Grant: Project Grant

Globally, nurses are the largest regulated healthcare profession providing all levels of care to patients within health systems. The deployment of various nursing roles (registered nurses, licensed practical nurses, etc) within healthcare settings is determined by using one of many nurse staffing models. These nurse staffing models range from all registered nurses (who hold a baccalaureate degree) to a mix of differentially educated nurses and aides. Cost of providing care and availability of specific nursing roles often drive decision-making about which model to use. Many systematic reviews have been used to examine the relationships between specific nursing skill mix models and a variety of specific or general health outcomes for patients (e.g. mortality, adverse events, health education, length of stay, health care costs etc.), with inconclusive or contradictory results. Given economic, quality, and contextual factors that confound the impact of individual staffing models, the approach to determining which nursing skill mix model to use is considerably more complex than a simple formula or ratio of nurses to patients needing care. By conducting a realist review and evaluation, we will determine in what contexts and through which mechanisms, certain nurse staffing models produce better health system, staff and patient outcomes. These results will allow us to produce Recommendations for Policy and Practice: Nurse Staffing Principles and Guidelines with our health system decision-makers and collaborators from four countries that will guide decision-making on the deployment of nursing roles across a variety of healthcare contexts to achieve better healthcare outcomes.