• Anne Marie Rafferty, Sean P Clarke, James Coles, Jane Ball, Philip James, Martin McKee, and Linda H Aiken.
• Florence Nightingale School of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK. anne_marie.rafferty@kcl.ac.uk
• Int J Nurs Stud. 2007 Feb 1;44(2):175-82.

ContextDespite growing evidence in the US, little evidence has been available to evaluate whether internationally, hospitals in which nurses care for fewer patients have better outcomes in terms of patient survival and nurse retention.ObjectivesTo examine the effects of hospital-wide nurse staffing levels (patient-to-nurse ratios) on patient mortality, failure to rescue (mortality risk for patients with complicated stays) and nurse job dissatisfaction, burnout and nurse-rated quality of care.Design And SettingCross-sectional analysis combining nurse survey data with discharge abstracts.ParticipantsNurses (N=3984) and general, orthopaedic, and vascular surgery patients (N=118752) in 30 English acute trusts.ResultsPatients and nurses in the quartile of hospitals with the most favourable staffing levels (the lowest patient-to-nurse ratios) had consistently better outcomes than those in hospitals with less favourable staffing. Patients in the hospitals with the highest patient to nurse ratios had 26% higher mortality (95% CI: 12-49%); the nurses in those hospitals were approximately twice as likely to be dissatisfied with their jobs, to show high burnout levels, and to report low or deteriorating quality of care on their wards and hospitals.ConclusionsNurse staffing levels in NHS hospitals appear to have the same impact on patient outcomes and factors influencing nurse retention as have been found in the USA.

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