• Vincent S Staggs and Nancy Dunton.
• Department of Biostatistics, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 3060, Kansas City, KS 66160, USA. vstaggs@kumc.edu.
• Int J Qual Health Care. 2014 Feb 1;26(1):87-92.

ObjectiveTo enhance understanding of how nurse staffing relates to unassisted falls by exploring non-linear associations between unassisted fall rates and levels of registered nurse (RN) and non-RN staffing on 5 nursing unit types, thereby enabling managers to improve patient safety by making better-informed decisions about staffing.DesignCross-sectional analysis of routinely collected data using hierarchical negative binomial regression.Setting8069 nursing units in 1361 U.S. hospitals participating in the National Database of Nursing Quality Indicators(®). Main outcome measure Rate of unassisted falls per inpatient day.ResultsAssociations between unassisted fall rates and nurse staffing varied by unit type. For medical-surgical units, higher RN staffing was weakly associated with lower fall rates. On step-down and medical units, the association between RN staffing and fall rates depended on the level of staffing: At lower staffing levels, the fall rate increased as staffing increased, but at moderate and high staffing levels, the fall rate decreased as staffing increased. Higher levels of non-RN staffing were generally associated with higher fall rates..ConclusionsIncreasing non-RN staffing seems ineffective at preventing unassisted falls. Increasing RN staffing may be effective, depending on the unit type and the current level of staffing.

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