First published 12 May 2021

The study, by QUT School of Nursing and the Center for Health Outcomes and Policy Research (CHOPR) at the University of Pennsylvania School of Nursing,  evaluated legislation enacted in 2016 as a safety measure.

QUT Faculty of Health Executive Dean Distinguished Professor Patsy Yates said the publication illustrated the value of research that had real-world impact.


Professor Patsy Yates

“This research is a clear example of good public health policy in Queensland being derived from evidence-based research,” Professor Yates, who is co-director of QUT Centre for Healthcare Transformation, said.

“The result benefits the health system, nurses, patients and the public at large.”

The new policy limited the average number of patients per nurse to four, similar to pending legislation in New York and Illinois.

Lead author Professor Matthew McHugh, who is the Independence Chair for Nursing Education and CHOPR Director, said the positive results in Queensland should inform policies in the US and elsewhere.

The researchers collected extensive data before and after the legislation from about 17,000 nurses and analysed outcomes for more than 400,000 patients. They found:

  • A clear need for a safe hospital nurse staffing standard. Before the policy was in place, nurse staffing levels varied significantly across Queensland hospitals. In some facilities, nurses cared for as few as three patients on adult medical and surgical wards, while nurses at other facilities were responsible for as many as 10 patients each.
  • The policy led to better nurse staffing in the intervention hospitals.  While staffing levels remained the same before and after the policy in comparison hospitals, the medical-surgical nurses at the intervention hospitals saw average reductions in their workload of nearly one patient per nurse, with some having three fewer assigned patients after policy implementation.
  • The staffing improvements stimulated by the policy led to better outcomes for patients. The researchers estimated that intervention hospitals had 145 fewer deaths, 255 fewer readmissions, and 29,222 fewer hospital days than if they had not implemented the policy.
  • The policy yielded a good return on investment for the public. In addition to better quality of care and patient outcomes, the savings due to fewer readmissions and shorter lengths of stay in hospitals was about A$70 million, more than twice the cost of the additional nurse staffing.

The findings are consistent with a substantial body of evidence on the positive effects on patient outcomes when nurses have a reasonable number of patients in their care.

There is similarly strong evidence that when staffing levels improve, nurses experience less burnout and job dissatisfaction, which are key drivers to costly turnover and result in nurses leaving their careers at the bedside.

The study’s release coincides with International Nurses Day.

Professor McHugh, who is also a Senior Fellow at the Leonard Davis Institute of Health Economics at Penn, said “These results are all the more relevant in the context of COVID-19, which has pushed an already strained and burnt-out hospital nurse workforce to the brink.

“Minimum safeguards to ensure that there are enough nurses to provide high-quality care to every patient is a simple but effective public safety measure.”

Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals was published in The Lancet.

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