Cochrane · systematic review · CD007019
Hospital nurse‐staffing models and patient‐ and staff‐related outcomes
Butler, M, Schultz, TJ, Halligan, P, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
28
current version
GRADE rated
10
No studies
18
Included studies
NR
No studies 18 · 64.3%Ungraded 0 · 0%Very low 9 · 32.1%Low 1 · 3.6%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyThe introduction of advanced or specialist nurses to the nursing workforce versus usual staffing
Population: medical patients and patients with cancer, asthma, diabetes, heart failure and chronic illness
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Nursing‐staff turnover The introduction of advanced or specialist nurses to the nursing workforce vs usual staffing | no estimate extracted | NR | No studies |
Patient mortality The introduction of advanced or specialist nurses to the nursing workforce vs usual staffing | no estimate extracted | 1358 participants | Low Downgraded: risk of bias |
Patient readmissions The introduction of advanced or specialist nurses to the nursing workforce vs usual staffing | no estimate extracted | 2995 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Patient attendances at the ED The introduction of advanced or specialist nurses to the nursing workforce vs usual staffing | no estimate extracted | 5 studies · 2274 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Length of stay The introduction of advanced or specialist nurses to the nursing workforce vs usual staffing | no estimate extracted | 907 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Patients with pressure ulcers The introduction of advanced or specialist nurses to the nursing workforce vs usual staffing | no estimate extracted | 753 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Costs The introduction of advanced or specialist nurses to the nursing workforce vs usual staffing | no estimate extracted | 617 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
The introduction of nursing assistive personnel (NAP) to the hospital workforce versus usual staffing
Population: patients admitted to a cardiovascular surgery/urology/ophthalmology unit, a kidney transplant/plastic surgery unit, an oncology unit, or an orthopaedic surgery unit
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Nursing‐staff turnover The introduction of nursing assistive personnel (NAP) to the hospital workforce vs usual staffing | no estimate extracted | NR | No studies |
Patient mortality The introduction of nursing assistive personnel (NAP) to the hospital workforce vs usual staffing | no estimate extracted | NR | No studies |
Patient readmissions The introduction of nursing assistive personnel (NAP) to the hospital workforce vs usual staffing | no estimate extracted | NR | No studies |
Patient attendances at the ED The introduction of nursing assistive personnel (NAP) to the hospital workforce vs usual staffing | no estimate extracted | NR | No studies |
Length of stay The introduction of nursing assistive personnel (NAP) to the hospital workforce vs usual staffing | no estimate extracted | NR | No studies |
Patients with pressure ulcers The introduction of nursing assistive personnel (NAP) to the hospital workforce vs usual staffing | no estimate extracted | NR | No studies |
Costs The introduction of nursing assistive personnel (NAP) to the hospital workforce vs usual staffing | no estimate extracted | 6769 participants | Very low Downgraded: risk of bias |
Primary nursing compared to usual/team/functional nursing
Population: nurses working on medical or long‐term psychiatric units
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Nursing‐staff turnover Primary nursing vs usual/team/functional nursing | no estimate extracted | 464 participants | Very low Downgraded: risk of bias, imprecision |
Patient mortality Primary nursing vs usual/team/functional nursing | no estimate extracted | NR | No studies |
Patient readmissions Primary nursing vs usual/team/functional nursing | no estimate extracted | NR | No studies |
Patient attendances at the ED Primary nursing vs usual/team/functional nursing | no estimate extracted | NR | No studies |
Length of stay Primary nursing vs usual/team/functional nursing | no estimate extracted | NR | No studies |
Patients with pressure ulcers Primary nursing vs usual/team/functional nursing | no estimate extracted | NR | No studies |
Costs Primary nursing vs usual/team/functional nursing | no estimate extracted | 138 participants | Very low Downgraded: risk of bias, imprecision |
Self‐staffing versus usual staffing
Population: nurses working on acute care, intensive care or medical care units
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Nursing‐staff turnover Self‐staffing vs usual staffing | no estimate extracted | 674 participants | Very low Downgraded: risk of bias |
Patient mortality Self‐staffing vs usual staffing | no estimate extracted | NR | No studies |
Patient readmissions Self‐staffing vs usual staffing | no estimate extracted | NR | No studies |
Patient attendances at the ED Self‐staffing vs usual staffing | no estimate extracted | NR | No studies |
Length of stay Self‐staffing vs usual staffing | no estimate extracted | NR | No studies |
Patients with pressure ulcers Self‐staffing vs usual staffing | no estimate extracted | NR | No studies |
Costs Self‐staffing vs usual staffing | no estimate extracted | NR | No studies |
The effect of adding a specialist nursing post(s) to nurse staffing compared to usual nurse staffing on patient outcomes
Population: patients with patient outcomes
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcomes$ The effect of adding a specialist nursing post(s) to nurse staffing vs usual nurse staffing on patient outcomes | no estimate extracted | NR | No studies |
In‐hospital mortality The effect of adding a specialist nursing post(s) to nurse staffing vs usual nurse staffing on patient outcomes | RR 0.96 [0.59, 1.56] | 1 study · 612 participants | Moderate Downgraded: imprecision |
Length of stay The effect of adding a specialist nursing post(s) to nurse staffing vs usual nurse staffing on patient outcomes | no estimate extracted | 2 studies · 235 participants | Moderate Downgraded: imprecision |
Readmission The effect of adding a specialist nursing post(s) to nurse staffing vs usual nurse staffing on patient outcomes | RR 1.15 [0.88, 1.52] | 3 studies · 878 participants | Moderate Downgraded: imprecision |
Attendance at ED within 30 days The effect of adding a specialist nursing post(s) to nurse staffing vs usual nurse staffing on patient outcomes | RR 1.14 [0.79, 1.62] | 1 study · 472 participants | Moderate Downgraded: imprecision |
Post‐discharge admission, ED visit or death The effect of adding a specialist nursing post(s) to nurse staffing vs usual nurse staffing on patient outcomes | RR 1.33 [0.93, 1.91] | 1 study · 328 participants | Moderate Downgraded: imprecision |
Post‐discharge adverse events The effect of adding a specialist nursing post(s) to nurse staffing vs usual nurse staffing on patient outcomes | RR 1.03 [0.7, 1.53] | 1 study · 328 participants | Moderate Downgraded: imprecision |
Glycosylated haemoglobin The effect of adding a specialist nursing post(s) to nurse staffing vs usual nurse staffing on patient outcomes | no estimate extracted | 1 study · 88 participants | Low Downgraded: imprecision |
Effect of adding dietary assistants to nurse staffing compared to usual nurse staffing on patient outcomes
Population: patients with patient outcomes
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality ‐ Deaths in trauma unit Effect of adding dietary assistants to nurse staffing vs usual nurse staffing on patient outcomes | RR 0.41 [0.16, 1.01] | 1 study · 302 participants | Moderate |
Mortality ‐ Deaths in hospital Effect of adding dietary assistants to nurse staffing vs usual nurse staffing on patient outcomes | RR 0.56 [0.29, 1.09] | 1 study · 302 participants | Moderate |
Mortality ‐ Deaths at 4 months Effect of adding dietary assistants to nurse staffing vs usual nurse staffing on patient outcomes | RR 0.57 [0.34, 0.95] | 1 study · 302 participants | Moderate |
The effect of team midwifery compared to usual midwifery staffing on maternity care outcomes
Population: patients with maternity care outcomes
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Perinatal death The effect of team midwifery vs usual midwifery staffing on maternity care outcomes | RR 1.22 [0.33, 4.5] | 1 study · 884 participants | High |
Length of stay in hospital (days) The effect of team midwifery vs usual midwifery staffing on maternity care outcomes | no estimate extracted | 1 study · 884 participants | High |
Length of stay in special care nursery (days) The effect of team midwifery vs usual midwifery staffing on maternity care outcomes | no estimate extracted | 1 study · 884 participants | High |