The development of neonatal intensive care has substantially reduced infant mortality, still, infants remain at high risk for adverse outcomes. Safe care relies on adequate nurse staffing and an appropriate skill mix, which is especially important in neonatal intensive care as infants are extremely vulnerable to harm when quality lapses occur. Although international guidelines recommend optimal nurse-to-patient ratios for neonatal care, these standards have not been fully implemented, leaving it unclear whether current staffing levels align with recommendations for safe staffing. To benchmark the acuity-adjusted registered nurse staffing provision ratio in neonatal intensive care and determine the skill mix distribution and variation of nursing staff across shifts. This retrospective cohort study included infant data from a 16-week period in 2022 in three neonatal intensive care units with a common administration at a university hospital. Data were obtained from the hospital's data repository and the Swedish Neonatal Quality Register, including 609 neonatal admissions and 345 nursing staff members working 1008 shifts. Infants' daily acuity levels were assessed using an adapted version of the British Association of Perinatal Medicine's guideline, classifying infants into three levels: intensive care, high dependency care, and special care. Staffing provision was measured as the number of worked hours per shift, staff category, and unit. The registered nurse provision ratio was defined as the number of registered nurse hours provided divided by the recommended hours. A ratio below 1.0 indicates understaffing. The population's total in-hospital days were 4674, and the mean birth weight was 2843 g (SD 1029), with 57.0 % being boys. The proportion of registered nurses relative to nursing assistants ranged from 22.2 % to 85.7 %, with a median of 46.5 %. Registered nurses with specialist education accounted for a median of 73.0 % of total registered nurse hours. Within each unit, the mean acuity-adjusted number of registered nurses recommended by the British Association of Perinatal Medicine's standard was relatively consistent across shift types and between weekdays and weekends. However, the required number of registered nurses between individual shifts showed considerable variation, ranging from 2.5 to 10.3. During the inclusion period, 81.2 % of the shifts had a registered nurse provision ratio below 1.0, suggesting that most shifts did not meet the recommendations for staffing levels. This study highlights a shortfall in registered nurse staffing relative to recommended levels. Ensuring adequate registered nurse staffing levels is crucial for maintaining high-quality neonatal care and improving infant outcomes.

Nurse staffing models that rely on employment of temporary nurses: A realist review.

Where You Are Matters: Neighborhood Impacts on Nursing Home Staffing Levels.

Research on nursing workforce policy has increasingly shifted from the examining relationship between nurse staffing levels and care quality toward considering a more comprehensive framework that simultaneously considers nurse staffing levels, care quality, and care costs in analyses of optimal nursing staff allocation. In line with this trend, an extended version of Park's Sweet Spot Theory adapted as a multiple inputs and outputs model is proposed in this study. This adapted model may be used to estimate the optimal level of inpatient care quality based on actual inpatient quality indicators and, in concert with a hospital's cost-minimization production model, identify the optimal allocation of nursing staff across three shifts in acute care hospital wards. Beyond providing an empirical framework for analyzing and making decisions regarding optimal nursing staff allocation in hospital acute care wards, the extended theory proposed in this study may be used as an evidence-based tool by the Taiwan Ministry of Health and Welfare for future policymaking related to three-shift staffing standards and nursing salary adjustments.

Delays in hospital discharge to skilled nursing facilities (SNFs) are widely viewed by hospital administrators and policymakers as a significant contributor to hospital crowding and adverse patient outcomes. However, the extent to which regional SNF capacity is associated with hospital length of stay (LOS) is not well understood. To construct empirically derived hospital-SNF markets using a network science approach and to examine whether variation in SNF capacity within these markets is associated with hospital LOS. This cross-sectional study used 2018 and 2019 Medicare fee-for-service claims linked with publicly available SNF data and included 3.34 million inpatient admissions discharged to SNFs from short-term hospitals in the US. Data were analyzed from October 1, 2024, to February 28, 2026. Monthly mean SNF occupancy rates and nurse and therapy staffing levels within an empirically defined regional hospital-SNF market from a patient-sharing network analysis. The main outcome was hospital LOS. Linear regression models estimated associations between market-level SNF capacity measures and LOS, adjusting for patient characteristics, hospital-level postacute care demand, SNF organizational features, and time and hospital-SNF market fixed effects. Analyses were stratified by dual Medicare-Medicaid eligibility. The study sample included 3.34 million Medicare inpatient admissions (mean [SD] age, 78.6 [11.3] years; 60.2% women) discharged to SNFs across 62 303 hospital-SNF dyads, and 421 empirically derived hospital-SNF markets. The mean (SD) hospital LOS was 6.9 (6.8) days (7.4 [7.8] days for dual-eligible patients and 6.7 [6.2] days for non-dual-eligible patients). Within markets, each additional nurse staffing hour per patient-day was associated with a 3.5% shorter LOS (95% CI, -5.5% to -1.4%); associations were also found among dual-eligible patients (-3.9% [95% CI, -6.7% to -0.9%) and non-dual-eligible patients (-3.2% [95% CI, -5.4% to -0.9%]). Differences in occupancy rates and therapy staffing within networks were not associated with differences in LOS after adjusting for patient, hospital, and network factors. Hospital-SNF markets defined by the strength of patient-sharing relationships provide a reproducible framework for examining postacute care capacity across payer populations. Within these markets, for the Medicare fee-for-service population, higher nurse staffing levels were associated with shorter hospital LOS. Strategies to reduce discharge delays and hospital crowding may require closer alignment between hospitals and highly connected SNFs to maintain adequate postacute care capacity.

The THErapeutic Optimisation (THEO) project developed by the NICHE Anchor Institute at the University of East Anglia, is a novel and complex intervention research study aimed at optimising the patients’ experience of care. THEO is providing an uplift of two registered nurses working as embedded researchers, combined with a process of participatory action research (PAR) The THEO intervention is partly influenced by evidence that showed that higher nurse staffing levels were associated with better patient outcomes, shorter length of stay and less frequent nurse burnout or job dissatisfaction. The participatory action research (PAR) intervention uses an emancipatory, systematic and rigorous process philosophy; which will involve recruiting core volunteer co-researchers from the existing ward nursing team as bringing expertise in this innovation. In addition, participation will be sought from the wider team and patients/ service users through methods such as observation of care and sharing experiences of care. Wrapped around the implementation of PAR are three other research elements; i) quantitative data (eg Length of Stay), ii) qualitative and iii) process evaluation being led by an external collaborating research partner. Practice development (PD) methods will also be used within the PAR framework, as a facilitated intervention to achieve a participatory approach to inquiry, engaging with staff and patients, within two NHS clinical wards. The co-research team which will comprise of the new embedded researchers and the volunteer co- researchers will have time and space to work in collaboration, to “look” (i.e., gather evidence about a situation or context), “think” (i.e., reflect together to critically analyse the evidence), then “act” (i.e., develop a shared action plan, from which to take informed action). This process will generate both knowledge and agreed action from which to improve the experience and care for both the ward staff and the people who receive care on the ward. The intervention phase of THEO is anticipated to commence in Feb/ March 2025. This paper will be sharing the THEO intervention participatory approach and PD methods that are planned and being implemented. It will also highlight how facilitated practice development offers the chance for health care teams to learn together, hear the voices of patients and shape and innovate their care delivery approach to improve the care experience for all. Participatory approaches to research moves away from the traditional stance of “studying a subject and making a judgement about that subject” and involves a collaborative, participatory and inclusive approach where all involved are partners in both the research and resulting actions and outcomes. This approach is very rewarding and often time consuming in building relationships and partnerships, which is why some avoid this approach in favour of the more traditional approach. However, we will argue that pursuing a participatory approach will result in the ripple effect of ownership and sustainable action for staff and enable patients voices to be heard. This presentation will an opportunity to reflect on the lessons learnt so far in this collaborative and participatory research study between 3 different universities and two NHS sites.

South Korea revised its nurse staffing grade indicators in 2018 by changing the evaluation criteria from nurse-to-bed ratios to nurse-to-patient ratios, enabling hospitals to qualify for higher inpatient reimbursement rates. Beginning in 2020, during the peak of the COVID-19 pandemic, this policy was extended to all medical institutions except tertiary hospitals. This study investigated whether the revised indicators resulted in actual increases in nurse employment and examined their implications for addressing persistent nurse shortages during the COVID-19 pandemic in South Korea. A longitudinal study analyzed data from 1,152 hospitals between 2019 and 2023, examining changes in nurse staffing levels and related indicators. The data were analyzed using descriptive statistics, chi-square tests, and generalized estimating equations. By 2023, 35.9% of hospitals achieved the highest nurse-to-patient ratio grade (Grade 1), compared to only 3.0% under the nurse-to-bed ratio indicator. However, 20.8% of hospitals showed improved nurse-to-patient ratios without corresponding changes in nurse-to-bed ratios, suggesting that the improvements may be due to shifts in patient numbers rather than actual increases in nurse employment. The relative risk (RR) of improving nurse-to-bed ratio grades during the pandemic was less than 1 (RR 0.88-0.94), indicating a worsening trend, while nurse-to-patient ratio grades improved (RR 1.19-1.22). The revised indicators improved apparent compliance, but this change was driven by metric changes and reduced patient admissions, not a substantive reinforcement of staffing levels. Without sufficient recruitment, rising post-pandemic patient volumes may exacerbate nurse workloads and compromise care quality. Policymakers should closely evaluate the outcomes of staffing policies and ensure adequate incentives for nurse recruitment.

To explore experienced nursing staff's perceptions of essential nursing care in the emergency department (ED). Nurse staffing levels in the ED are known to influence a variety of patient outcomes, such as time to medication, incidence of unexpected cardiac arrest, and flow indications such as length of stay. In addition, studies highlight an issue with missed nursing care in the ED setting, particularly for basic care needs. This suggests a need for deeper understanding of the content of ED nursing, and nursing staff's perceptions of their responsibilities towards ED patients' needs. A qualitative focus group interview study with an exploratory design, interviewing experienced nursing staff at four Swedish EDs of various sizes and locations. Data were analysed through inductive, reflexive thematic analysis. Three main themes of essential ED nursing emerged, which were for nursing staff to Create control, Take Action and Be a safety net. The themes were united by the overarching theme of Making knowledge-based priorities in an ever-changing environment. ED nursing is complex and requires skill to prioritise among multiple essential nursing tasks constantly in an environment that itself is constantly changing. A priority is to identify warning signs quickly, ensure patient safety and keep length of stay as short as possible. Due to variation in patients' symptoms, almost all nursing tasks, such as performing various medical interventions and meeting physical and psychosocial needs, were considered to be essential nursing. However, the need to prioritise among essential tasks may lead to less urgent tasks being postponed or missed.

The study aimed to identify the determinants of patient satisfaction with nursing care in internal medicine wards, recognising patient satisfaction as an important indicator of healthcare quality. The objectives included examining the relationship between patient satisfaction and selected organisational factors, such as nurse staffing levels, work environment, supervisor support, team relations, and nurse burnout, as well as selected patient-related variables, including length of hospitalisation. A multicentre cross-sectional study was conducted between June 2019 and January 2020 in 11 hospitals located in southern Poland. The study included 209 nurses and 533 adult patients hospitalised in internal medicine wards. Data were collected using validated research instruments, including the Practice Environment Scale of the Nursing Work Index (PES-NWI), the Newcastle Nursing Care Satisfaction Scale (NSNS), and the Maslach Burnout Inventory (MBI), which were selected to ensure reliable assessment of the nursing work environment, patient satisfaction, and occupational burnout. Quantitative statistical analysis was performed using correlation measures to examine relationships between variables. The design was chosen to allow simultaneous assessment of organisational, staff-related, and patient-related factors influencing satisfaction with nursing care in real clinical settings.

Labor unions representing workers in US nursing homes bargain for higher wages and safer working conditions, which may reduce staff turnover and increase the quality of care. However, if higher labor costs lead employers to reduce nurse staffing, unionization may reduce care quality. We used a difference-in-differences event study design to estimate the effects of unionization on nurse staffing ratios for total nurse staffing and separately for registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs), as well as the effects of unionization on the quality of care, during the period 2013-21. We found that unionization had no effect on total nurse staffing levels but had opposing effects on RNs and LPNs. Unionization increased LPN staffing by roughly 2.7 nurse hours per day in the average nursing home, but it decreased RN staffing by roughly 3.2 nurse hours per day. Despite this substitution from RNs to LPNs, we found that unionization did not appear to reduce the quality of care, a result consistent with unions increasing nurse productivity.

Missed nursing care (MNC) is defined as any aspect of patient care that is either omitted (in part or in whole) or delayed. Consequently, the potential risks associated with MNC represent a significant threat to patient safety. Identifying MNC is essential for enhancing patient safety, the quality of care, and the overall efficiency of the healthcare system. To investigate the type, prevalence, and reasons for MNC within a surgical context, and to investigate associations between MNC, work-related factors, and individual characteristics of the nursing staff. A cross-sectional design was employed. Data were collected online from November to December 2024 using the MISSCARE survey - Swedish Version 2.0. Registered nurses (RNs) and nurse assistants (NAs) from three surgical units at one Swedish university hospital participated (n=84). Most MNC involved basic care and individual needs, with the most frequently missed items being ambulation (78.0%), mouth care (77.1%), and turning (73.5%). The main reason for MNC was lack of labor resources (59.7%). Over three-quarters of the respondents reported inadequate staffing, interruptions/multitasking, and unexpected increases in patient volume or acuity as significant reasons. Analysis of associated factors indicated that reported MNC and contributing factors may vary according to professional role, work experience, and unit type as less experienced nurses reported higher MNC rates in an acute setting. MNC frequently occurs in surgical units, and is particularly reported in acute care. The discrepancy between nursing staff levels and patient acuity forces the prioritization of essential nursing tasks.

The COVID-19 pandemic exacerbated long-standing challenges in US nursing homes around staffing conditions, with nearly one in five nursing homes reporting severe staffing shortages during the early months of the pandemic in 2020. However, less is known about how nursing home staffing has evolved since the early part of the pandemic. This study used Payroll-Based Journal daily staffing data from the second quarter of 2018 through the fourth quarter of 2024 and other administrative data to examine trends in nursing home staffing levels and turnover before, during, and after the COVID-19 pandemic. Since the start of the pandemic, staffing hours per resident day decreased for all nurse types, especially in nursing homes associated with private equity funds or real estate investment trusts, during the late pandemic and postpandemic periods. Staff turnover decreased slightly during the pandemic and postpandemic periods for all nurse types. Policy makers should consider additional measures to ensure appropriate nursing home staffing levels going forward.

Abstract Nursing staff levels are associated with nursing home (NH) quality, but NHs face substantial challenges recruiting and retaining nursing staff. Medicaid, which does not cover the cost of care, is the primary payer for approximately two-thirds of residents, constraining NHs from increasing staff. While past work has studied state-level Medicaid payment rates, there is little work examining the relationship between staffing levels and facility-level payments. This study utilized data from the Payroll-Based Journal data along with Medicaid payment rates collected from states to examine the association between Medicaid rates and staffing levels, and to determine if this association varied by ownership (i.e., for-profit, not-for-profit, government). The study population consisted of 9,513 freestanding NHs in 44 states in 2019. Average staffing levels were calculated for total nursing staff, as well as registered nurses, licensed practical nurses, and nurse aides. Regression results accounted for facility/resident characteristics (e.g., case-mix) and state-fixed effects. Across all ownership types, higher Medicaid rates were associated with higher staffing levels for all staffing outcomes, though average nursing staff levels are lower among for-profits and government owned NHs when compared to not-for-profits. Results also indicated that for-profit and not-for-profit NHs reacted to increases in Medicaid payment rates similarly (i.e., had higher staffing levels), whereas government NHs responded more strongly to payment increases. By raising Medicaid payment rates, policymakers can address staffing shortages by providing NHs with more financial resources, which in turn allows them to invest in additional nursing staff.

Workload in ICU nurses: A systematic review and meta-analysis of the Nursing Activities Score.

Patient satisfaction is vital in healthcare, influencing treatment adherence, health outcomes, occurrence of complications, and the likelihood of returning for care. This study aimed to assess the impact of the nursing workforce's nationality diversity, years of service, and staffing levels on patient satisfaction in a tertiary hospital, in Saudi Arabia. A retrospective analysis was conducted, correlating patient satisfaction scores from Press Ganey® reports with nursing data from hospital manpower reports collected from 1 July 2019 to 30 June 2023. Descriptive statistics were used, with significance set at p ⩽ 0.05. Pearson's correlation coefficient yielded no relationship between: the nurses' years of service versus mean patient satisfaction scores (r = -0.02, p = 0.695), nursing staff levels versus mean patient satisfaction scores (r = 0.04, p = 0.49; Figure 2) and number of nationalities in the care units versus mean patient satisfaction scores (r = -0.057, p = 0.27). These findings suggest that factors beyond nurse numbers, tenure, or nationality diversity might significantly influence patient satisfaction. Improving other aspects of care and addressing diverse patient needs can allow nursing to further enhance patient satisfaction, health outcomes, and the quality of nursing services provided.

This paper examines whether Medicaid payment rates are aligned with the cost of caring for Medicaid residents and how this relationship varies by facility characteristics. Medicaid is the primary payer for most nursing home residents, but limited information exists on the relationship between payment rates and costs of caring for Medicaid beneficiaries. Per diem Medicaid payment rates were obtained directly from states. Estimated Medicaid per diem costs were calculated from Medicare Cost Reports, then combined with payment rates to calculate a payment-to-cost ratio. Medicaid payment rates and payment-to-cost ratios were examined by key facility characteristics: ownership, Medicaid payer-mix, and nursing staff levels. Nationally, the mean Medicaid payment rate was $198 per resident-day, while the mean Medicaid cost was $253. On average, Medicaid payment rates covered about 82 cents per dollar of estimated Medicaid costs in nursing homes in 2019. This figure declined to 76 cents in not-for-profit facilities. Most nursing homes (92%) had Medicaid per-diem costs that exceed Medicaid payments. Nursing homes with a greater share of Medicaid residents had Medicaid costs that better aligned with Medicaid payment rates. Furthermore, Medicaid payments covered a smaller share of Medicaid costs in nursing homes with the highest nursing staff levels compared with those with lower staffing levels. Policymakers should consider Medicaid payment as part of nursing home reform, as Medicaid payment levels that do not cover costs reduce available financial resources to increase nursing staff levels and improve quality of care absent cross-subsidization from other funding sources.

Nurse staffing configurations and sickness absence in English intensive care units: A longitudinal observational study

Segregation was a 20th-century practice that was used to separate people based on race and other factors. Schools continue to be the central battleground for these issues. The purpose of this study was to explore relationships between school nurse (SN) staffing levels and student outcomes in the state of Georgia. Descriptive statistics were used to understand SN staffing practices across the state of Georgia. Linear regression was used to understand relationships between variables. Choropleth geomapping and Getis-Ord Gi* hot spot analysis were used. Descriptive statistics revealed disparities in SN staffing across the state of Georgia. Linear regression showed a relationship between SN staffing and academic outcomes. Mapping revealed patterns that indicated educational inequities in counties where the majority of residents are Black. Disproportionate school nurse staffing levels may be related to disproportionate funding, with roots from the 20th-century practices.

Cervical Ripening and Labor Induction and Augmentation, 6th Edition.

Were hospital financial resources associated with nurse staffing levels before and during COVID-19?