhaustion, and Job Dissatisfaction. Clinical Nurse Specialist, 19 (5), 241-251.