Grant: Project Grant

Adverse events (AEs) are a leading cause of death in acute care hospitals. Recent cross-sectional studies have suggested that several nurse staffing practices (e.g., understaffing, the use of less qualified nursing staff and of high volumes of overtime hours) may be important contributors to the incidence of AEs in these settings. There is also emerging evidence that nurses' levels of education and experience might also be related to AE occurrence. The next step in investigation is to determine the optimal number and composition of the nursing staff, and the optimal volumes of overtime hours that are needed to minimize the risk of AEs. To this end, the temporal associations between these nurse staffing practices and the incidence of AEs, and the thresholds for safe staffing levels need to be determined by conducting longitudinal studies. Until recently, detailed daily patient and staffing data were not readily available to conduct such an investigation. With the advent of electronic health records and the digital capture of payroll and staffing data, an exciting opportunity has emerged to address these important questions in the management of nursing staff in acute care hospitals. The objectives of this multisite study are to determine: a) if and which nurse staffing practices are associated with an increased risk of AEs and, b) if thresholds for 'safe' nurse staffing can be established. The results of this study will likely produce evidence-based information that will assist hospital managers in making the most effective use of the scare nursing resources, and in identifying optimal nurse staffing practices that minimize the incidence of AEs. Such evidence is urgently needed given that the international shortage of registered nurses is expected to worsen in the coming years, and because hospitals are increasingly turning to overtime hours and to hiring less experienced or less qualified nursing workers to maintain the accessibility to health care services.