Evidence Report/Technology Assessment

Number 151

Nurse Staffing and Quality of Patient Care
Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov

Contract No. 290-02-0009

Prepared by: Minnesota Evidence-based Practice Center, Minneapolis, Minnesota

Investigators Robert L. Kane, M.D. Tatyana Shamliyan, M.D., M.S. Christine Mueller, Ph.D., R.N. Sue Duval, Ph.D. Timothy J. Wilt, M.D., M.P.H.

AHRQ Publication No. 07-E005 March 2007

This report is based on research conducted by the Minnesota Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0009). The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment. This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

This document is in the public domain and may be used and reprinted without permission except those copyrighted materials noted for which further reproduction is prohibited without the specific permission of copyright holders.

Suggested Citation: Kane RL, Shamliyan T, Mueller C, Duval S, Wilt T. Nursing Staffing and Quality of Patient Care. Evidence Report/Technology Assessment No. 151 (Prepared by the Minnesota Evidencebased Practice Center under Contract No. 290-02-0009.) AHRQ Publication No. 07-E005. Rockville, MD: Agency for Healthcare Research and Quality. March 2007.

No investigators have any affilications or financial involvement (e.g., employment, consultancies, honoraria, stock options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in this report.

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Preface
The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-Based Practice Centers (EPCs), sponsors the development of evidence reports and technology assessments to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. The reports and assessments provide organizations with comprehensive, science-based information on common, costly medical conditions, and new health care technologies. The EPCs systematically review the relevant scientific literature on topics assigned to them by AHRQ and conduct additional analyses when appropriate prior to developing their reports and assessments. To bring the broadest range of experts into the development of evidence reports and health technology assessments, AHRQ encourages the EPCs to form partnerships and enter into collaborations with other medical and research organizations. The EPCs work with these partner organizations to ensure that the evidence reports and technology assessments they produce will become building blocks for health care quality improvement projects throughout the Nation. The reports undergo peer review prior to their release. AHRQ expects that the EPC evidence reports and technology assessments will inform individual health plans, providers, and purchasers as well as the health care system as a whole by providing important information to help improve health care quality. We welcome written comments on this evidence report. They may be sent to the Task Order Officer named below at: Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, or by email to epc@ahrq.gov. Carolyn M. Clancy, M.D. Director Agency for Healthcare Research and Quality Beth A. Collins Sharp, Ph.D.,R.N. Director, EPC Program Agency for Healthcare Research and Quality Jean Slutsky, P.A., M.S.P.H. Director, Center for Outcomes and Evidence Agency for Healthcare Research and Quality Ernestine Murray, M.A.S., R.N. EPC Program Task Order Officer Agency for Healthcare Research and Quality

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Acknowledgments
We would like to thank David Jacobs, Ph.D., for his contribution to conceptualization and methodology of meta-analysis; the librarians Jim Beattie, MLIS, Lisa McGuire, MLIS, Judy Stanke, M.A., and Delbert Reed, Ph.D., for their contributions to the literature search; Kim Belzberg, R.N., B.S.N., and John Nelson, M.S., R.N., for assistance with the literature search and data abstraction; and Marilyn Eells for editing and formatting this report. We would also like to thank Mary Blegen, Ph.D., R.N., F.A.A.N., and Barbara Mark, Ph.D., R.N., F.A.A.N., for their cooperation in sharing their raw data. We also want to thank Mary Blegen, Ph.D., M.A., B.S.N., R.N.; Peter Buerhaus, Ph.D., R.N., M.S., F.A.A.N.; Sean Clarke, Ph.D., M.S., B.A., B.S., C.R.N..P, R.N.; Linda McGillis-Hall, Ph.D., M.Sc., B.A.S., R.N.; and Linda O’Brien-Pallas, Ph.D., M.Sc.N., B.Sc.N., R.N., for reviewing the draft of this report and providing us with helpful recommendations for revisions and clarifications.

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Structured Abstract
Objectives: To assess how nurse to patient ratios and nurse work hours were associated with patient outcomes in acute care hospitals, factors that influence nurse staffing policies, and nurse staffing strategies that improved patient outcomes. Data Sources: MEDLINE® (PubMed®), CINAHL, Cochrane Databases, EBSCO research database, BioMed Central, Federal reports, National Database of Nursing Quality Indicators, National Center for Workforce Analysis, American Nurses Association, American Academy of Nurse Practitioners, and Digital Dissertations. Review Methods: In the absence of randomized controlled trials, observational studies were reviewed to examine the relationship between nurse staffing and outcomes. Meta-analysis tested the consistency of the association between nurse staffing and patient outcomes; classes of patient and hospital characteristics were analyzed separately. Results: Higher registered nurse staffing was associated with less hospital-related mortality, failure to rescue, cardiac arrest, hospital acquired pneumonia, and other adverse events. The effect of increased registered nurse staffing on patients safety was strong and consistent in intensive care units and in surgical patients. Greater registered nurse hours spent on direct patient care were associated with decreased risk of hospital-related death and shorter lengths of stay. Limited evidence suggests that the higher proportion of registered nurses with BSN degrees was associated with lower mortality and failure to rescue. More overtime hours were associated with an increase in hospital related mortality, nosocomial infections, shock, and bloodstream infections. No studies directly examined the factors that influence nurse staffing policy. Few studies addressed the role of agency staff. No studies evaluated the role of internationally educated nurse staffing policies. Conclusions: Increased nursing staffing in hospitals was associated with lower hospital-related mortality, failure to rescue, and other patient outcomes, but the association is not necessarily causal. The effect size varied with the nurse staffing measure, the reduction in relative risk was greater and more consistent across the studies, corresponding to an increased registered nurse to patient ratio but not hours and skill mix. Estimates of the size of the nursing effect must be tempered by provider characteristics including hospital commitment to high quality care not considered in most of the studies. Greater nurse staffing was associated with better outcomes in intensive care units and in surgical patients.

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Contents
Executive Summary ........................................................................................................................ 1 Evidence Report ............................................................................................................................ 7 Chapter 1. Introduction ................................................................................................................... 9 Overview .................................................................................................................................. 9 Chapter 2. Methods....................................................................................................................... 21 Literature Search Strategy and Eligibility Criteria ................................................................. 21 Search Strategy................................................................................................................. 21 Eligibility.......................................................................................................................... 21 Data Synthesis .................................................................................................................. 23 Chapter 3. Results ......................................................................................................................... 25 Association Between Nursing Hours and Ratios and Patient Outcomes................................ 26 Distribution of Nurse Staffing Hours and Ratios ................................................................... 26 Question 1. Association Between Nurse to Patient Ratios and Hospital-Related Mortality ........................................................................................................................... 26 Nurse Ratios and Mortality .............................................................................................. 26 Association Between Nurse to Patient Ratios and Nurse Sensitive Patient Outcomes.................................................................................................................... 28 Question 2. Association Between Nurse Hours per Patient Day and Patient Outcomes .......................................................................................................................... 31 Total Nurse Hours per Patient Day and Hospital Related Mortality................................ 31 Question 3. What Factors Influence Nurse Staffing Policies? ............................................... 36 Staffing Ratios/Mix/Hours ............................................................................................... 37 Question 4. Association Between Nurse Staffing Strategies and Patient Outcomes .............. 42 Patient Outcomes Corresponding to an Increase by 1 Percent in the Proportion of RNs ........................................................................................................................ 42 Patient Outcomes Corresponding to an Increase by 1 Percent in the Proportion of Licensed Nurses ..................................................................................................... 43 Patient Outcomes Corresponding to an Increase by 1 Percent in Overtime Hours .......................................................................................................................... 44 Patient Outcomes Corresponding to an Increase by 1 Percent in Contract Hours ........... 44 Chapter 4. Discussion ................................................................................................................... 91 Association or Cause ........................................................................................................ 91 Marginal Effects ............................................................................................................... 92 Nurse Staffing and Patient Outcomes in Hospitals .......................................................... 93 Staffing Measures............................................................................................................. 93 Care Setting ...................................................................................................................... 94 Other Factors .................................................................................................................... 95 Policy Implications........................................................................................................... 96 Strength of the Evidence .................................................................................................. 97 vii

Recommendations for Future Research............................................................................ 97 References and Included Studies ................................................................................................ 105 List of Acronyms/Abbreviations................................................................................................. 115

Tables Table 1. Table 2. Table 3. Table 4. Table 5. Table 6. Table 7. Table 8. Table 9. Table 10. Table 11. Table 12. Table 13. Table 14. Table 15. Operational Definitions .............................................................................................. 14 Distribution of the Studies’ Quality (94 Studies)....................................................... 47 Distribution of Nurse Hours and Ratios (94 Studies) ................................................ 48 Hospital Related Mortality Rates Corresponding to Changes in Patients/RN Ratio (Pooled Weighted Estimates from Published Studies) ..................................... 49 RN to Patient Ratios and Relative Risk of Hospital Related Mortality (Pooled Adjusted Estimates from Published Studies)................................................ 50 Number of Avoided Deaths/1,000 Hospitalized Patients Attributable to RN/Patient Day Ratio (Pooled Adjusted Estimates from Published Studies)............ 53 Calculated Relative Risk of Hospital-Related Mortality Corresponding to Increased RN Staffing (Results from Individual Studies).......................................... 54 Association Between RN Staffing Ratio and Mortality and Proportion of Mortality Attributable to Nurse Staffing (Results from Individual Studies) ............. 55 Correlation Between Nurse Staffing and Age Adjusted Fatal Adverse Events Related to Medical Care at the State Level .................................................... 56 Association Between Nurse Education, Experience, and Mortality .......................... 57 Patient Outcomes Rates (%) Corresponding to an Increase in RN Staffing Ratios (Pooled Estimation from the Published Studies) ............................................ 58 Relative Risk of Patient Outcomes Corresponding to an Increase in RN Staffing Ratios (Pooled Estimation from the Studies) ............................................... 59 Length of Stay Corresponding to an Increase in RN Staffing Ratios (Pooled Analysis) .................................................................................................................... 62 Patient Outcomes Rates (%) Corresponding to an Increase by 1 Hour in Total Nursing Hours/Patient Day (Pooled Analysis) ................................................. 67 Patient Outcomes Rates (%) Corresponding to an Increase by 1 Hour in RN Hours/Patient Day (Pooled Analysis Reported by the Authors and Estimated RN Hours/Patient Day) ............................................................................. 69 Patient Outcomes Rates (%) Corresponding to an Increase by 1 Hour in LPN/LVN Hours/Patient Day (Pooled Analysis)....................................................... 72 Differences in Outcomes Rates (%) in Quartiles of Total Nursing Hours/Patient Day Distribution (Pooled Analysis) .................................................... 75 The Distribution of Nurse Skill and Experience Mix, Nurse Education, and Proportion of Temporary and Full-Time Nurse Hours .............................................. 78 Calculated Changes in Rates of Patient Outcomes Corresponding to an Increase by 1% in the Proportion of RNs................................................................... 79 Relative Risk of Patient Outcomes Corresponding to an Increase by 1% in Licensed Nurse Hours ................................................................................................ 86

Table 16. Table 17. Table 18. Table 19. Table 20.

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Table 21. The Number of Patient Adverse Events that Could be Avoided by Additional 8 RN Hours a Patient Receives During 24 Hours in a Hospital............... 99 Table 22. The Proportion of Patient Adverse Events (%) that Could be Avoided by Reducing the Number of Patients Assigned to an RN During an 8-Hour Shift .......................................................................................................................... 100 Table 23. Relative Risk of Mortality and Nurse Sensitive Patient Outcomes Corresponding to One Unit Increase in Nurse Staffing Ratios and Hours (Pooled Estimates) ................................................................................................... 101 Table 24. Consistent Across the Studies, Significant Association Between Nurse Staffing and Patient Outcomes (Results from Pooled Analysis), Attributable to Nurse Staffing Proportion of Events, and Number of Avoided Events Per 1,000 Hospitalized Patients ..................................................... 103

Figures Figure 1. Figure 2. Figure 3. Figure 4. Figure 5. Conceptual Framework of Nurse Staffing and Patient Outcomes ............................. 13 Factors Affecting Nurse Staffing Policies.................................................................. 18 Nurse Staffing Strategies and Patient Outcomes ....................................................... 19 Flow of Study Selection for Questions 1, 2, and 4..................................................... 46 Relative Risk of Patient Hospital-Related Mortality Corresponding to Change in Registered Nurse to Patient Ratio (Pooled Estimation from the Studies)....................................................................................................................... 51 Relative Risk of Death Among Different Categories of Patients/RN/Shift (Pooled Analysis) ....................................................................................................... 52 Patient Outcomes Rates (%) Corresponding to an Increase by Patient per LPN/LVN per Shift (Calculated from One Study) .................................................... 60 Patient Outcomes Rates (%) Corresponding to an Increase by Patient/UAP/Shift (Estimates from Individual Studies and Pooled Analysis)........... 61 Relative Changes in LOS Corresponding to an Increase in RN Staffing Ratios (Pooled Estimation from the Studies) ............................................................. 63 Relative Risk of Hospital Acquired Infections in Quartiles of Patients/RN/Shift Distribution (Pooled Analysis) ..................................................... 64 Relative Risk of Patient Outcomes in Quartiles of Patients/RN/Shift Distribution (Pooled Analysis)................................................................................... 65 Relative Risk of Patient Outcomes in Quartiles of Patients/RN/Shift Distribution (Pooled Analysis)................................................................................... 66 Relative Risk of Patient Outcomes Corresponding to an Increase by 1 Hour in Total Nursing Hours/Patient Day........................................................................... 68 Relative Risk of Patient Outcomes Corresponding to an Increase by 1 Hour in RN Hours/Patient Day (Pooled Analysis).............................................................. 70 Relative Risk of Outcomes Corresponding to an Increase by 1 Hour in RN Hours/Patient Day (Pooled Analysis Combined from Reported and Estimated Hours)........................................................................................................ 71 Patient Outcomes Rates (%) Corresponding to an Increase by 1 Hour in UAP Hours/Patient Day (Pooled Analysis) ............................................................... 73

Figure 6. Figure 7. Figure 8. Figure 9. Figure 10. Figure 11. Figure 12. Figure 13. Figure 14. Figure 15.

Figure 16.

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...................... 98 Appendixes Appendix A: Appendix B: Appendix C: Appendix D: Appendix E: Appendix F: Appendix G: Exact Search Strings List of Excluded Studies Technical Expert Panel Members and Affiliation Sample Abstraction Forms Quality of the Studies Analytic Framework Evidence Tables Appendix and Evidence Tables for this report are provided electronically at http://www.......................... Patient Outcome Rates Corresponding to an Increase in Nurses’ Education and Experience (Results from Individual Studies)............................................ 82 Figure 22....... 85 Figure 25............ Relative Risk of Hospital Related Mortality and Failure to Rescue Corresponding to an Increase by 1% in the Proportion of RNs (Results from Individual Studies and Pooled Estimates) .............................ahrq............ Relative Risk of Patient Outcomes Corresponding to an Increase by 1% in the Proportion of Licensed Nurses.......................................................gov/downloads/pub/evidence/pdf/nursestaff/nursestaff.................... 74 Figure 18.......................... Relative Risk of Hospital Related Mortality and Failure to Rescue Corresponding to an Increase by 1% in the Proportion of Licensed Nurses .................................................. x ................................ 77 Figure 20............................... 90 Figure 27......................... 81 Figure 21... Changes in LOS Corresponding to an Increase by 1 Nursing Hour/Patient Day (Pooled Analysis) ................. Relative Risk of Patient Outcomes Corresponding to an Increase by 1% in the Proportion of RNs (Pooled Analysis).pdf ................................................................................................................... 76 Figure 19.Figure 17.......................................................................... Relative Risk of Outcomes Corresponding to an Increase by RN FTE/Patient Day Consistent Across the Studies .............. Relative Risk of Treatment Complications Corresponding to an Increase by 1% in the Proportion of RNs (Results from Individual Studies and Pooled Estimates).................................. Relative Risk of Patient Outcomes Corresponding to an Increase by 1% in the Proportion of RNs (Results from Individual Studies and Pooled Estimates).............................. 89 Figure 26..................................................... 83 Figure 23........................................... 84 Figure 24............................ Calculated Changes in Rates of Patient Outcomes Corresponding to an Increase by 1% in the Proportion of RNs....................... Relative Risk of Patient Outcomes in Quartiles of RN Hours/Patient Day (Pooled Analysis of RN Hours Reported by the Authors and Estimated from RN Ratios ..........

whereas nurse work hours look specifically at nurses involved in patient care. The literature associated with question 3 does not lend itself to meta-analysis. How is a specific nurse to patient ratio associated with patient outcomes (i.7 This systematic review analyzes associations between hospital nurse staffing and patient outcomes with consideration of variables that could influence the primary association. administrative reports.. Studies for question 3 addressed implications for nurse staffing policies. has the potential to threaten quality of care.5 However. adverse drug events.4. the varied ways staffing rates are calculated complicates pooling data. the analyses were conducted separately for classes of patients and hospital characteristics. 1 . and 4. What gaps in research on nurse staffing and patient outcomes can be identified to address in future studies? Questions 1. What factors influence nurse staffing policies? 4. which may include all nurses assigned to a unit. How is a measure of nurse work hours (hours per patient or patient day) associated with the same patient outcomes? 3. length of stay. The basic research questions were: 1. Even beyond this distinction. patient satisfaction with nurse care)? How does this association vary by patient characteristics. and dissertations. and nursing outcomes? 2. and 4 are addressed in the systematic review using meta-analytic approaches. and 4.g. Methods Observational studies from from 1990 to 2006 from the United States and Canada were reviewed for questions 1. we present the relative risks of nurse staffing levels on various patient outcomes adjusted for measured confounding factors.. 2. Meta-analysis was used to test the consistency of the association between nurse staffing and both patient outcomes and economic outcomes (e. nurse characteristics.Executive Summary Introduction A shortage of registered nurses. length of stay). nurse quality outcomes. organizational characteristics. including non-clinical time.e. The nurse to patient ratio relies on a general ratio. For questions 1. the cost effectiveness of increasing registered nurse (RN) staffing is controversial. in combination with increased workload. 2.1-3 Increasing the nurse to patient ratios has been recommended as a means to improve patient safety. Sources included journal articles. 2. Questions 1 and 2 address the same basic association but employ two different measures of nurse staffing.6. mortality. No studies primarily empirically examined a specific nurse staffing policy. What nurse staffing strategies are effective for improving the patient outcomes listed in question 1? 5.

000 surgical patients.13.13.13. ratios less than 2.22 In surgical patients.24 a 51 percent decrease of unplanned extubation.5 patients per RN in surgical units were associated with the largest risk reduction based on quartiles of nurse staffing ratios. an increase by one RN FTE per patient day was associated with a consistent decrease across studies in relative risk of these patient outcomes: a 28 percent decrease of cardiopulmonary resuscitation.23.13.000 hospitalized patients.14. We estimated that if the relationship were causal. Pooled results showed that every additional RN full time equivalent (FTE) per patient day was associated with a relative risk reduction in hospital-related mortality by 9 percent in intensive care units and 16 percent in surgical patients.1 and other nurse sensitive outcomes.20.000 medical patients.000 hospitalized patients and nine lives per 1.21 and in nosocomial bloodstream infections of 31 percent. 1 2 . and six per 1.14.23-25 a 60 percent decrease of pulmonary failure. A further reduction from two to four patients to less than 1.12. In ICUs.Results Of the 94 eligible studies from 96 reports.24 The increase in relative risk of unplanned extubation and pulmonary failure was higher and in hospital acquired pneumonia was lower. as well as reduced length of stay (LOS).13.23. Every additional patient per RN per shift was associated with a 7 percent increase in relative risk of hospital acquired pneumonia. The effect size is greater in surgical patients. one additional patient per RN per shift would result in 12 additional cases of failure to rescue. 3 percent were case-series. The number of deaths in patients who developed an adverse occurrence among the number of patients who developed an adverse occurrence.15.13.14.22 a 53 percent increase in pulmonary failure. 46 percent assessed temporality in the association between nurse staffing and patient outcomes.14. an increase of one RN FTE per patient day was associated with a consistent reduction in the relative risk of failure to rescue by 16 percent. failure to rescue. Reducing the workload from more than six to two or less patients per RN per shift would save 25 lives per 1. staffing rates of this magnitude may not be realistic.000 surgical patients. 7 percent were case-control studies.5 patients per RN would save four lives per 1. However.13.24 a 45 percent increase in unplanned extubation. The associations vary by clinical settings and patient population.000 surgical patients.23.14.16.23-25 and a 17 percent increase in medical complications.14.000 hospitalized patients and 15 lives per 1. and five accidental extubations per 1. The overall quality of the studies averaged 38 (of a possible 50). Patient Outcomes and Nurse Staffing Ratios Consistent evidence from observational studies suggests that an increase in Registered Nurse (RN) to patient ratios was associated with a reduction in hospital-related mortality. we estimate that an increase by one RN FTE per patient day would save five lives per 1.23. 44 percent were cross-sectional studies.13.5 patients per RN per shift in intensive care units (ICUs) and less than 3. corresponding to an increase in patients per nurse ratios.8-21 If the relationship were indeed causal. six cases of pulmonary failure. after adjustment for patient and provider characteristics but does not establish a causal relationship.24 and a 30 percent decrease of hospital acquired pneumonia.

hospitals37 includes qualitative exploratory studies38. LOS was shorter by 24 percent in ICUs and by 31 percent in surgical patients. Other Attributes of Nursing There was a significant negative correlation between the percentage of nurses with Bachelor of Science in Nursing (BSN) degrees and the incidence of deaths related to health care (r = -0.9.33. part-time. failure to rescue. p = 0.30-32 and surgical patients. and the skill mix (licensed vs.26. Trends in the literature suggested that rotating shifts may have negative effects on nurses’ stress levels and job performance perceptions.20. mandatory overtime.13. The death rate decreased by 1.23.22 pulmonary failure by 11 percent.9.98 percent for every additional total nurse hours per patient day (95 percent confidence interval [CI] 0.27.14.15. and other adverse events.26.13.24 unplanned extubation by 9 percent in ICUs.17.16.14. Overall.26-29 The association with RN hours per patient day did not show significant changes in mortality rates. No studies empirically evaluated the interaction of IEN staffing policies with organizational.9.20.13. use of agency or temporary nurses.1216. Further. and internationally educated nurses (IENs).26.26-29 The relative risk of death was lower by 1 percent per 1 additional RN hour per patient day in ICUs8.27. No research provides guidance on the impact or effective use of agency/temporary staff.11.30 and medical patients. several studies indicated that nurses working longer hours may have a negative impact on patient outcomes and safety.27.17-19.46.27.14.35 The LOS in hospitals was lower for additional total nursing. assigning nurses to nursing units other than those they are regularly assigned to work (floating).96-3 percent). or patient care unit factors. unlicensed staff) of nursing units.02). Research on the use and effectiveness of IENs in U. The association between RN hours and LOS was not consistent across studies. An increase in nurse turnover increased the rate of patient falls by 0.20. nurse. 3 . weekend staffing. Nurse job satisfaction and autonomy was associated with a significant reduction in the risk of death.23-25 failure to rescue by 1 percent in surgical12. but not for licensed LPN/LVN and unlicensed assistive personnel (UAP) hours.34 The association between patient outcomes and RN and LPN/LVN hours was inconsistent across the studies.16 and in medical8.39 and descriptive studies40-42 that examined IEN use in healthcare. few studies for any of these staffing policy variables limited drawing any conclusions. scheduling nurses to rotate to different shifts.14 Patient Outcomes and Nurse Staffing Hours An increase in total nurse hours per patient day was associated with reduced hospital mortality. corresponding to an additional RN FTE per patient day.26.35 and deep venous thrombosis by 2 percent in medical patients. the nurse-topatient ratio or nursing hours per patient day for nursing units.14.27 The association between LPN/LVN hours per patient day and death rate was not consistent across studies.8.27.S.13.26.36 Staffing policies examined for this review related to the shift length.10.2 percent. Pooled analysis showed that 1 additional RN hour per patient day was associated with a reduction in relative risk of hospital acquired pneumonia by four percent.The data on other nursing personnel is limited and not replicable in the studies. use of full-time.13.

shock. The proportion of float nurses was positively associated with the risk of nosocomial bloodstream infections. and 1 percent for an additional RN hour per patient day in surgical patients. and nurse satisfaction with job and provided care.19 sometimes including only productive hours worked in direct care.45-47 More contract hours was associated with an increase in LOS. The effect of an additional nurse hour might be quite dissimilar in ICUs and typical hospital units. It is difficult to transition between nurse hours and nurse-to-patient ratios. RN overtime is not associated with the location of the hospital.60 One addressed hours of care provided by nursing staff averaging FTEs of different nurse categories at the hospital level.27 the present meta-analysis found consistent evidence that surgical patients are sensitive to nurse staffing. The comparison of the effect size on patient outcomes among quartiles of patients per RN per shift ratio and nurse hours per patient day detected the same pattern. acute average daily census. teaching status of the hospital.28.42-44 More overtime hours were associated with an increase in hospital-related mortality.37. the maximum reduction in relative risk of hospital-related mortality and adverse events occurred when no more than two patients were assigned to an RN and more than 11 nurse hours were spent per 1 patient day.62 The other relies on less precise data of total nurse staffing to patient volume derived from administrative databases61. Assuming that every additional RN FTE per patient day would provide approximately 8 additional RN hours per patient day. Nurse hours per patient day reflect average staffing across a 24-hour period and do not reflect fluctuations in patient census. educational activities.66.Within the limits of scant literature.52-59 Two general measures of nurse staffing were studied. The effect size varied with the nurse staffing measure.10. 4 . scheduling patterns during different shifts (even the length of shifts varies).50 Discussion This review confirms previous contentions that increased nurse staffing in hospitals is associated with better care outcomes. Nurse staffing could have a different effect in different hospital settings. Hospitals that invest in more nurses may also invest in other actions that improve quality.20 The ratio of patients per RN per shift ratio was more frequently used and provided greater evidence of the effect.45.10.52 Overall hospital commitment to a high quality of care in combination with effective nurse retention strategies leads to better patient outcomes.67 They do not account for the time nurses spend in meetings. acute bed occupancy.18. and bloodstream infections.63-65 averaging annual nurse to patient ratios20 at the hospital or unit level. We did not find consistent evidence that a further increase in RN FTE per patient day ratio can provide better patient safety. or financial margin of the hospital.61. patient satisfaction with overall and nursing care. Magnet hospitals that are said to provide high quality care have better nurse staffing strategies. but both showed generally the same trends. average hours in a nurses’ work week.26. The evidence of the effects of LPN/LVNs and UAP were limited and inconsistent. As shown in previous studies.13 and periods of the year. The reduction in relative risk of hospital related mortality was 16 percent for one RN FTE per patient day.48. and administrative work.28. the expected reduction should be more than observed in the studies that examined the risk of mortality in relation to nurse hours.9. The addition of one unit of nursing care may depend on the baseline rate.11.51 but this association has not been shown to reflect a causal relationship. nosocomial infections.

and leadership undoubtedly play a role but are much more difficult to assess. Adjustments for comorbidity depend on simple averages. and organization of nursing units and staffs.. Skill mix did not demonstrate consistent associations with tested patient outcomes in the present review. it is unlikely that all the salient variables can be addressed in any one study. No direct measure of other influences on outcomes is typically made.e. such as the nature of the primary medical and surgical treatment and the skill of the physician staff. Nurse competence requirements include education. surgical units). The traditional concerns about factors that affect quality of care. The size of the nursing effect must be tempered by all the other factors not considered in most of these studies. Nonetheless. and experience68. More studies should be conducted at the patient level to allow for better control of issues like comorbidity. Many of the studies are performed on data collected at the hospital level over a long period of time. are not addressed and are assumed to be evenly distributed to yield noise.69 Nurse education was associated with lower mortality. patient characteristics. Future work will need to target specific questions and collect and analyze enough information to isolate the effects of nurse staffing levels.70-73 Conclusions Increased nurse staffing in hospitals is associated with better care outcomes. The effect size varied with the nurse staffing measure and sites of patient care (i. medical vs. Larger multi-center studies will be needed. but this association is not necessarily causal. organization. expertise. but not bias. Hierarchical models that control for both institutional and nursing effects could be employed. Future Research Future observational studies will need to take cognizance of the many other factors that can affect the outcomes of interest. Skill.The size of the nursing effect must be tempered by all the other factors not considered in most of these studies. 5 . especially medical care. The importance of nurses’ professional competence and performance have been discussed with regard to developing standards of nurse performance to encourage high quality of care. ICU.

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Evidence Report .

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91 A nurse shortage.35. ANA).51. and failure to rescue.8 billion.27 The design of nurse staffing studies varies. but there is less consensus on other quality measures such as hospital acquired pneumonia (AHRQ.95 AHRQ.S.27 Hospital restructuring in the last two decades.74. ANA).84 Estimates suggest that 1 percent of health expenditures. NQF). patient-oriented.19 Increased patient turnover placed new stresses on nurses to provide safe patient care. in combination with increased workload.6.26.74. the U.27.94.74 Nurses constitute 54 percent of all health care workers in the United States.74 Because of the key role nurses play in patient safety and quality of care.5. while others use administrative data bases that address data at the hospital level and do not permit statistical adjustment for many potentially relevant factors.89. and catheter associated bloodstream infections (NQF). and shorter lengths of stay. or $8.3. they reported the overall correlation with selected patient outcomes.84.84 Patient safety is included in certification process of health care organizations by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)4 and monitored by the voluntary National Quality Forum (NQF). reduced nurses’ trust in hospital and nursing administration as well as reducing nurse autonomy.51 Hospitals with inadequate nurse staffing have higher rates of adverse events such as hospital acquired infection. ventilator associated pneumonia. Introduction Overview Reports from the Institute of Medicine addressing quality of health care provided in the United States call for significant improvements at a system level to guarantee effective. is attributable to preventable adverse events.89.93 A simulation model based on extensive research on nurse staffing estimates the need for additional nurses to achieve the quality goals set for hospital care. and the NQF considered failure to rescue and pressure ulcers as patient outcomes that are sensitive to nursing care. patient satisfaction with nursing care (ANA).89.85 Patient safety from injuries caused by the health care system is critical to improving quality of care and reducing health care costs.92. the American Nurses Association (ANA).1. instead.51 Systematic reviews of the published literature show that better nurse staffing is associated with less hospital mortality and failure to rescue. An additional 9 . Quality indicators directly related to nurse staffing have been developed. The latter designs allow for only crude associations. resulted in shorter hospitalizations of acutely ill patients to increase hospitals’ efficiency and financial performance.87 The health care workforce is crucial to providing patients with high-quality care.Chapter 1.26.74 The increased workload. evidence-based. in response to the advent of managed care. urinary tract infection (NQF.95 Few studies have evaluated optimal nurse staffing ratios and hours in different clinical settings. when 23 percent of hospitals reported 7-12 patients per nurse in most medical-surgical units. and equitable care.74 At least part of the growing nurse shortage from 6 percent in 2000 to a projected 20 percent in 2020 can be traced to nurse job dissatisfaction.65.5. efficient. Some look specifically at individual units or nurses. has the potential to threaten quality of care.90 to examine the association between nurse staffing and patient outcomes which showed that the work environment was a major threat to safe nursing practice in hospitals. patient falls (NQF.92.96-99 The effect size varied widely using different definitions of RN to patient ratio. shock. Department of Health and Human Services (DHHS) and the Agency for Healthcare Research and Quality (AHRQ) conducted several studies51.

functional capacity ii. patient characteristics such as acuity/severity of illness. stage of treatment process. and patient adverse events (urinary tract infections. The idea for this systematic review was supported by the American Organization of Nurse Executives (AONE). hospital acquired pneumonia. nurse characteristics such as nurse level of education. nurse vacancy rate. nurse quality outcomes.16 An increased patient/RN ratio in the evening was associated with a 90 percent increase in relative risk of death in ICUs. patient satisfaction with nurse care b.27 Each additional patient per RN was associated with a 5 percent increase in failure to rescue. shock.28. stage of treatment process. nursing outcomes such as nurse satisfaction. Patient outcomes: mortality.9 An increase from 1.17 Failure to rescue was reduced by 4-6 percent in surgical patients26 when the proportion of RNs increased by 13 percent. and failure to rescue) concluded that increased RN hours per patient day without increased total nursing hours could yield a net reduction in cost of care. A series of research questions was developed by AONE in conjunction with AHRQ staff as follows: 1. most legislative efforts related to mandatory staffing regulations cannot be supported by research that has yielded evidence-based optimal nurse-to-patient ratios or hours.64. organizational characteristics such as type of clinical unit. contract nurses. How is a specific nurse-to-patient ratio associated with patient outcomes? a. foreign-trained nurses 10 .104 Moreover.patient per RN per shift was associated with increased relative risk of mortality by 6-7 percent in surgical patients. duration of shift. The aim of this systematic review is to analyze associations between hospital nurse staffing and patient outcomes with consideration of variables that could influence the primary association.30. shift rotation iv.74 Mandatory nurse-to-patient ratios and staffing plans have been established in several states102 and proposed for all Medicare participating hospitals. adverse drug events. such as overtime hours100 and contract or agency nurses. How does this association vary by: i. nurse retention rate 2.105-107 A national estimation of the cost of increasing RN staffing and the concomitant benefits from avoided deaths.103 However. functional capacity ii.06 to 2. AONE had representation on the Technical Expert Panel. length of stay.66 RN FTE per patient day was associated with a relative reduction in hospital-related mortality by 9 percent. length of stay. the cost effectiveness of increasing the number of RN hours or RN patient ratios is controversial. nurse characteristics such as nurse level of education. patient satisfaction with nurse care b.15. contract nurses. reduced length of stay.101 Increasing the nurse-to-patient ratios and hours has been recommended as a means to improve patient safety. adverse drug events.16 Few studies examined the effect on patient outcomes of nurse staffing strategies. nurse quality outcomes. patient characteristics such as acuity/severity of illness. nursing years in practice. upper gastrointestinal bleeding. How does this association vary by: i. nursing years in practice. Patient outcomes: mortality.6 Comparing the results of different studies is complicated by the way both staffing and outcomes are measured. How is a measure of nurse work hours (hours per patient or patient day) associated with patient outcomes? a. nurse turnover rate. foreign-trained nurses iii.

• FTE per 1. In the case of nurse staffing. What nurse staffing strategies (use of temporary nursing agencies. most nursing studies emphasize the 11 . such as the nature of the disease and patient characteristics. The literature associated with question 3 does not lend itself to meta-analysis. The fifth question is addressed from the results of the overall review and analysis of the studies on nurse staffing and quality. weekend staffing. Rather. nurse vacancy rate. Nurse staffing is only one component of treatment. including nonclinical time. Hours per patient day (HPD) cannot readily be used to accurately determine nurse-to-patient ratios. or absenteeism. Even within this distinction. part-time nurses.000 patient days. The ideal study design would simultaneously adjust for the effects of other treatment elements. Not all productive nursing hours are spent at the bedside. Some studies include only RNs and other studies include both RNs and LPNs/LVNs. What gaps in the body of research of nurse staffing and patient outcomes can be identified to address in future studies? Questions 1. scheduling patterns. Various authors used different operational definitions for the nurse to patient ratio..109 Other challenges are associated with the type of nursing staff included in the nursing hours or nurse ratios. and the magnitude of the discrepancy may vary from hospital to hospital. HPD are likely to overestimate the actual amount of bedside care. Thus. nursing outcomes such as nurse satisfaction.iii. proportion of RNs. vacation. 2. HPD reflect average staffing across a 24-hour period and do not reflect fluctuations in census. use of ancillary personnel) are effective for improving the patient outcomes listed in question 1? 5. conferences) that is included in the ratio. Outcomes research attempts to isolate the relationship between any type of treatment and outcomes by adjusting for the effects of other salient variables. duration of shift.60. shift rotations.108 The nurse to patient ratio relies on a general ratio. and 4 are addressed in the systematic review using meta-analytic approaches. experience mix of nursing staff. hours per patient day. such as the specific medications and procedures given and the skills of the medical staff. Questions about nurse ratios and hours are basically similar and examine the same conceptual association between nurse staffing and patient outcomes but employ two different measures of nurse staffing. Ideally. full-time/part-time mix. the situation is somewhat different. These differences provide challenges to pool data across studies. What factors influence nurse staffing policies (staffing ratios. administration. shift rotation iv. a number of important differences exist in the way staffing ratios are calculated. temporary nurses.g. organizational characteristics such as type of clinical unit. Nurses may be engaged in activities such as education. foreign graduate nurses)? 4. whereas nurse work hours look specifically at nurses involved in patient care. skill mix. nurse turnover rate. floating to nursing units. and quality assurance. sick leave. Instead. overtime (mandatory and voluntary). including: • Number of patients cared for by one nurse per shift. nurse retention rate 3. worked hours should not include other time (e. shift durations. which may include all nurses assigned to a unit. • Nurse per patient day or FTE per occupied bed. the third question is approached by a review of the literature. continuing nurse education. It is important to distinguish wherever possible paid hours from those actually worked.

112-115 Two types of outcomes are proposed to be related to nurse staffing: nurse outcomes and patient outcomes. this variable is not overtly considered in this analysis. The conceptual model for question 4 (Figure 3) emphasizes the relationship between nurse staffing strategies and patient outcomes. Hospital factors and patient factors can directly affect patient outcomes. Although these strategies may be influenced by nurse staffing models. 12 . Table 1 provides definitions for the variables included in Figure 1. greater complication rates will increase LOS. Patient outcomes will. Nurse characteristics can influence nurse staffing. The conceptual model for question 3 (Figure 2) focuses on nurse staffing policies and illustrates factors that might affect such policies. Indeed. but most studies were conducted at the unit and hospital level where average values may result from various mixes of patient types. however. as can medical care and nurse staffing levels (not shown in the model). at least not in any detail. individual level patient characteristics are not usually directly addressed. The composition of the nursing staff. the conceptual model for the relationship between nurse staffing and outcomes (questions 1 and 2) (shown in Figure 1) focuses on those aspects of care that are generally addressed in such studies. The model includes patient factors and hospital organizational factors that may influence the effect of nurse staffing on patient outcomes. but the disease mix and severity are generally not addressed specifically. assuming that all other variables are constant and use average comorbidity scores across hospitals instead of more patient-specific measures. may also play a role in determining nurse staffing policies and vice versa. Hospital factors will influence nurse staffing policies. and hence is shown in a dotted box. such as the extent of experience or extent of contract nursing staff. in turn. it is proposed that nursing organizational factors are an intervening factor.110.86 Whereas a typical medical outcomes study would include variables on patients’ disease severity and comorbidities. affect LOS. The definitions for the variables are provided in Table 1. these can best be addressed in the nurse staffing analyses conducted at patient levels.111 Given this reality. Some studies may be conducted on specific units that treat certain types of patients.effect of nursing resources. nurse outcomes can interact with nurse staffing to affect patient outcomes. While patient outcomes are the ultimate concern. including patient care unit factors.

Conceptual framework of nurse staffing and patient outcomes Patient Factors • Age • Primary diagnosis • Acuity and severity • Comorbidity • Treatment stage Hospital Factors • Size • Volume • Teaching • Technology Medical care Nurse Staffing • Hours/patient day: Delivered care hours Total paid hours • Skill mix • Nurse staffing ratio Patient Outcomes • Mortality • Adverse drug events • Patient satisfaction • Nurse quality outcomes Length of stay Nurse Characteristics • Education • Experience • Age • Contract nurses • Internationally educated nurses Nurse Outcomes • Satisfaction • Retention rate • Burnout rate Organization Factors • Clinical units • Duration of shift • Shift rotation 13 .Figure 1.

or a combination of part-time employees whose combined hours are the equivalent of a full-time position. direct patient care related) hours worked by each skill mix category (RN.Table 1. Operational definitions Questions 1 and 2: How is a specific nurse to patient ratio or a measure of nurse work hours associated with patient outcomes and how does this association vary by patient. LP/VN.. nursing assistants. UAP) RN and LP/VN Nursing personnel Nurse Staffing Measures Patient to nurse ratios RN to patient ratio LPN to patient ratio UAP to patient ratio Nurse hours per patient day RN hours per patient day LPN/LVN hours per patient day UAP hours per patient day RN/LPN/UAP FTEs per patient day FTE Skill mix Licensed nurse Patient Outcomes Mortality Mortality Death in low mortality Diagnosis Related Groups (DRGs) Adverse Drug Event Adverse Drug Events Length of Stay Length of stay Patient Satisfaction Patient satisfaction with nursing care Death from all causes (intra hospital. orderlies. 30 days after discharge) In-hospital deaths in DRGs with less than 0. This term refers to the full range of nursing personnel including RNs. Unlicensed individuals who assist nursing staff in the provision of basic care to clients and who work under the supervision of licensed nursing personnel. specified by job category Number of patients cared for by one RN Number of patients cared for by one LPN Number of patients cared for by one UAP Total number of productive hours worked by all nursing staff with direct care responsibilities per patient day (a patient day is the number of days any one patient stays in the hospital) Number of productive hours worked by RN with direct care responsibilities per patient day (a patient day is the number of days any one patient stays in the hospital) Number of productive hours worked by LPN/LVN with direct care responsibilities per patient day (a patient day is the number of days any one patient stays in the hospital) Number of productive hours worked by UAP with direct care responsibilities per patient day (a patient day is the number of days any one patient stays in the hospital) Number of RN/LPN/UAP FTEs per patient day (FTEs can be composed of multiple part-time or one full-time individual) This ratio has been calculated in several different ways: number of patients cared for by one nurse per shift. and home health aides. as defined by the employer Proportion of productive (i. attendants. nurse/patient day or FTE/occupied bed. Included in.5% mortality An injury related to drugs caused by medical management rather than by the underlying disease or condition of the patient Average length of stay: the number of patient days divided by the number of discharges for a time period Measure of patient perception of the hospital experience related to satisfaction with nursing care 14 . personal care aides. For analytic purposes we operationalized the nurse to patient ratio as the number of patients cared by one nurse per shift and FTE/patient day (see Appendix F for calculations) A full-time employee. but not limited to.e. LPNs/LVNs and UAPs. this category are nurses aides. nurse. FTE/1.000 patient-days. An individual who holds a current license to practice as a practical or vocational nurse in at least one jurisdiction of the United States. Number of patients cared for by one nurse. and organizational characteristics? Variable Nurse Workforce116 Registered Nurse (RN) Licensed Practical/Vocational Nurse (LPN/LVN) UAP Assistive Nursing Personnel Definition An individual who holds a current license to practice within the scope of professional nursing in at least one jurisdiction of the United States. medication technicians.

critically. This applies largely to surgical patients and would be pre-op/post-op. could also be used to distinguish rehabilitative phase from acute treatment. and spiritual domains of life Patient Characteristics Age Primary diagnosis Comorbidity Severity Stage of treatment Functional capacity 15 . Individual’s maximum capacity to perform daily activities in the physical. the 117 number of patients who developed an adverse occurrence Disorder involving repeated or prolonged bacterial infection of the bladder or lower urinary tract (urethra) Post-surgical hematoma or hemorrhage Gastrointestinal hemorrhage Deep vein thrombosis or pulmonary embolism among surgical patients Iatrogenic atelectasis and acute respiratory failure in hospitalized patients Iatrogenic accidental extubation An infection of the lungs contracted during a hospital stay Any infection of post-surgical wounds Cessation of cardiac mechanical activity as confirmed by the absence of signs of circulation Restricting free movement of another person Iatrogenic infection of urinary tract associated with a catheterization Patient satisfaction with overall care Nurse Quality Outcomes Patient falls. or major. moderate. Operational definitions (continued) Variable Patient satisfaction with pain management Patient satisfaction with educational information Definition Patient opinion of how well nursing staff managed their pain as determined by scaled responses to a uniform series of questions designed to elicit patient views regarding specific aspects of pain management Patient opinion of nursing staff efforts to educate them regarding their conditions and care requirements as determined by scaled responses to a uniform series of questions designed to elicit patient views regarding specific aspects of patient education activities Patient opinion of care received during the hospital stay as determined by scaled responses to a uniform series of questions designed to elicit patient views regarding global aspects of care Unplanned descent to the floor during the course of a hospital stay Stage I-IV ulcers An infection occurring in a patient in a hospital or other healthcare facility in whom it was not present or incubating at the time of admission The number of deaths in patients who developed an adverse occurrence. psychological. social. Severity of illness classified as none or minor. or terminally ill. administration style. a fourth class is added for patients having catastrophic comorbidities or complications. could apply to persons undergoing some other defined intervention. professional status. including chronically. reward. injuries Maintenance of skin integrity/pressure ulcers Nosocomial infection rate Failure to rescue Urinary tract infection rate Surgical bleeding Upper gastrointestinal bleeding Post surgical thrombosis Atelectasis and pulmonary failure Accidental extubation Hospital-acquired pneumonia Postoperative infection Cardiac arrest/shock *Restraint prevalence (vest and limb only) Urinary catheter associated infections Nurse Outcomes Staff vacancy rate Nurse satisfaction Staff turnover rate Retention rate Burnout rate Open positions divided by total positions Opinion of nurses about their job in terms of pay. For surgical patients. This data can be collected on the individual patient level or an average figure can be calculated for an entire hospital. and interaction with colleagues Departures from the staff (or hires) divided by total positions Proportion of nurses employed at the beginning of the year who are still employed there at the end in each participating unit Proportion of nurses who reported an excessive stress reaction to professional environment manifested by feelings of emotional and physical exhaustion coupled with a sense of frustration and failure Mean age in years Diagnosis which was a cause for hospitalization (ICD-9 codes) Coexistence of two or more disease-processes measured with weighted scales. based on expected impact on length of stay.Table 1.

10 hours. discharges. medical. telemetry..g. LPN/LVN hours. pay period. or 12 hour shift) Organizations that represent nurses for the purposes of collective bargaining Affiliation with a medical school Number of beds Annual number of procedures performed in a hospital Weighted sum of the number of technologies for direct patient care and services available in a hospital. Availability and saturation in use of computerized physician orders entry systems. LPN/LVN. transfers of patients in a nursing unit or a hospital Staff mix Shift rotations Shift durations Overtime (mandatory and voluntary) Weekend staffing Temporary nurses Full-time/part-time mix Floating to nursing units International Educated Nurses (IEN) Patient Care Unit Factors Patient classification system Patient flow/census fluctuations 16 . nights) during a defined period of time (e. LPN/LVN. critical care) Length of working shift (8. 8 hours. UAP hours) Policies regarding the proportion of productive hours worked by each skill mix category (RN. evenings. Diploma. and patient medical records * Nurse process measures Question 3: What factors influence nurse staffing policies? Variable Nurse Staffing Policies Staffing ratios Staffing hours per patient day Definition Policies regarding the number of patients cared for by one nurse specified by job category (RN.g. BSN. surgical. UAP) Policies regarding scheduling nursing staff to work different work shifts (days. 10. Operational definitions (continued) Variable Nurse Characteristics Demographics Level of education Nursing experience UAP International Educated Nurse (IEN) Contract/temporary/agency nurses Organizational Characteristics Type of clinical units Duration of shift Nursing unions Hospital Factors Teaching status Size Volume Technology index Definition Age and gender Proportion of nurses with nursing degree: Associate degree..Table 1. RN hours. UAP) Policies regarding the total number of productive hours worked by nursing staff with direct care responsibilities on acute care units per patient day (total nursing hours.g.. 12 hours) Policies requiring or permitting additional worked hours over 40 hours/week or more than 8 hours in a day or more than 80 hours in a pay period Policies regarding the frequency of weekends worked Policies regarding the use of temporary/agency nurses Policies regarding the number and type of nursing staff that are full time and part time Policies regarding when nurses can be assigned to work on nursing units other than their regularly assigned nursing unit Policies regarding the hiring and use of nurses that have graduated from schools of nursing in foreign countries Systems that classify patients according to the intensity of nursing care required Frequency of admissions. Master of Science (MS). schedule period) Policies regarding the length of shifts (e. Doctor of Philosophy (PhD) Experience in nursing practice in years Unlicensed assistive personnel (not RNs or LPNs) Nurses who graduated from schools of nursing in foreign countries Any licensed nurse who is providing service at the facility as an employee of another entity Types of patients and services provided on a nursing unit (e. computerized nursing.

clerical staff. medical. Operational definitions (continued) Type of nursing unit Nursing Organization Factors Governance Management/leadership style Types of patients and services provided in a nursing unit (e. It consists of planned learning experiences which are designed to augment the knowledge. diploma. rural. masters. and communicate with nursing staff Teaching. provides direct care for patient RN assumes total responsibility for care of the patient during the time the nurse is on duty RN is a team leader and LPNs and UAPs provide patient care as directed by the RN team leader Nursing staff are assigned specific tasks (e. value. medications. baccalaureate. Aides. critical care) Organizational models through which nurses control their practice as well as influence administrative areas Degree to which nurses in management and leadership positions make themselves visible and accessible to nursing staff.g.Table 1. surgical. doctorate Hospital Factors Type Ownership Technology use Risk management Unionization Nurse Factors Experience in nursing Age Education Question 4: What nurse staffing strategies are effective for improving outcomes? Variable Nurse Staffing Models Patient focused care Definition RNs serve as care managers managing unlicensed assistive personnel in expanded roles (drawing blood. associate degree. and not-for-profit Electronic medical record Degree to which the organization addresses the prevention of adverse events Percent or proportion of nurses who are members of a collective bargaining unit Years working as a licensed nurse or UAP Age in years Proportion of nurses by highest level of education in nursing: practical nursing.. government/public. and incorporate feedback from nursing staff. performing EKGs. and attitudes of registered nurses to improve quality of care and patient outcomes. seek. phlebotomists Primary nursing Total patient care Team nursing Functional nursing Staffing Strategies Use of temporary nursing agencies Use of part-time nurses Proportion of RNs Experience mix of nursing staff Continuing nurse education Use of ancillary personnel Patient outcome measures used for questions 1 and 2 will be used for question 4 as well. patient hygiene care) according to their skill and education Use of nursing personnel that are employed by an organization that supplies nursing staff Proportion of nurses (RN and LPN) working part time (less than 8 hours per shift or less than 40 hours per week) Proportion of RNs among total hospital and total nursing personnel Proportion of nursing staff (by type) according to their years of experience Professional development process after the completion of the pre-registration nurse education program. pediatric.. non teaching. skills. telemetry. urban Proprietary. 17 . treatments. and performing certain assessment activities) RN accountable for care of patient from admission to discharge. coordinates all care.g.

Factors affecting nurse staffing policies Patient Care Unit Factors • Patient factors − Age − Primary diagnosis − Acuity and severity − Comorbidity − Treatment stage • Patient flow/census fluctuations • Unit function Hospital Related • Type • Ownership • Mission • Technology level • Risk management • Unionization Nursing Organization Factors • Governance • Management/leadership Nurse Staffing Policies • Staffing ratio/mix/hours • Shift • Shift rotation • Shift duration • Overtime • Weekend staffing • Temporary nurses • Full time/part time mix • Internationally educated nurses • Floating to other units Nurse Factors • Experience • Age • Education • Contract nurses 18 .Figure 2.

Figure 3. Nurse staffing strategies and patient outcomes Nurse Staffing Models • Patient focused care • Primary nursing • Total nursing care • Team nursing • Functional nursing Hospital Factors • Size • Volume • Teaching • Technology Patient Outcomes • Mortality • Adverse events • Satisfaction • Nurse quality outcomes Nurse Staffing Strategies • Use of temporary nursing agencies • Use of part-time nurses • Proportion of RNs • Experience mix of the nursing staff • Continuing nurse education • Use of ancillary personnel Patient Factors • Age • Primary diagnosis • Severity • Comorbidity • Treatment stage 19 .

.

Then we excluded studies that did not test the associative hypotheses and did not provide adequate information on tested hypotheses (e. and editorials. and Digital Dissertations. excluding secondary data analysis.htm 21 . selection of studies. Methods Literature Search Strategy and Eligibility Criteria Search Strategy Studies were sought from a wide variety of sources. CINAHL. Excluded references are shown in Appendix B.Chapter 2.. All work was conducted under the guidance of a Technical Expert Panel (TEP). least square means. • Randomized controlled trials with random allocation of subjects to intervention and control groups 2 • Controlled not randomized clinical trials • The studies must evaluate the associations between nurse staffing and patient outcomes/nurse quality measures among eligible target populations (patients hospitalized in acute care hospitals in the United States and Canada) and published after 1990 except conducted in 1982-1989 but frequently cited in recent publications • Ecologic studies on correlations between nurse staffing and patients outcomes • Cost-effectiveness analysis of nurse staffing 1 ∗ The literature in this area contained no randomized controlled trials or even non-randomized trials.118 We reviewed abstracts to exclude studies with ineligible target populations conducted in countries other than the United States and Canada and in long-term nursing facilities. National Center for Health Workforce Analysis. The same eligibility criteria. Members are identified in Appendix C. Eligibility Two investigators independently decided on the eligibility of the studies. American Academy of Nurse Practitioners. comments. including MEDLINE®. The approach was different to identify studies that examined factors that influence nurse staffing policies. reviews. The data abstraction forms are shown in Appendix D. federal reports. The search strategies for the four research questions are described in Appendix A∗. National Database of Nursing Quality Indicators.gov/clinic/tp/nursesttp. EBSCO research database. letters. As noted earlier. the question about policies was not appropriate for meta-analysis. American Nurses Association. The full texts of the original epidemiologic studies were examined to define eligible independent variables (nurse staffing and strategies) and eligible outcomes. BioMed Central.g.ahrq. PubMed®. Then we confirmed the eligibility status of the study designs. 2. Studies needed to meet one of the following criteria for questions 1. and analysis of studies were used to examine the association between nurse staffing and strategies and patient outcomes. Appendixes and Evidence Tables for this report are provided electronically at http://www. relative risk). legal cases. and 4: • Retrospective observational cohort studies and retrospective cross sectional comparisons • Administrative cross-sectional survey and analyses. Cochrane databases. Inclusion criteria were applied to select articles for full review.

and 4) The assessment of the studies’ quality was based on “Systems to Rate the Strength of Scientific Evidence. and skewness in the data. certified nurse midwives. design. The evaluations of the studies and the data extraction were performed manually and independently by two researchers. Preventive Services Task Force120 criteria noted below: II-2A: Well-designed cohort (prospective) study with concurrent controls II-2B: Well-designed cohort (prospective) study with historical controls II-2C: Well-designed cohort (retrospective) study with concurrent controls II-3: Well-designed case controlled (retrospective) study III: Large differences from comparisons between times and/or places with or without interventions (cross-sectional comparisons). and 4. and sample size. 2.Studies were selected for question 3 if the study provided implications for nurse staffing policies.”119 For questions 1. Errors in the data extractions were assessed by a comparison with the established ranges for each variable and by a comparison of the data charts with the original articles. an evidence table was developed for each of the nurse staffing variables identifying the purpose of the study. sample. and 95 percent CI were calculated from reported means. Any discrepancies were detected and discussed. variances. For questions 1. and F and T tests for treatment differences were used to assess reported outliers. The exclusion criteria included the following: • Studies published before 1990 • Studies conducted in countries other than United States and Canada and not published in the English language • Studies with target population as outpatients and patients in long-term care facilities • Studies with no information relevant to nurse staffing policies and strategies • Studies that examined the contributions of advance practice nurses (nurse practitioners.S. No studies had as a primary purpose to empirically examine a specific nurse staffing policy.125 We used the Trim and Fill method126 to detect publication bias defined as the tendency to publish positive results and to predict the association when all conducted (published and unpublished) studies are analyzed. independent and dependent variables.122 Baseline data were compared in different studies to test the differences in the target population and unusual patterns in the data. nurse anesthetists) • Studies that evaluated the association between nurse staffing and ineligible outcomes (questions 1. Given the absence of RCTs. standard deviations. regression coefficients.121. and findings.121. nurse clinicians.122 The protocol for the meta-analyses was created according to the recommendations for Meta-analysis Of Observational Studies in Epidemiology (MOOSE). Time trends in positive results were assessed with interaction models with time of the events as continuous variables.124 Standard errors. correlation and regression coefficients. The principal investigators of some studies were contacted to assess the additional and missing information when necessary.123. the level of evidence for all studies was estimated using a subset of the U. descriptive statistics. and 4) • Administrative reports and single hospital studies with no control comparisons that do not test an associative hypothesis (questions 1. and 4 we grouped all criteria into ten dimensions with scores for each aspect assigned a value from 0 to 5 (highest) for a total possible score of 50 for the statistical analysis of the studies’ quality (Appendix E). 22 . 2. For question 3. 2. 2.

Meta-analysis was used to assess the consistency of the association between nurse staffing and patient outcomes and improvement in economic outcomes including LOS. holidays. odds ratios and 95 percent CIs were calculated with fixed and random effects models.800 hours per year). and similarity in reported and not reported variance. We estimated that: • Nurse hours per patient day = (FTE * 40)/patient days130 • One nurse per patient day = 8 working hours per patient day129 • Then the patient per nurse ratio = 24 hours/nurse hours per patient day130 We made the following assumptions: • 37. The analyses were conducted separately for classes of patient and hospital characteristics. but we have also created two standardized rates for purposes of comparison: 1.5 hour work week on average • 48 working weeks per year (4 weeks vacation. 2. medical. and UAP. and clustering of patients and providers were extracted from the studies. The number of patients cared by one nurse per shift3 2. sick time). • All FTEs are full-time nurses with the same shift distribution (assume three 8-hour shifts) • The length of shift does not modify the association between nurse staffing and patient outcomes • Patient density is the same over the year The same estimation was used for each nurse job category—RN.26.g. RN FTE per patient day FTE per occupied bed ratios were calculated based on FTE per mean annual number of occupied bed days (patient days). gender. 23 . similarity in target populations. LPN/LVN. the results of individual studies were summarized in an evidence table with relation to the sample size and 95 percent CI in outcomes.127 Consistency in the results was tested comparing the direction and strength of the association in models with nurse staffing variables as continuous (overall trend) and categorical. Some investigators assume a 40 hour week and 52 working weeks per year (2.27 Different methods have been used to estimate nurse hours per patient day from FTEs. and with surgical and medical patients.Patient populations were classified as surgical.5 hours per week for 48 weeks = 1. socioeconomic status. we conducted separated analyses and report the results: • With definitions the authors used • Corresponding to an increase by one RN FTE per patient day • In categories of patients per RN per shift in ICUs.129 In our conversions.27 Adjustments for patient age. Therefore. in studies reporting outcome rates and adjusted 3 We assume an 8-hour shift.080 hours per year). Weighted by the number of patients and hospitals. Others use more conservative estimates (e. and combined samples.. Assumptions underlying meta-analysis included valid measurements of nurse staffing and patient outcomes.128 We report the nurse to patient ratios as they were used by individual authors. 37. race. and 4. comorbidities. provider characteristics.127 Data Synthesis For questions 1. Sub-analyses were conducted to test whether the direction and strength of the association was independent of study design and financial support. we used the latter estimate (Appendix F).

Chi squared tests were used to assess heterogeneity in study results. adjustment for confounding factors. and patient population. We also transformed nurse staffing levels into a risk estimate per unit of exposure and assigned an exposure value to each categorical group. Meta-analysis was used to estimate pooled regression coefficients: changes in outcomes corresponding to incremental changes by one unit in nurse staffing. where the latter was arranged in quartiles. hospital units.136 To ascertain whether the relationships were linear.132 Significant heterogeneity means the effects of nurse staffing on patient outcomes were not consistent in the studies (not replicable results). The hypotheses of the associations between outcomes and nurse staffing variables were tested with random effects models (random intercept for each study) to incorporate between variability in the studies and to provide valid pooled estimates weighted by sample size.relative risk. The research question examining factors that influence nurse staffing policies (question 3) involved the identification of studies that included one or more of the nurse staffing variables. Individual studies were analyzed with simple linear regression to find slopes for each study when possible.135 and SAS 9. 24 . analytic units. Meta-regression models analyzed possible interactions with the year of publication.132. The studies were summarized in evidence tables followed by a synthesis of the studies for each staffing policy. and with goodness of fit tests. two different forms of staffing variables were tested: continuous and categorical.131. The analytic framework and algorithms for the metaanalysis are shown in Appendix F. When authors reported outcome rates and relative risks grouped by different exposure cut points and reference. assuming a specific parametric distribution for the exposure in the population.133 The calculations were performed using the following software: STATA.134.137 This method can test a linear doseresponse relation and assess the nonlinearity of the dose-response relation. assuming a normal distribution.2 Proc Mixed. we assigned exposure levels as the mean or median of nurse staffing variables.

p = 0. Three studies received <50 percent of the maximum quality score. and 21 studies had >88 percent of the maximum quality score. The quality scores of the studies did not change over the decades (p = 0. interview. Within this score. Medical records were obtained to measure patient outcomes in 27 studies (29 percent). none was eligible.Chapter 3. 25 . 2 percent – legal cases. 2. 2 percent – editorials and expert opinions. 7 percent were case control studies. The investigators generally obtained national and state administrative databases to identify eligible populations. We identified 94 eligible studies presented in 96 reports. and sampling bias was assessed in 15 studies (16 percent). random sampling was reported in 16 studies (17 percent). 17 studies did not provide information on adjustment for confounding factors. the mean external validity was 3. and 4 percent – reviews and secondary data analyses. 2 percent were case reports.15). The overall quality of the studies averaged 38 (where the maximum possible score was 50) (Table 2). Medicare populations were used in 11 studies (12 percent). We excluded 21 percent of the studies that lacked relevant components. 23 percent). Results Figure 4 traces the flow of our literature search for questions 1. 76 percent in American. 6 percent without eligible outcomes. 44 percent were cross sectional studies. Few studies reported the validation to measure nurse staffing variables (11 studies. The mean score for adjustment for assessed confounding factors as a characteristic of internal validity was 2. 38 were conducted in European countries or included nurses in long-term nursing facilities.44). and 4. Geographical locations of eligible hospitals were reported in 49 studies (52 percent). p = 0.02). five reported ineligible outcomes. 56 tested ineligible interventions. Among 101 potentially relevant randomized controlled clinical trials. and news that reprinted the results of the original reports. 12 percent) and patient outcomes (22 studies. 30 percent without eligible target populations. 5 percent – letters.5 ± 1 (70 percent of the maximum score) with 67 percent for the sampling of the study populations. and one web survey. we excluded 97 percent of the studies. 20 percent – comments and success stories. and 13 studies (17 percent) used hospital units.858 potentially relevant references from eight databases identified. and 21 percent that did not test associative hypotheses between nurse staffing and patient outcomes. The test for publication bias was not valid due to a small number of studies for each association and heterogeneity in the results. 3 percent were case series. Single hospital studies constituted 25 percent of all eligible studies (23 reports). 24 studies had <66 percent. The majority of the studies were conducted in the United States (84 studies) with no significant differences in quality (80 percent in Canadian studies vs. Of the 2.9 ± 1. 58 studies (62 percent) used administrative databases.6 (only 58 percent of the possible maximum score). guidelines. More than 9 percent of the sampled analytic units were excluded from 27 studies. The studies supported by national grants had higher quality (80 percent of maximum) compared with unknown sponsorship (73 percent. Thirty-two studies used hospitals as analytic units (34 percent). 43 studies (46 percent) used patients. 46 percent assessed temporality in the association between nurse staffing and patient outcomes.

ahrq.27.26-28.10.30.26. Table G2).000 patient days. overall and within ICUs and surgical units.8-21.14. Some relied on surveys of nurse managers to measure nurse staffing variables (Appendix G∗. one additional patient per RN per shift was associated with an increase in hospital-related mortality by 0.15-17. Table G1).18-20.23 (Table 4).gov/clinic/tp/nursesttp.21.11. Total nursing hours per patient day were measured in 36 studies (38 percent).1 percent13.140 For analysis purposes we combined in-hospital mortality and 30-day mortality.13.34 The same tendency was shown corresponding to one additional RN per 1. Ratios of patients per RN and RN FTE per patient day were examined in 36 studies (38 percent). state. The means and distribution of nursing hours and ratios are presented in Table 3. 26 .834 patients with congestive heart failure who were admitted to 30 hospitals and found a significant correlation in standardized mortality ratios sensitive to individual hospital characteristics.30.24 percent reduction in death rate.27.33 In contrast.9.htm. and UAP hours in three studies.34 or death within 30 days after hospital admission.Association Between Nursing Hours and Ratios and Patient Outcomes Distribution of Nurse Staffing Hours and Ratios Many investigators obtained administrative databases on national.32-34. licensed nurse ratios in three studies. The association with nurse ratios or hours was presented as changes in crude death rates and adjusted relative risk of death corresponding to one unit increase in nurse staffing or in nurse staffing categories defined by authors. Estimating hospital-related mortality based only on in-hospital deaths may be influenced by hospital discharge practices142 and could result in lower in-hospital mortality rates that are independent of the quality or effectiveness of hospital care.33.12. RN hours in 27 studies (29 percent). Association Between Nurse to Patient Ratios and Hospital-Related Mortality We identified 26 studies that examined the association between hospital related mortality and nursing hours or ratios (Appendix G.32. An additional RN FTE per patient day was associated with a 1.16.23. The distribution of nurse staffing variables in eligible published studies was comparable with that published in literature with higher LPN/LVN hours per patient days in medical patients. and UAP ratios in nine studies (10 percent).17.138 Question 1. LPN/LVN hours in 12 studies (13 percent). weighted by the sample size (number of hospitals and patients) showed a reduction in the crude death rate in association with increase RN staffing.139-141 The authors defined hospital related mortality as in-hospital mortality8. and hospital levels. ∗ Appendixes and Evidence Tables for this report are provided electronically at http://www. licensed nurse hours in three studies. One study143 compared the relationship of in-hospital and 30-day mortality rates in 13. Nurses Ratios and Mortality The pooled results. LPN/LVN ratios in eight studies (9 percent).

95).17.20. The reduction was 6 percent in ICUs when one RN was assigned to less than three patients vs.18-20 For those analyzed at the patient level. In contrast.5 RN FTE per patient day (p for heterogeneity 0. Reducing the workload from more than six to two to four patients per RN per shift would save 23 lives per 1.21 Among medical patients it was 6 percent (95 percent CI 0.95).12.12.000 hospitalized patients.9.21 We calculated the relative risk of death in quartiles of patients per RN per shift and found a consistently significant reduction in the relative risk of hospital-related mortality corresponding to a reduced number of patients assigned to an RN (Table 5 and Figure 6).12-16. 95 percent CI 0. An increase by one RN FTE per patient day was associated with a smaller but consistent across the studies’ reduction in mortality by 6 percent (RR 0.16.8.5 surgical patients per RN per shift would save 13 lives. The pooled relative risk was 0.000 medical patients.9.13-17.11. 16 percent (95 percent CI 0.10.76 times less when one RN was assigned to less than two patients compared with four to six patients.13. 38 percent of deaths were linked to poorer nurse staffing in hospitals with more than six patients per RN compared to less than two patients in surgical units. Extrapolating these relationships even further to examine the public health impact of RNs per patient ratio. The decrease from more than six to 2-3. and a further reduction to less than two patients per RN would result in 15 avoided deaths per 1. 95 percent CI 1.2 percent reduction in mortality rates in all studies. The effect was larger in surgical patients.16. five lives per 1.13. The reduction in a workload from 3 to 4 to less than three patients per RN would eliminate 6 percent of deaths in ICUs.89)9. we estimate that an increase by one RN FTE per patient day would save five lives per 1.23 A nonlinear quadratic association between patients per RN per shift and the death rate was noted.17.8-0.93-0.000 hospitalized surgical patients. we calculated changes in death rates and relative risk of death corresponding to an increase by one unit in nurse staffing (Appendix G 27 . The rates increased from 1 to 5 patients per RN per shift (p for heterogeneity <0. an additional patient per RN per shift was associated with an 8 percent increase in mortality risk (RR 1.95)8.94-0.000 hospitalized patients.89-0.10-12. The proportion of deaths attributable to patients per RN per shift ratio is larger in surgical patients.000 hospitalized patients. three to four patients. More RN staffing was consistently associated with a reduction in adjusted relative risk of hospital-related mortality.17-19 and among surgical patients.09).8-21 For studies analyzed at the hospital level. and six per 1. The nadir for the relative risk of death was 1.20 The relative risk of hospital related death was associated with a decrease by 8 percent corresponding to an additional one RN FTE per patient day in pooled analysis.98).20. Table 5 shows both the effects of increasing staff with the authors’ definitions of nurse to patient ratios by one RN FTE per patient day and the relative effects in quartiles of patients per RN per shift distribution in different clinical settings.000 surgical patients (Table 6).23. The effect varies from 4 percent at a hospital level analysis to 8 percent at a patient level analysis.94-0.10. we found that an increase of one RN FTE per patient day would reduce hospital mortality by 8 percent.08. it was 8 percent (95 percent CI 0.21 (Figure 5). To compare the results from individual studies.A pooled analysis showed that an increase by one RN FTE per patient day was associated with a 1.94.13-16.07-1.62 times less compared with more than six patients per RN.002). If the relationship between staffing and outcomes was causal.11. A reduction from three to four to less than three patients per RN per shift in ICUs would save three lives per 1.001).34 The association was consistent in ICUs. the associated decrease in relative risk was 4 percent (95 percent CI 0. and 0.

20.One study reported a significant increase in the death rate of 1.15. 51 percent of deaths was associated with a reduction from 3.5-2. Using state level administrative reports on nurse distribution in the United States1.145 Association Between Nurse to Patient Ratios and Nurse Sensitive Patient Outcomes Authors used different definitions of nurse sensitive patient outcomes.1 to 1. 47 percent of deaths in patients after abdominal aortic surgery was attributable to nurse staffing in these hospitals.11 percent) had 19-34 percent less mortality.17 In patients hospitalized with bladder carcinoma.16.14. falls.21.23 and surgical13.20 Three studies that examined the effect of the LPN/LVN per patient day ratio17.0001).7 RN FTE per patient day. but the effect size differed in studies that used medical records in contrast to administrative databases to measure mortality among hospital units and patient populations (Appendix G Tables G3 and G4).4 RNs per occupied bed ratio.101 Nursing experience did not impact hospitalrelated mortality.Table G2 and Table 7).94 We found some evidence that nurse education and experience are associated with hospitalrelated mortality.One study in surgical patients16 reported a 5 percent reduction in mortality with each 10 percent increase in nurses with BSN degrees (Table 10).16 that about 6-7 percent of deaths were attributable to an increase in patients per RN per shift (Table 8).5 percent) for every additional patient per UAP (p = <.23 complications related to health care. we found a significant negative correlation between the percentage of nurses with BSN degrees and the incidence of deaths related to health care (r = -0.144 and the CDC data148 on fatal injuries related to health care. including a combination of medical13. The associations were presented as differences in the rates or relative risk of outcomes by various categories of nurse staffing. failure to rescue.46.9 Ten percent of avoided deaths in patients with acute myocardial infarction was attributable to an increase from 1. p = 0.101 Nurse manager support was negatively correlated with mortality (r = 0. Table G5).15.16. Hospitals where nurses had the freedom to make important patient care and work decisions experienced 21 percent lower mortality.101 an increase by 17 percent in nurses reporting they were satisfied or very satisfied with their job was associated with a 15 percent decrease in mortality. 28 . We calculated from the individual studies10.94 reported inconsistent changes in the death rate.9 percent (95 percent CI 1.06 to 2. and thrombo-embolic complications related to health care (Appendix G. The death rate was lowest when one UAP was assigned to 7-12 medical patients (p for quadratic association 0.19 A decrease in the nurse to patient ratio in the evening was associated with a 90 percent increase in mortality.3) in one single hospital study in 21 hospital units. pulmonary and cardiac failure.35 and secondary diagnoses of patient nosocomial infections. A nonlinear association between patients per LPN/LVN per shift ratio and relative risk of hospital-related mortality was observed in medical patients with the lowest risk corresponding to 9-12 patients per LPN/LVN (p for quadratic association 0.18.0029).140 Nurse job satisfaction was associated with a significant reduction in the risk of death. Hospitals with a higher proportion of nurses with BSN degrees (36 percent vs.000 patient days.02) (Table 9).0003). pressure ulcers. The majority of the studies (57 percent) reported a significant reduction in risk of death corresponding to an increase in RN staffing. The observed death rate could be reduced by 9-10 percent when increasing by one RN FTE per 1.34.

07. In surgical patients.14. An increase by one patient per RN per shift was associated with a significant increase in failure to rescue by 0.23 However.04 percent (95 percent CI 0.14.13. patient falls by 0.03 percent (95 percent CI 0. We found nonlinear quadratic associations between the RN FTE per patient day ratio and unplanned extubation in ICUs with the nadir at 1.16.13.23-25 and cardiac arrest by 28 percent.16 times higher risk of cardiac arrest (95 percent CI 1.21 and 0.07). a 0.13.22-24.05-1.9 RN FTE per patient day (p for quadratic association 0. One large study in 1.9-2.03 percent decrease in atelectasis and pulmonary failure. nosocomial infections.005).13.23.24 unplanned extubation by 51 percent. the largest decrease in the relative risk of central line associated bloodstream infection was seen in surgical patients in ICUs corresponding to increased nurse to patient ratio. 05).64 times less risk of nosocomial bloodstream infections. In contrast with the analyses of outcomes rates.02) and the ranges of 1.13.13. One unpublished dissertation33 reported an increase in falls.29). Pooled analysis of crude rates (Table 11) showed inconsistent results on patient outcomes.04).21 and a 1. Patient outcomes corresponding to an increase by one patient per LPN/LVN per shift (Appendix G.22.147 In individual studies. Table G7).84 times less risk of failure to rescue12. the ranges of RN FTE per patient day at 0.15. An additional patient per RN per shift was associated with a 1.03 percent (95 percent CI 0. pooled analysis of adjusted relative risks (Table 12) detected a significant.13.24 The risk of pulmonary failure was greater by 53 percent and the risk of unplanned extubation by 45 percent corresponding to an additional patient per RN per shift.477 hospitals94 examined the association between LPN/LVN per patient ratios and patient outcomes (Figure 7) and reported that one additional patient per LPN/LVN per shift increased the rates of surgical wound infection by 0.01-0.23.07-1. pneumonia by 0.33. generally consistent reduction in patient outcomes corresponding to an increase in RN staffing.146 Studies that defined RN FTE per patient day ratio did not show significant changes in outcomes.14.06 percent (95 percent CI 0.09).35 percent.16.08 times higher risk of failure to rescue (95 percent CI 1.2 were associated with the lowest relative risk of hospital acquired pneumonia (p for quadratic association 0. and pressure ulcers corresponding to an increase of one RN FTE per 1.23.24 An increase by one RN FTE per patient day in surgical patients was associated with 0.04) in a multi-hospital study15 by 7 percent corresponding to every additional patient per RN (RR 1.04).14.02-0.07 times higher risk of hospital acquired pneumonia (95 percent CI 1.23 An increase by one RN FTE per patient day was association with 0.146 and a 5 percent increase corresponded to one RN FTE per patient day.02-0. The data on LPNs/LVNs is varied and inconclusive. 95 percent CI 1.35 The effect was larger in surgical patients in ICUs with a 12 percent reduction in pulmonary failure.04).14.22 pulmonary failure by 60 percent.14. and cardiac arrest by 0.23-25 We estimated that an increase by one RN FTE per patient day in ICUs was associated with a consistent reduction in the relative risk of hospital acquired pneumonia by 30 percent.14.031.02 percent (95 percent CI 0.15.04-0.05).13.13.Patient outcomes corresponding to an increase in registered nurse per patient ratio.02-0.16 and pulmonary failure by 6. One study18 reported a nonsignificant risk of pneumonia and 29 .22 a 1. pulmonary failure by 0.000 patient days (Appendix G. Table G6).13.5-2 RN FTE per patient day were associated with the lowest risk of failure to rescue (p for quadratic association 0.20.147 Surgical patients also experienced greater increase in the risk of failure to rescue (p for interaction 0.14.71 percent reduction in urinary tract infection was associated with one additional patient per RN per shift22.11).23.11).54 percent.13.02-1.14.

86)9.000 patient days increased the length of stay by 1. Surgical patients experienced cardiac arrest 0. and pressure and decubitus ulcers by 0.5 percent (95 percent CI 0. In contrast. One study94 reported that every additional LPN/LVN FTE per 1.urinary tract infections (UTI) corresponding to an increase by one LPN/LVN FTE per patient day. The effect of reduction in patients per RN per shift on patient outcomes was greater in ICUs and in surgical patients (Figure 11).65 corresponding to an additional patient per licensed nurse.01 percent (95 percent CI 0. The reduction by 0.150 (Table 13) detected a reduction in length of stay by 0.55-0.25 days per one RN FTE per patient day was significant but not consistent in medical patients. Patient outcomes in quartiles of nurse to patient distribution.75 an increase in the rate of patient falls by 0. Table G8).14 corresponding to an increase by one RN FTE per patient day. An examination of the association between UAP per patient ratio and patient outcomes (Figure 8) showed that one additional patient per UAP was associated with an increase in the rate of surgical wound infection by 0.94)8.13. Relative risk of nosocomial infection was 94 percent less in surgical patients corresponding to a reduction from 2.8 days (95 percent CI 1. heterogeneity NS).9 patients compared to more than five patients per shift (Figure 10).75 times less in surgical patients when an RN was assigned to 4. Pooled analysis9.02-0.03 percent (95 percent CI 0.25 days corresponding to an additional RN FTE per patient day (p value for heterogeneity <0. The significant reduction in LOS was 31 percent in surgical patients (95 percent CI 0. In medical patients. Few studies examined the association between patient outcomes and licensed nurse ratio defining licensed nurses as RN or LPN/LVN.13.75 times less when one RN was assigned to 3. Random changes in LOS in relation to UAP workload were reported in one study.35-2. The associations between nurse staffing ratios and LOS in hospitals and in hospital units were reported in days and in relative changes in days adjusted for patients and provider characteristics (Appendix G.86). Length of stay corresponding to an increase in nurse staffing ratios.14. We analyzed the relative risk of patient outcomes among different quartiles of patients per RN per shift distribution (Figures 10-12). cardiac arrest by 0. Table G9).71-0.147. Relative risk of hospital acquired pneumonia was 0.35.05). the relative risk of urinary tract infection was higher in medical patients corresponding to an increase in RN staffing.3 and more than four patients.05).33 Pooled analysis of adjusted relative changes in LOS (Figure 9) detected a 20 percent increase in LOS corresponding to one additional patient per RN per shift (95 percent CI 1.8).03).62-0.08-1. the reduction in ratio from more than six to two or less patients per RN per shift was associated with a 41 percent reduction in hospital acquired pneumonia.04 percent (95 percent CI 0.9. respectively compared with two patients per RN per shift.04) (heterogeneity not significant [NS]) was detected corresponding to an increase by one patient per UAP per shift (Appendix G.25). Nonsignificant changes in the rates of pressure ulcers were reported in one study64 and in patient falls in two studies64.02-0.23.69- 30 . Consistently across three studies33.54 and 0. The relative risk of cardiopulmonary resuscitation was 0. A significant consistent across the studies reduction in relative risk of nosocomial infection in medical patients was observed by 3338 percent when one RN was assigned to less than two patients.2-0. one study19 reported that every patient per LPN/LVN reduced LOS by 22 percent (95 percent CI 0.61.13.14 and 24 percent in ICUs (95 percent CI 0. Patient outcomes corresponding to an increase by one patient per UAP per shift.35.009-0.8 to two or less patients per RN per shift. In contrast.33.146.

0005.26. the optimal ratio seems to be within the first quartiles of distribution of patients per RN per shift in ICU and in surgical patients.98 percent for every additional nurse hour per patient (95 percent CI 0.26-28 One multi-hospital study reported a 2 percent reduction in mortality (RR 0.75 times less often with less than two patients per RN vs. The same direction of association in ICUs and in surgical patients was shown with the reduction in relative risk of pulmonary failure.03. respectively. The evidence in medical patients is less consistent and needs further investigation.96-3 percent) was observed (p = 0. heterogeneity NS).4. The association with RN hours per patient day did not show significant changes in mortality rates in four studies.26.3) in surgical patients26.0004). While the effect size is greater in surgical patients and ICUs. The reduction in RN workload was consistently associated with a decrease in relative risk of failure to rescue in surgical patients by 25-39 percent when one RN was assigned to less than two patients vs. despite the substantial heterogeneity in the studies. In conclusion. heterogeneity NS).27 (heterogeneity NS). Question 2. The LOS was 22 percent shorter with a ratio of 1.5 patients was associated with a relative decrease by 17 percent (p = 0.141 31 .139 Pooled analysis that examined the relative risk of death in relation to RN hours per patient day did not detect significant association.97-0.27 in surgical patients. A nonlinear association between patients per RN ratio and medical complications was observed in ICUs.26. 2. One large study reported non-significant changes in the relative risk of death corresponding to an increase by one hour in total nursing hours per patient day.150 Another study demonstrated a small but significant increase in the relative risk of death corresponding to one additional RN hour per patient day.8 and 4.9 patients per RN respectively. pulmonary failure.03.0. Association Between Nurse Hours per Patient Day and Patient Outcomes Total Nurse Hours per Patient Day and Hospital Related Mortality Four studies examined the association between total nurse hours per patient day and hospital related mortality.27 RN hours per patient day and hospital related mortality.4 percent (95 percent CI 0. unplanned extubation.27.5 patients per RN compared with 3-3.3) in medical patients26-28 and by 2.9 and more than five patients. 95 percent CI 0. The reduction from 3-3. The rate was slightly higher (2.27 and in medical patients.3 percent (95 percent CI 1.5-2.6 patients per RN in ICUs (p = 0.30.99) in medical patients.30 in medical units.98. some consistent evidence from observational studies suggests that increased RN to patient ratio is associated with a reduction in hospital-related mortality. three at the hospital level26-28 and one at the unit level.6 patients per RN to less than 1.6-2. and unplanned extubation across quartiles of patients per RN per shift distribution (Figure 12).27. Every additional nurse hour per patient day reduced the death rate by 1.2-3. and bloodstream infections after adjustment for patient and provider characteristics and reduced LOS of surgical patients.18. failure to rescue.1 percent) in three studies analyzed at the hospital level (95 per cent CI 1-3.141 Random changes in the risk of death were observed by pooling three studies at hospital level analysis18.1 percent.19.139 A consistent and significant reduction in death rate by 1. heterogeneity NS) in LOS in ICUs.19. p = 0.26-28.

33.27 with a greater increase in surgical patients by 3. 95 percent CI 0.26.97 percent.49 percent.27 and deep venous thrombosis by 0.11.5 percent.62 Four studies that assessed the risk of pressure ulcers and total nurse hours did 32 . 95 percent CI 0. The relative risk of hospitalrelated mortality was not significant in individual studies (Appendix G.8.88 ± 0.16 in surgical patients (RR 0.26. One study reported an additional LPN/LVN hour was associated with a 2.4-4.23 ± 0.98-1.36 percent.34 ± 0.27 percent.14.39 ± 0.26-28.26.89 ± 0.77 ± 0.129 Three studies that examined the risk of sepsis found only random changes in relation to nurse hours.63.26.27.26.27 urinary tract infection by 4.27.90.78.99-1.27 pressure ulcers by 2.27 In medical patients an additional nurse hour per patient day was associated with a consistent reduction in failure to rescue by 1.80 However.26.26.75.99) per one total nurse hour per patient day.45.33 ± 0. Tables G11-G13).01 percent corresponding to additional nurse hour per patient day.3 percent (95 percent CI 2.2 ± 0.26-28.76-78.71-0.2)26. The results of pooled analysis of changes in patient outcomes corresponding to one additional nurse hour per patient day are presented in Table 14.27 pulmonary failure by 2.15 ± 0.27 (heterogeneity NS).76.8).61.0).26. Two studies examined the association between death rates and LPN/LVN hours per patient day26.001).13.26 ± 0.05 percent.39 ± 0.52 percent.5 percent increase in the crude death rate in medical units (95 percent CI 1. but the heterogeneity was significant (p for heterogeneity = 0.96.27 percent.34 percent. Two studies that assessed the relative risk of thrombo-embolic complications reported random changes in risk.81 hospital acquired pneumonia by 0. A reduction of 1 percent was observed in ICUs (RR 0.46 failure to rescue by 3.99) and in gastrointestinal bleeding by 1 percent (95 percent CI 0.2).0).9.26.84-0.78 hospital acquired pneumonia by 2. Table G10) and pooled analysis.45 ± 0.99-1.0).05 percent. One study reported a reduction in the risk of shock by 16 percent (95 percent CI 0. The pooled analysis showed a significant consistent reduction in sepsis among surgical patients by 1.76.4 percent (95 percent CI 2.27 urinary tract infection by 1. An increase of one RN hour per patient day was associated with a small but consistent reduction in the relative risk of hospital-related mortality.17-19 LPN/LVN and UAP hours per patient day and hospital related mortality.79.48 percent.27.81 shock by 0.139 with a reduction by 0. One study examined the association between mortality and UAP hours per patient day reporting random changes in crude death rates and adjusted risk of mortality.19. After pooling all three studies.27.151 shock by 0. Combined analysis of reported and estimated LPN/LVN hours detected inconsistent increases in death rate.10.8.27 and three18.8-3. Pooled analysis of the adjusted relative risk (Figure 13) detected a significant 12 percent reduction in nosocomial infection corresponding to an increase of one nurse hour per patient day (95 percent CI 0.11 percent.02) whereby an increase of more than nine total nurse hours per patient day was associated with a 13 percent reduction in the relative risk of nosocomial infection.27 An observed increase in nosocomial infection was not consistent across the studies.26.08 ± 0.05 percent.151 surgical wound infection by 0.92).1-4.27.53 ± 0. (Appendix G.26.We conducted combined pooled analysis with RN hours per patient day reported by the authors and estimated from RN to patient ratios.46.45.99.14 percent.26.27 reported the relative risk of death corresponding to increased LPN/LVN hours.27.64. a consistent nonlinear quadratic association was detected (p = 0. every additional LPN/LVN hour per patient day was associated with an increase in the crude death rate of 3. 95 percent CI 0. Differences in patient falls was significant in ICUs only49.27 Patient outcomes corresponding to an increase of 1 total nurse hour per patient day.12-16 and in medical patients (RR 0.31 ± 0.98-0.27 and deep venous thrombosis by 0.46.

26. an additional RN hour per patient day was associated with a consistent reduction in patient falls by 0.2 percent absolute reduction in the rate of this outcome between the 25th and 75th quartiles of RN hours. 95 percent CI 0.45.151 Nursing hours were not associated with failure to rescue in one study.01).24 for every additional RN hour per patient day.31 unplanned extubation by nine percent.27.47.001). In ICUs.23. Patient outcomes corresponding to an increase by one LPN/LVN hour per patient day.76.99) in upper gastrointestinal bleeding in medical patients per additional RN hour per patient day and a 5.62.64. Tables G14G15) corresponding to one additional RN hour per patient day (reported by the authors and estimated from RN FTE per patient day ratios) are presented in Table 15.26-28.75.01 percent61. Additional RN hours per patient day in ICUs were associated with a reduction in relative risk of hospital acquired pneumonia.151 Two studies that assessed relative risk of pulmonary failure also showed random change in risk of the outcomes. We conducted a combined pooled analysis using measures reported by the authors and estimated from ratios of RN hours per patient day (Figure 15).22.65.36.09 percent was seen22.0001) and the risk of nosocomial infections and nurse hours per patient day (p for interaction = 0.69-0.43 ± 0.20.32 percent.27 Patient characteristics can influence the association between outcomes and nurse hours.139.153.81 Patient outcomes corresponding to an increase by 1 RN hour per patient day.79 with a significant but not consistent decrease in pressure ulcers by 1.22 ± 0.12.98-1) corresponding to one additional RN hour per patient day and absolute reduction by 3. The crude rates of most outcomes increased corresponding 33 . a consistent reduction in bloodstream infection by 0.45.16.147 The large multi-center study showed a significant reduction by 1 percent in urinary tract infection in medical patients (RR 0. (We rely here largely on broad definitions like surgical vs.76.83) corresponding to one additional RN hour per patient day (p for heterogeneity <0.98. medical patients.139and pulmonary failure by 1. 47.13.13.13.62.147 One study reported a significant 21 percent reduction in the relative risk of central line associated bloodstream infections by (p <.35 was detected in medical patients.13.13.14.45.36.147 In surgical patients.6 percent in rates of urinary tract infection comparing 25th and 75th percentiles of RN hours.61.79.46.33.14.14.23 In medical patients. The same study also reported a relative reduction by 2 percent (RR 0.62 and deep venous thrombosis27.23.29.24 unplanned extubation.14.97-0. The associations varied in different clinical settings. Patient outcome rates from pooled analysis corresponding to one additional LPN/LVN hour per patient day are presented in Table 16.75.not detect significant changes.81.23. 30.22 pulmonary failure.26-28.06 ± 0.15.64.63.154 attenuated the effect of nursing hours on patient falls (p for interaction <.154-156 Additional RN hours were associated with an increase in rates of urinary tract infection in surgical and medical patients and hospital acquired pneumonia in medical patients (heterogeneity significant for all these associations).129.99.24 and cardiac arrest by four percent13. The results of a pooled analysis of the rates of various patient outcomes (Appendix G. 95 percent CI 0.0001) corresponding to an increase of one RN hour per patient day in surgical patients in ICUs.27.27.62 The relative risk of hospital acquired pneumonia was not associated with total nurse hours. Pooled analysis of the adjusted relative risk is presented in Figure 14 with a significant but not consistent reduction in nosocomial infection by 24 percent (95 percent CI 0.23 percent.45.129.27. Small reductions by 1 percent in relative risk of pulmonary failure35.06 ± 0. the relative risk of failure to rescue was lower by 1 percent.23-25 and nosocomial infection.) The adjustment for comorbidities28.77.

95 percent CI 0.48.26.2628. Patient falls were lower by 0.3 percent (p = 0.99) and bloodstream infections (RR 0.45.27 and hospital-acquired pneumonia was not associated with licensed hours per patient day27.43 days (95 percent CI 0. Length of stay corresponding to an increase by 1 nurse hour per patient day.31-2.45 The studies in surgical patients did not find a significant association with RN hours (p for heterogeneity = 0. An additional total nurse hour per patient day was associated with a decreased LOS by 1.61.99 95 percent CI 0.27 The relative risk of shock.98-1.002) corresponding to one additional LPN/LVN hour per patient day (Appendix G.45 The relationship between nurse staffing and LOS in medical patients showed conflicting results (p for heterogeneity = 0.159 falls.3) corresponding to an additional 34 .to an additional one LPN/LVN hour per patient day.36.48. The rate of pressure ulcers.26.16-2.78 and urinary tract infection by 1.21 days (95 percent CI 1.27 combined complications.157 did not find significant associations with LPN/LVN hours.45 days in medical patients (95 percent CI 0.65 and CPR159 was not associated with licensed hours per patient day.2 percent (p = 0. Table G16).159 thrombosis.76-78 We could find no studies that examined the relative risk of patient outcomes corresponding to UAP hours (Appendix G.36.8-0.2 percent (95 percent CI 0.88-3. 82.00).82.27.3 ± 0. this raise was consistent across the studies (heterogeneity NS for all outcomes). of pulmonary failure by -1.2 ± 0. Pooled analysis of the studies that analyzed relative risk of hospital acquired pneumonia26.36.36).83 by 0.27.26).19 -0.72.12 percent per 1 LPN hour per patient day (heterogeneity NS). additional LPN/LVN hours were associated with lower rates of several outcome in medical patients.33.27. Table G17).00) and hospital-acquired pneumonia (RR 0.157 and studies that assessed the risk of urinary tract infections26.01).45.48.36. However.98-1.64 failure to rescue.76-78 patient falls by 0.26-28.36 days in surgical patients (95 percent CI 1.82.004) for one LPN/LVN hour per patient day.89.36.83 and by 2. 95 percent CI 0. One large study reported a reduction by 11 percent in risk of urinary tract infections (RR 0.26-28.64.159 Patient outcomes corresponding to an increase by 1 UAP hour per patient day.25) in eight studies (heterogeneity NS).7 ± 0. 95 percent CI 0.1 percent (p = 0.27.34-3.0008). One study detected a significant reduction by 87 percent in the relative risk of hospital acquired pneumonia (p = 0.76.39.33.99).97) corresponding to an additional licensed hour per patient day in surgical patient at hospital level analysis.27.26-28.97.33. and pneumonia by -1.36.29 ± 0.987.21 ± 0. heterogeneity NS).94-0.013).26) (heterogeneity NS).33.14-0.83 The association between RN hours per patient day and LOS was not consistent across the studies with random changes in the pooled estimate and significant heterogeneity in the results (p for heterogeneity = 0.05).18 Patient outcomes corresponding to an increase of one licensed hour per patient day.03 and sepsis was lower by 0.002). An increase of 1 UAP hour per patient day was associated with a significant consistent reduction in pressure ulcers by 2. The results of the pooled analysis of patient outcomes corresponding to 1 additional UAP hour per patient day are presented in Figure 16. The results from a pooled analysis of changes in the length of stay corresponding to 1 additional total nurse hour per patient day are presented in Figure 17. One study158 reported a reduction in the rate of thrombo-embolic complications by -0.77. heterogeneity NS).07 percent (0. by 1 percent in gastrointestinal bleeding (RR 0.27.88-4. and by 3-4 percent in pressure ulcers (RR 0.95-0.96 95 percent CI 0.27.27 The studies that examined the association between LPN/LVN hours and LOS reported a significant increase by 3.75.26 percent (95 percent CI 0.

26.24 percent.LPN/LVN hour. The relative risk of unplanned extubation was three times higher in ICUs (RR 3. and unplanned extubation in ICUs.02). The relative risk of failure to rescue was 8 percent higher in medical (RR 1.96) corresponding to a decrease in RN hours per patient day from more than 16 to less than six. The effects of RN hours substantially differ among the studies and patient population. failure to rescue.1.3 hours in ICUs was associated with an increase in the rate of patient falls by 0.35 ± 0. and unplanned extubation. and 1. failure to rescue. urinary tract infections.85 percent.81 ± 0.3 ± 0.6 days (heterogeneity NS)27.04 percent (95 percent CI 0. and urinary tract infection but not other outcomes. A decrease in nurse hours per patient day from more than 11 vs. A reduction in the total nurse hours from more than 9. the relative risk of cardiopulmonary resuscitation was 1.31 ± 0.49-1. We analyzed rates of patient outcomes among different quartiles of nurse hours per patient day distribution (Table 17). but not LPN/LVN and UAP hours.42 ± 0. Table G18) suggests that nurse experience and education can influence patient outcomes (Figure 19). The same study reported that an increase in the crude rate of failure to rescue corresponding to 1 year of nurse 35 . and hospital inquired pneumonia in surgical patients.5 hours in surgical patients was associated with an increase in the rate of failure to rescue by 3.13) in LOS corresponded to 1 additional UAP hour per patient day (heterogeneity NS). In surgical patients. pulmonary failure.4 RN hours per patient day was associated with a 66 percent increase in the relative risk of cardiac arrest (RR 1. sepsis by 1. and pressure ulcers by 2.36.68 ± 0. A few studies suggest that LPN/LVN hours may increase the rates of sepsis. Additional UAP hours reduced the rate of pressure ulcers. 95 percent CI 1.36 ± 0.66.36) for each additional year of nurse experience in surgical patients in the ICU. 95 percent CI 1.16 In the same study.27 An increase by 1. The LOS in hospitals is lower along with additional total nursing.08.53 days (95 percent CI 0.16 percent.49.19 percent in urinary tract infection. urinary tract infection by 4. When we compared the highest and the lowest quartiles of RN hours per patient day (Figure 18). Increasing to more than 10 RN hours per patient day in surgical patients is associated with reduced risk of CPR.2 RN hours per patient day in ICUs.52 times higher corresponding to a decrease from more than 16 to 8. an increase by 1 percent in the proportion of nurses with BSN degrees reduced the rate of failure to rescue by 0.15 percent in hospital acquired pneumonia.32.1 hours to 8.49 ± 0. shock by 0.06-0. 2.45 The increase in medical patients was 1. pulmonary failure by 2. Evidence of the association between nurse characteristics and patient outcomes.76 ± 0.9-0. deep venous thrombosis by 0. Increasing to more than 16 RN hours per patient day may reduce the risk of cardiopulmonary resuscitation.6 hours per patient day in medical patients was associated with a 0.97-4.07-1.13 percent (95 percent CI 1. upper gastrointestinal bleeding by 0. A decrease in nurse hours per patient day from 12.29 ± 0.12. 95 percent CI 1. the evidence from observational studies suggests that an increase in total nurse hours per patient day was associated with reduced hospital mortality. and other adverse events.69).6 days for every LPN/LVN hour per patient day.6 percent.1) and 49 percent higher in surgical patients (RR 1.19 percent.27. The crude rates of complications were reduced by 1. patient falls.45 Patient outcomes in quartiles of the distribution of nurse hours per patient day.17 ± 0. nosocomial bloodstream and urinary tract infections. 9. surgical wound infection by 0.04 percent increase in the rate of shock.1 ± 0. 95 percent CI 1. shock.26.93-2.36.85).5 percent.22 percent. a reduction from more than 10 to 8.27 The effect was larger in surgical patients with an increase by 4.1 percent.22 ± 0.05 percent.31 percent. Some evidence (Appendix G. In conclusion.

154 Some studies. 95 percent CI 0. weekend staffing. Question 3.6 patient satisfaction scores.03).01.1 percent.165 Medical patients in units with higher proportions of RNs with BSN degrees (54percent) expressed satisfaction with care 1.36 There is limited evidence suggesting better nurse staffing is associated with patient satisfaction with nursing care and pain management (Appendix G.88. What Factors Influence Nurse Staffing Policies? Policies related to nurse staffing in hospitals can vary. Table G-20).02.6 ± 13 vs.66 A 2 percent increase in nurse autonomy accompanied a 0.160 Surgical patients in units using a total patient care model (larger proportion of RNs) were more satisfied with pain management compared with a team nursing model (84. 95 percent CI 0.99).44 ± 0.96-1. States with larger proportions of BSN degrees report lower rates of fatal injuries related to health care.) One large survey (8. assigning nurses to nursing units other than those they are regularly assigned to work (floating). Nurses’ perceived satisfaction may reflect the quality of care.910. 74 percent).5 times more often.77.2 percent.08 for an additional year of experience). Nurses responded to the survey question. “In general.6 ± 3. however. some evidence from a few observational studies suggests that an increase in nurses with BSN degrees may reduce the risk of hospital-related mortality and failure to rescue. and internationally 36 .78.95. Several nurse surveys assessed perceived nurses’ satisfaction about patient outcomes21. scheduling nurses to rotate to different shifts.101.62 patient satisfaction scores with pain management. use of full-time. use of agency or temporary nurses.96-1. part-time. 83.66.25 Other studies did not show significant changes in pressure ulcers.166 In conclusion. Hospitals with higher proportions of nurses with BSN degrees (36 percent vs.experience was not significant after adjustment for confounding factors (RR1. Table G19. The authors reported a 5 percent reduction in failure to rescue corresponding to a 10 percent increase in the proportion of nurses with BSN degrees (RR 0.160-164 (Appendix G. 95 percent CI 0.16 The adjusted relative risk of unplanned extubation in neonatal ICUs was not associated with nurse experience (relative risk 1.36. did not detect a significant improvement in patient satisfaction in relation to nurse staffing. how would you describe the quality of nursing care delivered to patients in your unit on your last shift?” A reduction by 16 percent in the relative risk of patient falls and medication errors corresponded to a 30 percent increase in nurses satisfied with the care provided.4 ± 13 scores on the Parkside Patient Satisfaction Survey).5 percent reduction in pressure ulcer rates. In an early study of this phenomenon. There may be policies related to the shift length. an increase by 1 percent in the proportion of nurses with BSN degrees was associated with greater satisfaction by 13.760 nurses)163 examined the relative risk of adverse events among Medicare patients in relation to perceived quality of care. patient falls. mandatory overtime.11 percent) have lower mortality. larger proportions of patients treated in magnet-designated hospitals were satisfied with provided care compared with conventional (nonmagnet designated) general medical units (85percent vs.88 An increase by 1 hour in total nurse hours per patient day was associated with an increase by 2.78.162 An increase in nurse turnover by approximately 2 percent increased the rate of patient falls by 0. or urinary tract infections in relation to nurse experience and education.163 An increase in the proportion of nurses’ perceived work related stress by 40 percent increased the rates of patient falls by 1.

The factors identified in Figure 2 were included in a few of the studies reviewed and will be described in the review for each of the staffing policy variables. One hundred seventeen studies were excluded for the following reasons: not related to the variable of interest (87). not in peer reviewed journals (17). the fluctuation of patient flow on a nursing unit may determine policies for the length of the shift for nurses. inadequate presentation of data (6). unlicensed staff) of nursing units (Figure 2). from conference proceedings (2). None of the studies empirically examined the effect or impact of a staffing policy related to staffing ratios/hours or staff mix.162 (Appendix G. Some studies addressed more than one staffing policy variable and are included in more than one evidence table. or restraint use.5 percent. there was no reduction in falls. Licensed nurses working in California acute care hospitals and nurse staffing in those hospitals were characterized prior to the implementation of mandated nurse staffing ratios. all studies found for this review examined one or more of the staffing policy variables. RN-to-patient ratios varied by type of hospital ownership in California (1:3.9 percent to 66.93 Both concluded that the studies reviewed had a number of limitations which implies caution in interpretation of the findings and translating 37 . One hundred forty-seven studies were identified as eligible and relating to one or more of the staffing policy variables (Appendix G.6 percent). an integrative review not related to the variables of interest (1).109 A low percentage of RNs (39 percent) have baccalaureate degrees and the mix of RNs ranged from 30 percent (sub-acute/transitional) to 84 percent (postpartum/labor/delivery) by different types of nursing care units. For the staffing policy variable staffing ratio/mix/hours. the prevalence of pressure ulcers. Table G21). relevant to nursing homes (3).educated nurses. These findings should be cautiously used to inform staffing policies because these studies have limitations in their design and data sources. For example. and 4 are applied. The age and/or tenure of nurses in a hospital may have an impact on policies regarding rotating shifts or frequency of working weekends. Review of the literature to determine factors that can influence nurse staffing policies did not reveal any studies that empirically examined influences on nurse staffing policy. and the skill mix (licensed vs.4)162 as well as RN skill mix (56. Tables G21-G26). There was no change in the use of contract staff. Nurse staffing policies can also be influenced in hospitals in which nurses are unionized or in which nurses have a strong governance structure.2 to 1:7.109. nurse. the findings from the studies analyzed for questions 1. Rather. 2. several studies examined the impact of the California mandated staffing ratios—an externally imposed staffing policy64. However. A review of 30 studies for each of the staffing policy variables is provided. Staffing policies can be influenced by patient and patient care unit factors. Following the implementation of the mandated staffing ratios. not research (1). total RN hours of care per patient day increased by 20.64 Two recent systematic reviews of nurse staffing and patient. the nurse-to-patient ratio or nursing hours per patient day for nursing units. Staffing Ratios/Mix/Hours The research literature related to nurse staffing ratios or hours and staff mix was comprehensively reviewed in the first two questions examined for this review using metaanalytic approaches. and hospital outcomes reached basically similar conclusions. However.8 percent and the number of patients per RN decreased by 17. despite the increased exposure of patients to RN time. Thirty-six studies were identified as eligible and relating to one or more of the staffing policy variables.92.

pain. skill mix. hospital level data.findings to staffing policies (e. The proportion of Regulated Nursing Staff (Canadian equivalent of RNs in the United States) was associated with better patient outcomes in regard to function.93 Studies with implications for staffing policies that were related to nurse-patient ratios or RN skill mix. Table G21. in fact.170 Diminishing effects of increased RN staffing on reducing the mortality ratio were also found. and in some cases diminishing effects. Greater than 15 nursing hours per patient day on medical and medical-surgical units no longer improved the patient fall rate. nurses’ perceptions of the quality of care.g. the findings from the meta-analyses conducted with these studies may have implications for nurse staffing policies regarding RN skill mix or nurse-to-patient ratios. whereas another study showed strong support for the positive relationship between higher RN skill mix and improved outcomes. and hospital outcomes. and fewer medication errors. there is a trend indicating that an increased LPN/LVN and UAP to patient ratio increases negative outcomes. of increased RN staffing and patient outcomes. there was stronger evidence that total nurse hours per patient day were associated with reduced mortality and negative patient outcomes. Nurses with baccalaureate degrees in nursing were associated with a reduction in mortality.168. education of nurse. satisfaction167 infections. but found to be ineligible for meta-analysis. The findings indicate that a higher RN to patient ratio is associated with a decrease in hospital-related mortality. care delivery models. The findings from the meta-analysis examining nurse staffing ratios suggest hospital staffing policies that provide for a higher RN skill mix.18 The findings from the meta-analyses in this report related to nurse-patient ratios/hours and RN skill mix and specifically examined the relationship between nurse staffing and patient and nurse outcomes. The largest proportion of studies for the metaanalysis was associated with nurse to patient ratios and hospital related mortality. no control for case mix variations. The studies examining the relationship between RN hours per patient day differed substantially. Canada. fall rates improved when nursing hours exceeded 15 hours. Figure 2 suggests that nursing organizational factors have an intervening effect on the relationship between hospital factors and nurse staffing policies. patient factors. There is less evidence for how LPNs/LVNs and UAPs reduce negative patient outcomes.92 These included acuity of the patients.169 Several studies found marginal.. A study conducted in 19 teaching hospitals in Ontario. nurse. supported the relationship between RN skill mix for patient. Other variables likely associated with quality of care should be considered for hospital staffing policies or legislated staffing ratios.g. This research supports probable relationships between richer nurse staffing and several patient and nurse outcomes. competence of nurses. None of the studies reviewed 38 . data from one unit or hospital. they need to consider the type of patient as well as other factors that may impact desired patient and nurse outcomes (e. These studies did not examine relationships between hospital factors. Negative patient outcomes are also reduced by increasing the RN to patient ratio.. patient factors). on surgical units. and institutional support of nursing. Staffing policies that require regular evaluation of staffing effectiveness on patient care units serving different types of patients would seem essential. or nursing characteristics on nurse staffing policy variables. Again. technological support. variations in staffing and outcome measures. are summarized in Appendix G. however. however. However. there was a trend indicating that LPN/LVN and UAP hours per patient day were associated with increased negative patient outcomes. If staffing ratios become part of a hospital staffing policy. or data presented as regression coefficients which are difficult to interpret clinically).

173 Of the 5. Shift work of nurses. and maternity units had significantly higher RN staffing than medical/surgical or gynecologic units. The technological sophistication of hospitals (technology level) was associated with a higher proportion of RNs on the unit. There was no relationship between physical health and mental depression of nurses working the day. a nursing care delivery model. explained more than half of the variability in nurse staffing. Older nurses (≥50 years) were less likely to work long shifts.172 While nursing care delivery models were not hypothesized in Figure 2 to be a factor influencing nurse staffing policies. Table G22). Among 687 RNs and LPNs surveyed in one hospital medication and procedural errors were associated with nurses that rotated shifts. Intensive care.7 percent of the shifts were 12.5 hours or more. or type of unit (unit factor) did not have any affect on errors or near errors. Among nurses from across the country who worked in critical care units on the day (n = 67) and night shifts (n = 75) the ones who worked permanently on the night shift had significantly more depression and poorer global sleep quality than nurses on the day shift. however. rural hospitals also had higher RN staffing. using about one-third more RNs per occupied bed. 55 minutes longer than scheduled each day.171 More sophisticated use of technology predicted increased RN hours. However.178 Nurses working rotating shifts experienced higher stress and lower perception of 39 . and 12 hours) and the types of shifts nurses were scheduled to work (days. Primary nursing. night. this finding seemed to be driven by two large for-profit health systems in the sample.177 Nurses working 12-hour shifts experienced significantly higher levels of stress than nurses working 8-hour shifts. nurses who rotated shifts had a higher risk of having an automobile accident or other injuries. evenings.162 For-profit hospitals and for-profit systems had fewer RN productive hours for medical-surgical nursing units. although several studies examined the direct relationship between hospital factors and nurse staffing policy variables.273)174 both found that nurses were working long hours. but the stress levels were similar when controlling for experience.175 In addition. More than half of hospital nurses were working 12 or more hours per day but half as likely to work 6-7 days a week. 10. hospital size (hospital factor). A survey of nurses who were members of the ANA (n=393)173 and a randomly selected sample of nurses who participated in the National Institute for Occupational Safety and Health (NIOSH) Nurse Worklife Survey (n = 2. nights. evening. Controlling for size. 38.176 There was no significant difference between night and day shift nurses in regards to chronic fatigue or anxiety. Nurses worked. or a combination) (Appendix G.5 hours or longer.172 The two studies were conducted in two different states. Seven studies specifically focused on the length of shift nurses work (8.317 shifts worked by the respondents during a 28 day period. on average. and rotating shifts from five hospitals (n = 463). 46 percent of the variance in chronic fatigue was explained by depression and global sleep quality. Two recent survey design studies examined the work patterns of hospital staff nurses. They did find that the type of unit (patient care unit factors) affected hospital RN staffing. One quarter of the respondents worked 50 hours per week for two or more weeks of the 28-day period. it makes sense that it would be a factor because the primary nursing care delivery model relies on a higher proportion of RNs to be successfully implemented.173 Age of the nurse (nurse factor). suggesting that more hospital nurses are working 12 hour shifts.for question 3 supported this relationship. pediatric.174 The likelihood of making medication and procedural errors (actual and near miss errors) increased with longer work hours and was three times higher when nurses worked shifts lasting 12.162 Another study did not find that ownership was related to nurse staffing variables.

There were discrepancies in the demographics reported for full. A trend in the studies was that full-time nurses experienced higher role overload. higher levels of stress. Implications for staffing policies indicate that the length of nurses’ shifts should be no more than 12 hours and strategies should be implemented to limit work hours exceeding 12 hours.187 Part-time nurses were associated with lower personnel and hospital costs.184 Full-time nurses were statistically more involved in their job183 and more likely to be confident.50 Internationally educated nurses. Contract (agency) nurses. From a hospital efficiency perspective. the risk of working more than 12 hours is high. and higher stress levels of nurses. given that nurses are often not able to finish their work by the end of their scheduled shift.job performance. hospitals.180 Nurse managers do not view agency nurses as cost effective but believe that using agency nurses reduces overtime and provides coverage for weekends. One descriptive study indicates that nurses choosing to work for a staffing agency are not necessarily motivated by nonsalary benefits and hospital nurses are not motivated by the higher salary paid to agency nurses. Two large surveys of Canadian nurses demonstrated these differences.and part-time nurses.179 In that same survey. There is beginning evidence that working more than 12 hours and rotating shifts can lead to errors that compromise patient safety as well as accidents. Because more nurses are working 12-hour shifts (by preference).177 The findings from these seven descriptive studies that used survey methodologies indicate that nurses are working long hours.186 Nurses who worked part time reported liking their work schedules more and experienced less interference between their work and nonwork activities.183 whereas full-time nurses were older. Requiring nurses to work rotating shifts should be curtailed.182 however. including being conducted on only one unit of a hospital and using medical record documentation as a measure of evaluating nursing care quality of agency staff. It should be noted that a number of studies were found on the use of agency nurses. The clinical activities differed by agency and hospital nurses reported having less opportunity to use their clinical skill. A strategy to address the nursing shortage and the growing demands of staffing in hospitals has been the utilization of IENs (Appendix G. Nurses working the night shift reported receiving the least amount of sleep and had the most trouble sleeping. injuries. there were significant limitations to the study. In one. Managers’ perceptions of quality care of supplemental staff did not differ for hospital pool supplemental staff versus agency staff.181 Float pool nurses had the highest rate of documentation on two clinical aspects of patient care.and part-time nurses. Research is needed to evaluate the effectiveness and effective use of agency staff in hospitals as a means to provide adequate staffing for quality patient care. Table G23).50 These studies provide limited insight to guide implications for staffing policies regarding agency nurses. There is a paucity of research on the use and effectiveness of IENs in U. Table G24). part-time nurses were reported to be older. and absenteeism. Table G25).S. functioning as a leader and professional. There is little research on the use of agency staff (Appendix G. but these studies were conducted in countries other than the United States and Canada.185 heavier workloads.39 and descriptive studies40-42 40 . and poorer physical wellbeing. From an organizational perspective. agency nurses were more likely to work evening and night shifts and weekends. Few studies addressed the full or part time status of nurses (Appendix G.184 This difference may be related to a 10-year difference in the time these studies were done. Full.37 The limited research available includes qualitative exploratory studies38. independent. agency nurses were associated with higher hospital operating cost. vacations.

173 Weekend overtime is associated with anticipated turnover. night.44 RN overtime does not seem to be associated with the location of the hospital.7 percent increase in overtime. The prevalence of overtime has been documented in a recent national survey. Seventeen percent of randomly selected nurses reported required mandatory overtime and those whose jobs included mandatory overtime worked significantly longer work hours. No studies empirically evaluated the interaction of IEN staffing policies with organizational. Table G26). nurse.173 Unionization does not seem to be effective in minimizing overtime. Again.37. Lack of research becomes more notable when it is recognized that IENs represent approximately 3. IENs experience moderate to high levels of stress for up to 10 years after coming to the United States to practice nursing. or financial margin of the hospital44 however.42 or general job satisfaction. worked overtime ten or more times during a 28-day period and more than 25 percent reported working mandatory overtime. higher RN straight hours was significantly associated with higher RN overtime. Another staff policy to secure adequate staffing for increasing patient demands and scarce resources is the use of overtime (Appendix G.42 younger in age. the accumulation of these exploratory and descriptive data may assist in understanding human resource demographics more clearly.S.43 Working overtime increased the odds of making at least one medication-related error and the risk of making errors increases when nurses work overtime after longer shifts.188 Lost time claim rates were associated with increasing overtime worked by nurses.37 No differences were found between IENs and U. average hourly wage.189 A few studies suggest that mandatory overtime and overtime in general is prevalent for nurses in U. in a survey of RNs who were members of the ANA. and evening shifts and more overtime.that examined IEN use in healthcare.174 Almost two-thirds of nurses.42 Despite the lack of empirical evidence that articulates the relationship of IENs within the organization. average hours in a nurse’s work week. Each 1 hour increase in straight time was associated with an 8.42 and half as likely to leave the organization. Further studies are warranted to understand healthful integration of IENs into the acute care system of the United States for the purpose of formulating organization policy.37 baccalaureate educated. few studies were found in regards to this staffing variable. A review of overtime use in New York State hospitals for 5 years found that overtime was 22 percent higher for unionized nurses.S. nurses when comparing perceptions of their control over practice or relationship with the physician.37.40.7 percent of the RN population within the United States.43 Occupancy. and hours in the average work week were not associated with RN overtime within hospitals. acute average daily census. There is evidence that overtime and excessively long working hours can compromise patient safety and impact turnover of nurses.38 Other idiosyncrasies noted about IENs include the tendency to gravitate to critical care. teaching status of the hospital. These findings suggest that practices related to nurse overtime and associated policies are important. acute bed occupancy.39 IENs from India experienced racism within the work setting with recommendations for interventions to assist with acculturation. an analysis of nurse overtime over 7 years in New York State hospitals found that overtime increased more in nongovernment unionized hospitals and nonteaching hospitals. 41 .42 the majority from the Philippines.37.37 Understanding this demographic group may facilitate more effective integration and use of nurses who are educated in and emigrate from other countries.41 job satisfaction as it relates to time to do the job or quality of care. When controlling for year-to-year variations in overtime for each hospital. hospitals. Nurse overtime.37 more likely to work full-time. or patient care unit factors.43.

the proportion of overtime hours.Question 4.36. and the proportion of full-time nurses employed in patient care.11 percent for each increase in the percent of RNs in two reports.33 One study139 reported nonlinear association in patient falls and pressure ulcers: the rates increased when more than 87.33.162 To estimate whether the direction or strength of the associations can explain the massive differences in the results.03-0.77. One study reported a 16 percent reduction in hospital-related mortality in hospitals with 83 percent of RNs compared with 63 percent (RR 42 .e. We identified 48 studies that assessed the proportion of RNs. The details on the sources used to measure nurse staffing strategies and on study design are presented in Appendix G.02). one unpublished dissertation showed a small but significant increase in mortality86 by 0. Tables G27-G28. and only a few studies evaluated overtime hours and the proportion of full-time nurses.33 Random changes in the rates of nosocomial infections were shown in the majority of the studies.81.81.04 percent.28. heterogeneity was significant when pooling eight studies that examined the rates of in-hospital mortality (p for heterogeneity = 0.146.22.28 A seemingly paradoxical finding was the increase in the rates of urinary tract infections in four studies.1-0. Pooled analysis (Figure 20) detected a significant reduction in patient falls by 0.191 eight studies that measured the rates of nosocomial infections (p <0. One large study27 contributed the most to the analysis. contract hours.61. For instance.04) corresponding to one additional percent of RNs in ICUs.64. The analysis of the adjusted relative risks of patient outcomes corresponding to an increase by 1 percent in RN composition is presented in Figure 21. Patient Outcomes Corresponding to an Increase by 1 Percent in the Proportion of RNs Studies examined the effects of changes in categories of nurse staffing patterns including not only the proportion of RNs. but nurse hours and ratios on a number of outcomes. direct patient care related] hours worked by registered and licensed nurses).04).52.28.03 percent (95 percent CI 0. The same unpublished study reported a small increase in pulmonary failure and other patient outcomes corresponding to an increase in RNs.33.76. One study detected a reduction in hospital-acquired pneumonia by 0. eight studies addressed licensed nurses.02 percent (95 percent CI 0..5 percent of RNs worked in units.001). Random changes in the relative risk of all patient outcomes were observed corresponding to each additional percent of RN time.001).01-0. with a significant increase by 0.140.190. Pooling these results with random effects models to examine the main effect of the nursing skill mix on patient outcomes detected substantial heterogeneity between studies.191 by 0.192-194 and 11 studies that evaluated the rates of pressure ulcers in relation to nursing skill mix (p for heterogeneity <0.139.26.151. Three studies reported significant reductions in mortality140.45.190. 12 studies examined the effects of contract nurse hours on patient outcomes. we calculated and compared the rates of outcomes in individual studies (Appendix G.05-0.26. Rates of patient outcomes were increased in medical and surgical patients per additional percent of RNs.28. The distribution of nurse staffing strategies is presented in Table 18.139. Table G28) when possible (Table 19).4 percent. Association Between Nurse Staffing Strategies and Patient Outcomes We defined eligible nurse staffing strategies as skill mix (proportion of productive [i. the rest did not find significant associations.

146.27 The same study reported a reduction in the relative risk of urinary tract infection in medical (RR 0.46. 95 percent CI 0. 43 .38-0.101 and one large study27 found substantial differences in the association with mortality in different levels of analysis and patient populations.30.09-0.194 Patient Outcomes Corresponding to an Increase by 1 Percent in the Proportion of Licensed Nurses Eight studies attempted to assess the proportion of licensed nurses in relation to patient outcomes26. Pulmonary failure demonstrated random changes in relation to nurse skill mix.67.1-0.150.27 The studies did not show significant associations with nosocomial infections.59 times less often in association with a 1 percent increase in the proportion of licensed nurses in medical and surgical patients (RR 0.83) for an additional percent of RN staffing.59.02).84 percent CI 0.98) for every additional percent of licensed nurses.31.45.63-65. 95 percent CI 0.3) but the association was not consistent across studies (p for heterogeneity <0.27-0.28) but still not consistent (p for heterogeneity <0.97.8).17 days (95 percent CI 0.98).27 Overall complications and thrombo-embolic complications increased with the increase in the proportion of RNs. and shock (RR 0.83.65-0. 95 percent CI 0.195 Three studies reported a tendency to reduce mortality.4-0.0.81) corresponding to an increase by 1 percent in the proportion of RN hours among licensed hours per patient day.46-0.78-0.8.63-0.26.33.45-0.62 The relative risk of shock was reduced by 41 percent for each additional percent of RN staffing in a large multi-hospital study.71) (Figure 26).001). One study reported a significant reduction in the risk of urinary tract infections in surgical patients. reported a consistent reduction in failure to rescue by 27 percent (RR 0. 95 percent CI .05).27 however.48. 95 percent CI 0.96).001) (Figure 22).49-0. upper gastrointestinal bleeding (RR 0.46-0.66.36.48. Cardiac arrest occurred 0.11-4. Every additional percent of licensed nurses was associated with a 47 percent reduction in the relative risk of shock (RR 0.92).53.26. and bloodstream infections. which resulted in significant statistical heterogeneity in the results (p for heterogeneity <0. 95 percent CI 0.61). The effect was significant in medical patients only with a decrease by 0.62) across different settings and patient populations in one study (Figure 24). An increase by 1 percent in the proportion of licensed nurses was associated with a 17 percent reduction in the risk of failure to rescue (RR 0.27.91) and in surgical patients (RR 0.98) in relative risk of pulmonary failure corresponding to doubling the proportion of RNs. 95 percent CI 0. The risk of hospital acquired pneumonia was reduced by 29 percent (RR 0. 95 percent CI 0.44-0. Pulmonary failure (Figure 23) was not associated with the proportion of RNs in one study. 95 percent CI 0. Hospital-related mortality was reduced by 3 percent (RR 0. 95 percent CI 0. hospital acquired pneumonia (RR 0.87) (Figure 25).28.27 An increase by 1 percent in the proportion of RN staffing was associated with a reduction in the risk of upper gastrointestinal bleeding by 42 percent (RR 0.03-0.24.78-0.58.73. surgical wounds infections.19 days for each 1 percent of RN staffing (95 percent CI 0.27 A higher proportion of RNs was associated with shorter lengths of stay by 0.59.8) in relation to every additional percent of licensed nurses.71.35. 95 percent CI 0. The same study.27 Another study reported a nonsignificant reduction by 25 percent (RR 0. 95 percent CI 0.159 (Table 20 and Figures 25-26) but one study27 contributed most of the data for the overall estimates. 95 percent CI 0. but the strength of the association differed across patient populations (p for heterogeneity = 0.84) and in pressure ulcers by 76 percent (RR 0.95-0.

79 time higher for every percent increase in float hours (RR 2.46. 44 .29.04-0. The risk was 2.30 The association was nonlinear (p = 0. 95 percent CI 1.8. The rate of nosocomial infections increased by 1.64 A small increase in the rate of nosocomial infections corresponded to an increase in contract hours.24) corresponding to a 5 percent increase in overtime hours.46 In contrast with contract hours.3-3. Some authors distinguished contract hours from hours worked by float nurses. 95 percent CI 1.05 days (95 percent CI 0. 95 percent CI 1.79).08-1.05-1. surgical wound infections. 95 percent CI 2.9 percent (95 percent CI 0.27 The same negative tendency was observed in the risk of thrombo-embolic complications.31 The relative risk for bloodstream infections increased by 11. Every additional 10 percent of overtime hours was associated with a 1.31 That study did not find an association between overtime hours and urinary tract infections.35 Patient Outcomes Corresponding to an Increase by 1 Percent in Overtime Hours Two studies30.61-2.9).006) with an increase in hospital-related mortality by 32 percent corresponding to an increase in overtime hours by 10 percent from nadir (7 percent) to 17 percent. pneumonia. Table G29). the proportion of float nurses was positively associated with the risk of nosocomial infection.71 times higher in patients cared for in units with more than 60 percent of float nurses. rather they reported patient outcomes in units and hospitals with different staffing patterns including nursing ratios and hours.193 The relative risk of shock increased by 12 percent in medical but not surgical patients (RR 1. the risk was 2.193 but another study did not find a significant association after adjustment for other factors.24).47 that examined the risk of sepsis in relation to float nurses.8-2. 95 percent CI 0.021-1. Patient Outcomes Corresponding to an Increase by 1 Percent in Contract Hours The majority of the studies that reported the proportion of contract hours did not examine the main effect of temporary nurses.47 One study showed no association between contract hours and the rates of urinary tract infections.54).87. where a 29 percent increase corresponded to an additional percent of licensed staff (RR 1.22) and by 14 percent in medical patients (RR 1.45 Summarizing the results from two studies46.05) for each additional 1 percent of licensed nurses.12. the risk of urinary tract infections was reduced by 13 percent (RR 0. or bloodstream infections.Among other nosocomial infections.83-0.193 others included the hours worked by float nurses as temporary hours.3 percent increase in hospital related mortality (RR 1.013.12.5 percent) with each additional percent of overtime hours. failure to rescue.28.47 Another study reported an increase in the rate of bloodstream infection by 5 percent corresponding to a 23 percent increase in the proportion of float nurses.001-1. 95 percent CI 1.28 Two studies reported an increase in rates of patient falls corresponding to additional contract hours.0001-1.65). 95 percent CI 1.14.5 percent in surgical (RR 1. pressure ulcers.45.28. One study reported a significant increase in the length of stay by 0.193 examined the association between overtime hours and patient outcomes (Appendix G. or gastrointestinal bleeding.64. while the risk of surgical wound infection and bloodstream infections was increased by 60 percent as reported in one study.

28.An increase in the proportion of temporary nurses by 1 percent of contract hours increased the length of stay by 0. and gastrointestinal bleeding. Overtime hours may increase the risk of hospital-related mortality and bloodstream infections. 95 percent CI 0.1 day (RR 0.45. A small amount of evidence suggests that an increase in hours worked by float nurses is associated with a large increase in the risk of bloodstream infections. An increase in contract hours may increase in-hospital LOS. 45 .11.18. pressure ulcers.48.03-0.50 In conclusion. some evidence from a few multi-hospital studies suggests that a higher proportion of RNs may reduce the risk of failure to rescue. shock. heterogeneity NS). A significant but not consistent reduction on LOS in medical patients was observed pooling the results from 12 studies.

Government Publications (U.Cumulative Index to Nursing & Allied Health Literature The Cochrane Library BioMed Central Catalog of U. Flow of study selection for questions 1.S. GPO) LexisNexis™ Government Periodicals Index Digital Dissertations Agency of Health Care Research and Quality Total Citations 2. expert opinions 21 letters 3 guidelines 24 interviews 44 legal cases 89 news. success stories 54 editorials.858 101 eligible for review 5 excluded (inadequate data presentation) 96 Included in meta-analysis (94 studies.S. 2 duplicates) Design: 7 case-control 3 case series 41 cross sectional 43 that assessed temporality Excluded 2.757 for the reason: 60 case reports 574 comments. secondary data analysis 158 no association tested 598 no information on nurse staffing and strategies 160 ineligible outcomes 859 ineligible target population 46 .Figure 4. reprinting of original reports 1 web survey 112 review. and 4 Databases: ® The National Library of Medicine via PubMed CINAHL . 2.

total of 50 for each study Mean 4.11 0.01 37.66 3.65 0.5 3 4 3.81 1.69 3.65 0.76 Median 5 4 4.62 0.48 4.61 2.70 3.40 Quality Measures Study question clearly focused and appropriate Clear definition of exposure Clear definition of the primary and secondary outcomes Sampling of study population Statistical analysis: assessment of confounding attempted Adjustment for the effects of various factors Statistical methods Measure of effect for outcomes External validity Conclusions Total scores * Maximum possible score of 5.68 6.34 3. Distribution of the studies’ quality* (94 studies) Standard Deviation 0.11 1.41 3.73 0.94 1.5 4 4 4 4 38 47 .Table 2.96 4.89 3.97 0.

1 2.3 2.0 4.3 12.6 2.1 4.6 1.7 8.8 2.9 48 .2 5.3 Standard Deviation 0.3 7.1 1.9 1.2 6.1 13.1 8.1 4.7 1.3 2.1 2.1 1.8 5. Distribution of nurse hours and ratios (94 studies) Nurse Staffing ICUs RN FTE/patient day Patients/RN/shift Total nursing hours/patient day RN hours/patient day LPN/LVN hours/patient day UAP hours/patient day Licensed nurse hours/patient day Surgical patients RN FTE/patient day Patients/RN/shift Patients/LPN/shift Total nursing hours/patient day RN hours/patient day LPN/LVN hours/patient day UAP hours/patient day Medical patients RN FTE/patient day Patients/RN/shift Patients/LPN/shift Patients/UAP/shift Patients/licensed nurse/shift Total nursing hours/patient day RN hours/patient day LPN/LVN hours/patient day UAP hours/patient day Licensed nurse hours/patient day Number of Studies 15 15 15 10 3 4 1 13 13 2 12 11 7 5 20 20 6 4 2 27 23 13 12 4 Mean 1.5 8.5 3.9 8.0 3.3 3.3 2.0 2.6 0.2 4.4 0.4 3.3 1.1 8.4 13.0 2.1 4.6 1.0 12.2 0.3 5.3 0.Table 3.1 0.1 1.3 2.

48 -1.67 <0.13 0.18 -3.001 0. Hospital-related mortality rates corresponding to changes in patients/RN ratio (pooled weighted estimates from published studies) Level of Analysis Number of Studies 3 3 1 8 3 5 3 3 5 Change in Death Rate.18 -0.001 49 . % 0.001 0.02 <0.25 0.68 0.97 -0.23 <0.041 Authors’ definition of nurse to patient ratio Increase by 1 patient/RN/shift Increase by 1 RN FTE/patient day Increase by 1 RN FTE/1.33 0.89 -1.24 -1.18 Standard Error 0.29 -1.78 2.076 0.001 <0.001 0.04 p Value for Heterogeneity 0.55 p Value for the Association 0.54 0.095 -1.08 0.49 0.311 0.49 0.28 0.Table 4.03 1.003 0.15 0.000 patient days Estimated Increase by 1 RN FTE/patient day All studies ICUs Surgical patients Medical patients Hospital level analysis Patient level analysis <0.

958 0. 3-4 Medical patients <2 vs.8273 <.5 vs.016 Consistency No Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 50 5 * Relative risk of outcomes .97 p Value for the Association <. 0.92.76 0.89 0. 2-4 Surgical patients <2 vs.90. 95% CI – ranges of relative risk with 95% confidence that we will have the same results repeating the study many times in the same population.94 6 0.86.70 0.96 <. >6 4-6 vs. >6 2-4 vs.88 0.09 0. 1.92 0.74.81 0.0001 <.95.71. 0.001 <.0001 0.61.0001 0.000 <.87 0.0001 0.908 0.62 0.63.82 0.the ratio of the incidence rate of outcomes corresponding to different nurse staffing levels (relative risk =1 means no association.0001 <.001 Yes Yes Yes Yes Yes 0. 4-6 2-3. RN to patient ratios and relative risk* of hospital-related mortality (pooled adjusted estimates from published studies) Level of Analysis Authors’ definition of nurse to patient ratio Increase by patient/RN/shift Increase by 1 RN FTE/patient day Increase by 1 RN FTE/1.94.88 0. 0.0001 <.66 0. 0.81 0.76. 0.0001 0.0001 <. 1. 0. 0.94 0.58. 0.919 0.0001 <. .59.0001 <.89. 0.0321 <.84 0.944 0. 0.5 vs.08 0.80 0.0002 0.5 vs.953 0. 0.92.65 0.0001 <. 4-6 <2 vs.000 patient days Estimated Increase by 1 RN FTE/patient day All studies Patient level analysis Hospital level analysis ICUs Surgical patients Medical patients Quartiles of patients/RN/shift ratio <2 vs.62 0. >6 2-3.66 0.07. 0.70 0.0001 <. 0.95 0.95 0. >6 Number of Studies 6 6 3 14 8 5 5 8 6 14 Relative Risk 1.04 0.87 0.>6 4-5. 0.81 0. 0.95 0. 0. 0. 2-4 <2 vs. <1 – protective effect of increased nurse staffing.Table 5.75.0001 0.995 0.0001 Yes 95% CI 1.93. 4-5.94 0.5 2-4 vs. 0.92.96 0.66 0.76 0. 0. >1 – increased probability of patient outcomes).94.76. 4-5.5 <2 vs.94 8 0.943 0.80. 0.0001 0.98 0. >6 ICUs <3 vs.70.82 0.

79 1 Relative risk of death 1.95) 0.95) 0.94.08.95. 0. 0.86.04) 0.08 (1. 0.80.98) 0.94. 0.1 51 . 0. 0.09) 0.Figure 5.92 (0.94) 0. 0.93.96 (0.90.95) 0. 1.89) .99 (0.000 patient days (3) Increase by 1 RN FTE/patient day (14) Hospital level analysis Increase by 1 RN FTE/patient day (5) ICUs Increase by 1 RN FTE/patient day (5) Medical patients Increase by 1 RN FTE/patient day (6) Patient level analysis Increase by 1 RN FTE/patient day (8) Surgical patients Increase by 1 RN FTE/patient day (8) Relative risk of death (95% CI) 1. Relative risk of patient hospital-related mortality corresponding to change in registered nurse to patient ratio (pooled estimation from the studies) Nurse staffing measure (number of studies) All studies Increase by 1 patient/RN/shift (6) Increase by 1 RN FTE/patient day (6) Increase by 1 RN FTE/1. 1.91 (0.84 (0.94 (0.94 (0.89.92 (0.96) 0.

95) 0.Figure 6.5 vs. >6 2-3.58.59.92. 2-4 Surgical patients <2 vs. >6 ICUs <3 vs. 0. 0.81) 0. 0.5 vs.76 (0. 3-4 Medical patients <2 vs.76.92.70) 0.74.70) 0.76 (0. 2-4 <2 vs. 0. 0.75.5 vs.97) 0.66 (0. >6 Relative risk of death (95% CI) 0.81 (0.94 (0.92. >6 2-4 vs. 4-6 2-3. 0. 0.95) 0.87) 0.5 1 Relative risk of death 52 .82 (0. >6 4-5.66) 0.66) 0.65 (0. 4-6 <2 vs.81 (0.82) 0.88) . 0.88) 0. 0.61.70.62 (0.94 (0.71. 4-5.76.87) 0. 0. 4-5.5 <2 vs.5 2-4 vs. Relative risk of death among different categories of patients/RN/shift (pooled analysis) Quartiles of patients/RN/shift distribution All studies <2 vs. 0.80 (0.62 (0. 0.94 (0. >6 4-6 vs.63. 0.

5) 16 (12. 2-4 <2 vs. 0.04) 6 (7. Number of avoided deaths/1. 19) 25 (23. 16) 3 (2. 34) 20 (26. 4-6 2-3. 4 5 ( 2. 18) 38 (42. >6 2-4 vs.93.88 0.76 0. 95% CI 5 (4.94. Percentage of Death.75.96 0. 10) Level of Analysis Authors’ definitions of nurse staffing ratio Increase by patient/RN/shift Increase by 1 RN FTE/patient day Estimated increase by 1 RN FTE/patient day All studies Patient level analysis Hospital level analysis Intensive care units Surgical patients Medical patients Quartiles of patients/RN/shift ratio <2 vs. 12) 6 (6. 5) 24 (29.63.74. 5) 4 (3. 0. 3-4 Medical patients <2 vs. 4-6 ≤2 vs. 15) 7 (5. 4-5.66 0.000 Hospitalized. 8) 5 (4.000 hospitalized patients attributable to RN FTE/patient day ratio (pooled adjusted estimates from published studies) Attributable to Nurse Staffing. 12) 6 (8.82 0.84 0. 0.81 0.95 0.96 0.07. >6 4-5.96 0.92 0. 12) Number of Avoided deaths/1.70 0. 2) 9 (14.07.61.86. 7) 5 (4. 10) 13 (12.5 2-4 vs. 8. 5) 4 (6. 28) 12 (9. 16) 8 (5.87 0. >6 Studies RR 95% CI NNT* 6 6 14 8 5 5 8 6 14 1. 0. 0. 4-5. 25) 12 (8.95 0.94 8 0. 0.66 0.70 0.92.80 0.70.89 0. 0. 19) 38 (41. >6 2-3.58.65 0.82 0.5 vs. 3) 6 (8.5 vs.76 0.92.94 0. 5) 6 (8.92. 0. 0.62 0.92 0.81 * Number needed to treat to generate benefit (saved life) .6 (7. 0.97 0.94.91 0. 0. 0. 0.08 0. 0. 16) 23 (20. 95% CI 7.62 0.94 1. 35) 19 (24.90.80.09 0. >6 4-6 vs.89.76.98 0.76. 1.66 0. 0. 5) 8 (10.95 0.59. 0. 13) 34 (37.94 0.5 vs.71. 5) 24 (30. 2-4 Surgical patients ≤2 vs. 30) 19 (25.95 0.81 0. 5) 6 (5. 12) 15 (13.94 0. >6 ICUs <3 vs. 6) 7 (4l 9) 3 (2. 6) 8 (11. 0. 13) 35 (39.87 0. 0. 0. 0. 30) 18 (24. 4) 16 ( 20. 7) 9 (7.5 <2 vs.Table 6. 5) 5 (4. 8) 6 (4.94 0.88 198 162 191 154 342 187 164 211 247 63 40 80 45 83 308 187 107 68 132 75 141 53 5 6 0.

patients/RN/shift Administrative.28 0.61* 95% CI 0. 200418 Mark.8 0. 1 p <0. 200316 Person. RN FTE/patient day Administrative. 0.02 1. RN FTE/patient day Administrative. RN FTE/patient day Administrative. and vascular surgery Combined 0. 200417 9 Pronovost. 200519 11 Robertson. orthopedic. RN FTE/patient day Units Combined Combined Combined Surgical Surgical Patients Combined Combined Medical Surgical Surgical Diagnosis Combined Combined Chronic obstructive pulmonary disease Combined Bladder carcinoma (ICD-9 codes 188. RN FTE/1. 2000 20 Elting.03 0.98 p <0. 0.Table 7.957.4. RN FTE/patient day Administrative. RN FTE/patient day Administrative.05 Data. 1.0 188.000 patient days Administrative.2.9 and 236. 1999 Amaravadi.58 0.1.934 0.05 p <0. 0.98. 1999 12 Silber. or vascular operation General surgical.1 0.13* 0. 200215 Aiken.39* 6.02* 1. 2005 Hospital unit Shortell.9. significance reported by authors . patients/RN/shift Administrative. 199910 Aiken.94 0. RN FTE/1. 19948 RR 1. Definition of RN Ratio Administrative.05 NS NS NS NS Medical records. 0. RN FTE/patient day Combined Combined ICU Combined ICU ICU ICU Surgical ICU Medical Surgical Surgical Medical Medical Surgical Surgical Surgical Medical 54 * 95% CI were not reported.5 0. vascular operation Acute myocardial infarction Abdominal aortic surgery Esophageal resection Hepatic resection General.7) after total cystectomy AIDS General surgical.5* 1.89 0.9. 2001 21 Halm.93* 0.000 patient days Administrative.848. Calculated relative risk of hospital-related mortality corresponding to increased RN staffing (results from individual studies) Study.97 0. 2005 Patient Aiken.02* 0.005 0. Analytic Unit Hospital Mark. RN FTE/patient day Administrative. patients/RN/shift Administrative. orthopedic. 200013 14 Dimick. orthopedic. patients/RN/shift Administrative.

987 0.87.04) 0.6 vs.06 (0.23) 0. 0. H = hospital.02) 0. 0.22) 0.95 (0.81.49) Person 17 P H H H C S C C Elting20 Mark19 Robertson11 Mark18 H C C Silber 12 H S S Increase by 1 patient/RN/shift th 4 quartile vs. orthopedic.988 0.10 (0.Table 8.9 (1.3) 0.7 RN FTE/patient day vs.05 (0.95. 0. 0.06 (1. 0.000 patient days 6. 0. general surgical. or vascular operation S.5 (1.02 (0.01. 3) 2.03) 0. 5.2) 1.04) P = patient. 1.96) 0.05.16. 0. ~1.92 (0.6 RN FTE/patient day) Hospitals with few RN FTE/occupied bed (median 1.000 patient days 4. 0.98) 0.16.04 (1.08.07 (0. general surgical. 0.03) 0. Association between RN staffing ratio and mortality and proportion of mortality attributable to nurse staffing (results from individual studies) Author Analytic Unit P P P Hospital Unit ICU C ICU Patients RN Ratio Relative Risk of Death (95% CI) 1.96 (0.95) 0.03. or vascular operation M. M = medical.97) 0.57 (0.01 0.04. 0.19.96) 0.7 patients/RN/shift 1.01 RN hours/patient day th 25 quartile of RN FTEs/1.16.3 (1.05 55 0. myocardial.1) Attributable Proportion.96.47 (0.03.12) 0. many (median 3.4) vs.97 2.24 RN hours/patient day th 50 quartile of RN FTEs/1.09 (0.000 patient days in hospitals with high HMO penetration Increase by 1 RN in RN FTE/patient day ratio in 1989 1990 1991 th 75 quartile of RN FTE/1. 0.09) Pronovost9 Aiken10 Aiken15 Aiken16 P ICU S.10 (0.01) 0.01 0. 0.33 (0. 1.04. 0. 0. 0.86.03.93. 4. 0. (95% CI) 0. 0. orthopedic.51 (0. S = surgical.96. C = combined.98) 0. Abdominal aortic surgery M.79 RN hours/patient day Increase by 1 RN FTE/1.76. 0.02) 0.04 (0.97 (0. >1:2 in evening Increase by 1 patient/RN/shift Increase in workload of 1 patient/RN/shift Increase by 6 patients/RN/shift 1. 0. Attributable Proportion = proportion of deaths attributable to nurse staffing .01. 2. infarction S.2.91 (0.91 (0.1 quartile of RN staffing (~2.99) 0. acute.000 patient days Hospitals with 1. 0. bladder carcinoma after total cystectomy C M Nurse to patient ratio <1:2 vs.86.000patient-days 7. 1.07 (1.15.11) 0. AIDS S.1) Increase by 1 RN FTE/1.02 0.978 0.3.17.98 (0.03 (0.

04 -0.11 -0.12 -0.10 -0.15 -0.14 0.84 0.56 0.50 0.64 0.24 -0.04 -0.26 0.11 0.11 0.58 0.86 0.144.55 0.Table 9.10 0.66 0.09 0.62 0.48 0.46* -0.08 -0.33 -0.13 -0.16 p Value 0.148 the state level r 0.62 0.59 0.52 0.46 Excess or shortage Percent of shortage Total number of nurses Employed in nursing Percent employed in nursing RN/100.000 population Full-time employed Percent full-time employed Part-time employed Percent part-time employed RN FTE Number of nurses with diploma Percent of nurses with diploma Number of nurses with associate degree Percent of nurses with associate degree Number of nurses with BSN Percent of nurses with BSN Number of nurses with MS and PhD Percent of nurses with MS and PhD * significant at 95% level r = correlation coefficient 56 .11 -0.13 -0. Correlation between nurse staffing and age adjusted fatal adverse events related to medical care at 1.02 0.33 0.55 0.10 -0.

Unit. 12. 4 patients/nurse 20-29% of hospital workforce with BSN or higher. % 2.20 2.98 1.Table 10.90 1.65 (0. 6 patients/nurse 40% of hospital workforce with BSN or higher. 9. 57 .68. 15 years of nurse experience 20% of hospital workforce with BSN or higher. 6 patients/nurse 60% of hospital workforce with BSN or higher. low (11%) (random effects model) Increase by 1 year in nursing experience in teaching hospitals Increase by 1 year in nurse experience Increase by 1 year in nursing experience in nonurban hospitals 30 days mortality in teaching hospitals. 4 patients/nurse 60% of hospital workforce with BSN or higher.02 15.09 Estabrooks101 Combined Medical Tourangeau140 Combined Medical *We calculated death rate corresponding to 10% increase in nurses with BSN and to 1 year increase in nurse experience.99 0.9.64 2. 0.38 1.99) 0.85 years of nurse experience 30 days mortality in nonurban community hospitals.70 1. 96) 0.47 years of nurse experience 30 days mortality in urban community hospitals. Association between nurse education. Patients Aiken16 ICU Surgical Nurse Education and Experience 40% of hospital workforce with BSN or higher 10% increase in nurses with BSN degree* Increase by 1 year in nurse experience Interactions: 60% of hospital workforce with BSN or higher.27 15.71) 0. 4 patient/nurse 20% of hospital workforce with BSN or higher.10 0.5 years of nurse experience 40-49% of hospital workforce with BSN or higher. and mortality Author. 8 patients/day 40% of hospital workforce with BSN or higher. 95% CI 0.99 1 14. 8.9 years of nurse experience Death Rate. 14 years of nurse experience <20% of hospital workforce with BSN or higher. 14 years of nurse experience Hospitals with higher proportion of nurses with BSN 36% vs.3 years of nurse experience 30-39% of hospital workforce with BSN or higher. low (11%) Hospitals with higher proportion of nurses with BSN.17 -0. 14.95 (0.23 1.80 0. 36% vs. experience. 6 patients/nurse 20% of hospital workforce with BSN or higher.30 2.97 1. 0.16 1. 7.98 2.81 (0. 8 patients/nurse >50% of hospital workforce with BSN or higher.80 1.80 1.6. significant at 95% level.05 Relative Risk.

71 0.35 0.04 1.26 Urinary tract infection 2 -0.68 0.04 0.40 Pressure ulcers 2 3.10 Sepsis 5 -1.06 0.001 0.001 0.12 CPR 3 0.62 Nosocomial Infection 5 -0.04 Estimated increase by 1 RN FTE/patient day in ICUs Failure to rescue 1 -3.55 Urinary tract infection 3 5.69 1.01 0.42 0.15 0.05 0.11 0.45 0.10 0.001 0.26 0.001 0.003 0.02 0.94 Pneumonia 2 -3.26 CPR 3 -0. % Standard Error p Value for the Association Consistency Authors’ definition of nurse staffing ratio Increase by 1 patient/RN/shift Failure to rescue 1 0.10 Pulmonary failure 3 -11.35 0.Table 11.001 0.02 0.31 Estimated increase by 1 RN FTE/patient day Failure to rescue 3 -0.20 Falls 3 -13.43 1.02 Unplanned extubation 3 -7.25 CPR 3 -0.001 0.01 0.04 Unplanned extubation 3 4.11 Pulmonary failure 4 -0.84 Nosocomial Infection 6 0.67 0.88 1.08 Pressure ulcers 2 -1.29 0.001 0.43 0.002 0.23 0.78 0.41 Pneumonia 2 2.35 0.57 2.55 Thrombosis 1 -0.02 No Yes Yes Yes No No Yes No No No Yes Yes No No Yes No No Yes No Yes No No 58 . Patient outcomes rates (%) corresponding to an increase in RN staffing ratios (pooled estimation from the published studies) Outcomes Studies Difference in Rate.43 0.78 0.45 1.06 Falls 2 3.82 Unplanned extubation 3 -7.002 0.03 0.18 1.03 0.54 1.57 0.05 0.55 Estimated increase by 1 RN FTE/patient day in surgical patients Failure to rescue 2 -3.32 1.94 1.41 Pulmonary failure 3 6.20 0.

06.001 <.07 1.7 0.051 0. 0. 0.67 0.94 0.46.16 1.002 Yes No Yes Yes No Yes Yes No 0. 1.89 0.94 0. 0.29 1.05 0. 0.03 1.36.89.72 0. 1.03. 1. 0.4 0.84 0.07 1.59 0. 0.0001 0.92. 0.84 0. 1.15 0.0001 Yes Yes Yes Yes Yes Yes No Yes Yes Yes 59 .005 0.02 0.03. 2. 0.Table 12.0001 0.62.24.92 1.015 0.89 1.008 0. 1.49 0.27.64 0.88 0.17 0. 1.45 1.001 0.86 1.91 0. 0.001 <.11 1. 0.24 0.6.53 1.001 <.002 <.98.08 0.94. 1.07.72 1.001 0.67 0.31 0.9 0.79.94 0.68 0.08 1.82 0.92 0.002 0. 0.0001 0.18 0.09 1.56.04.67 0.27. 0.01 0. Relative risk of patient outcomes corresponding to an increase in RN staffing ratios (pooled estimation from the studies) Outcomes Studies Relative Risk 95% CI p Value for the Association Consistency Authors’ definition of nurse staffing ratio Increase by 1 patient/RN/shift Hospital acquired pneumonia 3 Failure to rescue 3 Pulmonary failure 4 Unplanned extubation 5 Nosocomial infection 3 CPR 3 Medical complications 3 Increase by 1 RN FTE/patient day Failure to rescue 2 Estimated increase by 1 RN FTE/patient day ICU Hospital acquired pneumonia 3 Pulmonary failure 4 Unplanned extubation 5 CPR 3 Medical complications 3 Surgical patients Urinary tract infection 1 Failure to rescue 5 Nosocomial infection 2 Surgical wound infection 1 Sepsis 5 Patient level analysis Failure to rescue 4 Pulmonary failure 5 1.04.05.

02 (0. 0. 0. Patient outcomes rates (%) corresponding to an increase by patient per LPN/LVN per shift (calculated from one study) Patient outcomes Difference in outcome rate (95% CI) CPR Falls Urinary tract infection Hospital acquired pneumonia Surgical wound infection Pulmonary Failure 0. 0.04) 0.03 (0.07) 0.05) -.04 (0.2 60 . 0.04.Figure 7. 0.02.06 (-0.13) 0.06 (0.02) 0.01. 0.02.02.1 0 Difference in outcome rate .02.04) 0.03 (0.

0. 0.02.08. Patient outcomes rates (%) corresponding to an increase by patient/UAP/shift (estimates from individual studies and pooled analysis) Outcomes (number of studies) Difference in outcome rate (95% CI) CPR (1) Falls (7) Urinary tract infection (5) Hospital acquired pneumonia (2) Surgical wound infection (2) Pressure (decubitus) ulcers (7) Pulmonary failure (2) 0.01 (0.78) 0.17.04) 0.47 (0. 0.Figure 8.00.03) 0. 0.16) 0. 0. 0.03 (-0.02.01.05) 0. 0.07) -.04 (0.44) 0.78 61 .03 (0.04 (-0.78 0 Difference in outcome rate .24 (0.04.

02 1. Length of stay corresponding to an increase in RN staffing ratios (pooled analysis) Change in Length of Stay.64 1.0001 <.0001 Nurse Staffing Studies Consistency Authors’ definitions Increase by 1 patient/RN/shift 6 Increase by 1 RN FTE/patient day 2 Estimated increase by 1 RN FTE/patient day All studies 10 ICUs 5 Surgical patients 5 Medical patients 5 Yes Yes No Yes Yes No 62 .25 -0.03 0.70 -0.7 -0.8 0.50 0.0001 0.25 Standard Errors 0.25 -0.68 <.Table 13.63 -0.4 <.02 p Value for the Association 0.68 0. Days 0.

02) 0. 1.000 patient days (1) Increase by 1 RN FTE/patient day (5) ICUs Increase by 1 RN FTE/patient day (4) Medical patients Increase by 1 RN FTE/patient day (2) Surgical patients Increase by 1 RN FTE/ patient day (3) Relative change in LOS (95% CI) 1.86) .4 1 Relative change in LOS 1.5 63 .Figure 9. 1. Relative changes in LOS corresponding to an increase in RN staffing ratios (pooled estimation from the studies) Nurse staffing (number of studies) All studies Increase by 1 patient/RN per shift (3) Increase by 1 RN FTE/1.55.62.08.80. 0.94) 0.97 (0.78.69 (0.05) 0.92 (0.20 (1.76 (0.10) 0.93 (0.35) 0. 1. 1.93. 0.

85) 0.23) .02. 0.56 (0.13 (1. 3 (Medical patients) Relative risk of outcomes (95% CI) 0. 1 (Surgical patients) 0 vs.6 2.48.9 >5 Medical Patients <2 3.95) 0.06 (0.95) 0. 3 (Medical patients) Sepsis 0 vs. 3 (Medical patients) Nosocomial infection 0 vs. 0. 1. 3 (Surgical patients) 0 vs. 1 (Surgical patients) 0 vs.80 (0. 1 (Medical patients) 0 vs.Figure 10. 2 (ICUs) 0 vs.22) 1.8 >6 64 . 0. 0.11) 1.84) 0.82 (0. 0. 0.37. 0.22) 1. 3 (Surgical patients) 2 vs.11 (1.01.0 4.48. 1.11 (1.94) 0.8 4. 2 (ICUs) 1 vs.93) 0.60. 1 (Medical patients) 0 vs. Quartiles 0 1 2 3 ICU <1.28. Relative risk of hospital acquired infections in quartiles of patients/RN/shift distribution (pooled analysis) Quartiles of patients/RN per shift distribution* Hospital acquired pneumonia 2 vs.51 (0.01.62 (0.59 (0. 0.93) 0.55.91) 0.40. 0. 3 (Surgical patients) 0 vs. 2 (Medical patients) 0 vs.07 (1.91) 0. 0.91) 0. 1. 0.67 (0. 2 (Medical patients) 0 vs. 0. 3 (Surgical patients) Surgical wound infection 2 vs.87) 0.75 (0. 3 (Medical patients) 1 vs. 1.03.0 3.3 >4 Surgical Patients <2 2. 0.36.58 (0.71 (0.94) 1.68. 3 (Surgical patients) Urinary tract infection 2 vs.66 (0.01.57 (0.36.45.3 Relative risk of outcomes *The following table shows how the patients/RN/shift quartiles were established.3 1 1.70.34) 0.

3 (Surgical patients) 2 vs.75 (0.83) 0.73) 0.67.75 (0. 2 (ICUs) 1 vs. 0.66 (0.65 (0. 3 (ICUs) 0 vs.83) 0.79 (0. 1 (Surgical patients) 0 vs. 0.66) 0. 3 (Surgical patients) 1 vs.59.82 (0.0 3. 0. 2 (Surgical patients) Failure to rescue 0 vs.87) 0.70) 0. 0.Figure 11.9 >5 65 .91) .88) 0.67.95) 0.56. 0.69 (0. 2 (Surgical patients) 1 vs.8 4. 0.47. Quartiles 0 1 2 3 ICU <1. 0. 0.60.75 (0. 3 (Surgical patients) Relative risk of outcomes (95% CI) 0.59.54 (0. 0. 2 (ICUs) 1 vs.73. 2 (Surgical patients) 0 vs.72.3 >4 Surgical Patients <2 2.61) 0.61 (0.6 2.4 1 Relative risk of outcomes *The following table shows how the patients/RN/shift quartiles were established. 0. Relative risk of patient outcomes in quartiles of patients/RN/shift distribution (pooled analysis) Quartiles of patients/RN per shift distribution* CPR 0 vs.55.

62.58 (0.90) 1. 0.38 (1. 3 (ICUs) Pulmonary failure 0 vs.3 >4 Surgical Patients <2 2. 2 (ICUs) 0 vs.75 (0.59 (0. 3 (ICUs) 0 vs. 0.20. 1 (Surgical patients) 0 vs.2 1 1. 0. Relative risk of patient outcomes in quartiles of patients/RN/shift distribution (pooled analysis) Relative risk of outcomes (95% CI) 0.29 (0. 0. 3 (ICUs) 2 vs.62) 0.36 (0. 3 (ICUs) 1 vs.69) . 2 (Surgical patients) 1 vs.51 (0. 0. 0.38 (0.86) 0. 0.80) 0.66) 0. 1.43 (0.55) 0. 0.19.0 3. 0.39.11. Quartiles 0 1 2 3 ICU <1.32 (0.20.8 4. 0. 2 (Surgical patients) 0.46) 0.21.54 (0. 3 (ICUs) 2 vs. 1 (Surgical patients) 0 vs.23.42. 2 (ICUs) 1 vs.55 (0.44.69) 0. 0.17.43 (0. 2 (ICUs) 0 vs.78) 0.69) 0.9 >5 66 . 0. 2 (Surgical patients) Unplanned extubation 0 vs.7 Relative risk of outcomes *The following table shows how the patients/RN/shift quartiles were established.Figure 12.51) 0.72) 0.71) 0.38.56 (0.18.40 (0.82) 0.30. 2 (ICUs) 1 vs.49. 3 (ICUs) 0 vs. 3 (ICUs) 1 vs.25 (0. 0.38.6 2. 0. 0.64) Quartiles of patients/RN per shift distribution* Medical complications 0 vs.

02 0.48 0.14 0.33 -0.002 <.31 0.0001 0.05 0.83 -0.89 -0.65 0.47 0.001 0.001 0.0001 0.001 0.27 0.06 0.34 0.04 0.03 0.31 -2.39 -0.12 -4.000 0.44 -1.Table 14.52 0.05 0.19 0.27 0.18 0.88 -0. Patient outcomes rates (%) corresponding to an increase by 1 hour in total nursing hours/patient day (pooled analysis) Difference in Outcome Rate.01 0.008 Outcomes ICUs Falls Nosocomial infection Sepsis Pressure ulcers Surgical patients Failure to rescue Falls Urinary tract infection Hospital acquired pneumonia Nosocomial infection Sepsis Surgical wound infection Pressure ulcers Gastrointestinal bleeding Shock Pulmonary failure Thrombosis Medical patients Failure to rescue Falls Urinary tract infection Hospital acquired pneumonia Nosocomial infection Sepsis Pressure ulcers Gastrointestinal bleeding Shock Thrombosis Studies Consistency 5 4 3 5 2 3 4 3 2 3 2 5 2 2 2 2 2 11 7 5 5 5 13 2 2 2 Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes 67 .000 <.20 0.34 -0.0001 0.23 -2.44 -0.001 0.97 0.001 0.33 -0.16 0.53 0.002 0.01 0.77 -2.15 Standard Error 0.90 -3.10 0.05 0.17 -1.0001 0.11 -0.08 -0.11 0.004 0.20 0. % -0.50 0.49 0.13 0.05 p Value for the Association <0.39 -0.63 0.07 0.89 0.25 0.24 -0.002 0.30 <.26 -0.45 -1.18 <.36 0.27 0.10 0.

7 0 Relative risk of outcomes 1.84 (0.71.88 (0.99 (0.1 68 .92) .84.99) Gastrointestinal bleeding (1) 0. 0. 0.98.00) Nosocomial infection (5) 0.Figure 13. 1. Relative risk of patient outcomes corresponding to an increase by 1 hour in total nursing hours/patient day Relative risk of outcomes (95% CI) Outcomes (number of studies) Shock (1) 0.

461 0.01 0.01 0.17 0.966 0.312 0.48 0.303 0.04 0.458 0.01 1.92 0.46 0.16 0.44 0.013 0.18 0.023 0.0001 0.16 0.10 -0.001 0.168 0.05 0.03 0.18 0.0001 0.280 0.04 -0.53 0.06 1.397 0.05 0.105 Consistency No Yes Yes Yes Yes Yes Yes Yes No No No No No Yes No No No No No No No No No No Yes No No No Yes No No No Yes No 69 .73 0.22 1.353 0.01 -0.47 0.06 0.528 0.48 0.10 -0.23 0.60 0.02 0.003 0.000 0. Patient outcomes rates (%) corresponding to an increase by 1 hour in RN hours/patient day (pooled analysis reported by the authors and estimated RN hours/patient day) Outcomes ICUs Failure to rescue CPR Falls Urinary tract infection Hospital acquired pneumonia Nosocomial infection Sepsis Pressure ulcers Pulmonary failure Unplanned extubation Surgical patients Failure to rescue CPR Urinary tract infection Hospital acquired pneumonia Nosocomial infection Sepsis Surgical wound infection Pressure ulcers Gastrointestinal bleeding Shock Pulmonary failure Unplanned extubation Thrombosis Medical patients Failure to rescue CPR Falls Urinary tract infection Hospital acquired pneumonia Nosocomial infection Sepsis Pressure ulcers Gastrointestinal bleeding Shock Pulmonary failure Thrombosis Studies 1 4 4 1 3 7 7 4 3 3 4 5 7 6 3 7 2 4 2 2 7 3 4 3 3 11 9 6 7 6 12 2 2 2 3 Difference in Standard p Value for the Outcome Rate.203 0.05 0.15 0.14 -0.77 0.45 0.09 0.25 0.07 0. % Error Association -0.000 0.01 0.10 -0.01 0.07 0.46 -0.081 0.15 0.746 0.55 -0.16 1.43 -0.Table 15.40 0.120 0.001 0.000 0.20 0.0001 <.05 0.22 -1.92 -0.12 0.34 0.66 0.73 -0.61 0.01 0.43 1.002 0.039 0.612 <.01 1.08 0.760 0.23 0.07 0.70 0.33 1.19 -1.001 0.63 0.10 3.210 0.10 0.114 <.964 0.0001 <.32 0.

69.57) Surgical wound infection (2) 1.87.83) 1. 0. 1.98 (0.02) Nosocomial Infection (2) Pulmonary failure (1) 0.64 1 Relative risk of outcomes 1.98.76 (0.10) Pneumonia (4) 0.57 70 .00 (0.00 (0.90.Figure 14.64. 1.10) . 1. 1.00 (0. Relative risk of patient outcomes corresponding to an increase by 1 hour in RN hours/patient day (pooled analysis) Outcomes (number of studies) Relative risk of outcomes (95% CI) Sepsis (4) 1.

88.66. Relative risk of outcomes corresponding to an increase by 1 hour in RN hours/patient day (pooled analysis combined from reported and estimated hours) Outcomes (number of studies) ICUs Hospital acquired pneumonia (3) Pulmonary failure (4) Unplanned extubation (5) Nosocomial infection (4) Complications (2) Medical complications (3) Sepsis (6) Medical patients Urinary tract infection (6) Hospital acquired pneumonia (5) Failure to rescue (4) Pulmonary failure (2) Nosocomial infection (3) Thrombosis (2) Sepsis (5) Surgical patients Failure to rescue (7) Unplanned extubation (5) Nosocomial infection (2) CPR (3) Medical complications (3) Relative risk of outcomes (95% CI) 0.99) 0.1 1 Relative risk of outcomes 71 .03) 0.98) 0. 1.96 (0.93.94.96 (0. 0.73 (0. 1.98 (0. 0.96 (0.00) 0.99 (0.99) 0. 0.89. 0.03) 0.94.Figure 15.88.00 (0.95) 0. 1.94) 0. 1.96 (0.17) 0.03) 0. 0. 0. 0.91 (0.85.97.01) 0.97.99 (0. 0.98 (0.95.99) 0.98) 0.98) 0.99.94.99 (0.94.81) 0.6 1.95. 0.98.99 (0.02) 1. 1.98 (0.98) 0. 0. 0.84.99 (0.96 (0. 1.99 (0. 0.98) . 1.89 (0.91 (0.95) 0.98.99.

04 3.11 0.000 Outcomes Surgical patients Failure to rescue Urinary tract infection Hospital acquired pneumonia Nosocomial infection Sepsis Surgical wound infection Pressure ulcers Gastrointestinal bleeding Shock Pulmonary failure Thrombosis Medical patients Failure to rescue CPR Falls Urinary tract infection Hospital acquired pneumonia Sepsis Pressure ulcers Gastrointestinal bleeding Shock Pulmonary failure Thrombosis Studies Consistency 2 3 3 1 2 2 2 2 2 3 3 2 2 3 3 3 2 7 2 2 1 2 Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes No No Yes Yes 72 .0001 <.81 0.0001 <.28 0.% 2.06 0.56 0.27 0.89 0.15 0.002 0.26 -0.01 0.78 0.12 0.10 0.0001 0.0001 0.05 <.26 0.67 1.0001 <.40 0.15 0.001 0.Table 16.28 1.29 -2.70 1.0001 0.22 0.001 0.35 -0.08 0.19 <.0001 0.60 0.26 4.03 0.0001 <.04 <. Patient outcomes rates (%) corresponding to an increase by 1 hour in LPN/LVN hours/patient day (pooled analysis) Difference in Outcome Rate.24 Standard Error 1.04 p Value for the Association 0.21 0.25 -0.06 0.61 0.02 0.60 0.0001 <.002 <.31 0.06 0.81 -0.62 <.63 3.31 0.01 0.53 0.35 2.68 6.48 -2.0001 0.60 1.28 0.

0.15.23 (-0.42 (-1.38 (-0.-0.03.46.-0.16) -0.00) -2.20) Outcome (number of studies) CPR (1) Falls (6) Urinary tract infection (5) Hospital acquired pneumonia (3) Nosocomial infection (3) Sepsis (3) Surgical wound infection (2) Pressure ulcers (7) Shock (1) Pulmonary failure (2) Thrombosis (1) -5 0 . Patient outcomes rates (%) corresponding to an increase by 1 hour in UAP hours/patient day (pooled analysis) Difference in outcome rate (95% CI) -0. 0.03) -0.20 (-0.-0. 0.-0.07 (-3.30. 0.09 (-0.5 Difference in outcome rate 73 .78.36.03) 0.23 (-0.26.41) -0.26.Figure 16.14) -1.44.88) -0. 0.20 (-0.-0. 0.87.75) -0.20 (-0.07 (-0.16) -0.05) -0.26 (-2.59.

61) 0.47.60 (0. Changes in LOS corresponding to an increase by 1 nursing hour/patient day (pooled analysis) Level of analysis (number of studies) All studies 1 nurse hour (8) 1 RN hour (5) 1 LPN hour (3) 1 UAP hour (3) Medical patients 1 nurse hour (7) 1 RN hour (5) 1 UAP hour (3) Surgical patients 1 nurse hour (5) 1 RN hour (2) 1 LPN hour (2) 1 UAP hour (1) Difference in length of stay (days) (95% CI) -1.34) 1. 1.43 (-2. 0.13) -0.53 (0. 5. 0.73.56 (3.25) 1.65 (-1.04) 4.45 (-0.72.48. 5.25. 0.31 (-0. 4.93.50) 1.62) 3. 2.57 (-1.47) -3.88. 2.53) 1.19) -0.5 0 Difference in length of stay (days) 5.47 (0.39.61.23) -2.5 74 .36 (-3.Figure 17.21 (1.97. 2.87. 2.

3 Shock 2 vs.002 0.68 2.5 >11.000 <.97 0.17 0.81 0.42 0. 3 Shock 2 vs.000 0.6 7.36 4. 3 Urinary tract infection 0 vs. 3 Falls 2 vs.97 7.01 1.0001 0.0001 <.55 1. 3 Thrombosis 1 vs.39 2.85 97.00 0.31 0.6 Surgical Patients <5.3 12.63 0. 3 Hospital acquired pneumonia The following table shows how quartiles of nurse hours were established.51 0. Differences in outcomes rates (%) in quartiles of total nursing hours/patient day distribution (pooled analysis) Quartiles Outcomes Difference in Rate. % 0.75 75 .19 0.53 0.2 9.0001 <. 3 Pressure ulcers Medical patients 2 vs. 3 Urinary tract infection 2 vs.19 0. Quartiles 0 1 2 3 ICU <6. 3 Gastrointestinal bleeding 2 vs. 2 Falls 1 vs.002 0.04 0.35 Standard Error 0. 3 Hospital acquired pneumonia 2 vs.33 0.50 0. 3 Thrombosis 2 vs.37 Medical Patients <5.05 0. 2 Nosocomial infection 2 vs.10 1.0 9.49 1.6 >10.15 p Value for the Association 0.001 0.83 0.10 4.51 0.001 0.30 2. 3 Sepsis 2 vs.89 0.22 0.17 7.32 8.76 0. 3 Falls 2 vs.24 1. 2 Hospital acquired pneumonia 2 vs.Table 17.1 >14.0001 0.90 2.60 0.36 0. 3 Failure to rescue 2 vs.0001 Consistency Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes ICUs 1 vs.003 0.10 1.0001 <.13 3. 3 Gastrointestinal bleeding 2 vs.02 0. 3 Falls 2 vs. 3 Pulmonary failure 2 vs.62 5.29 0. 3 Pressure ulcers Surgical patients 2 vs.16 0.01 0.002 0.24 0. 3 Falls 1 vs.1 6.000 <.001 0.03 1.59 7.31 0.001 <.68 0.22 0. 3 Surgical wound infection 2 vs.06 0.

27 (1.57 (1.33 (1.68) 2.17.69) 1.85) 1.7 1 Relative risk of outcome 5 The following table shows how quartiles of nurse hours were established.9 6. 3 (ICUs) 1 vs.16.69) 1. 2 (ICUs) 1 vs.12 (1.20.9 >8.66 (1.49 (1.59 (1.06.32) 3. 3 (medical patients) Unplanned extubation 0 vs. 3 (ICUs) Thrombosis 2 vs.62.82. Relative risk of patient outcomes in quartiles of RN hours/patient day (pooled analysis of RN hours reported by the authors and estimated from RN ratios) Quartiles of RN hours/patient day CPR 0 vs. 4.07.37) 2.52 (1.08 (1.39 (1.2 12.50) 1.4 8.71) 1.09 (1. 1.25.49. 3 (surgical patients) 0 vs. 1.62) . 3 (surgical patients) Failure to rescue 0 vs.9 >16 Surgical Patients <4. 3 (medical patients) 2 vs. 2 (ICUs) 0 vs. 1. 2 (surgical patients) 0 vs.97.15.32 (1.46. 2 (ICUs) 0 vs.11) 2. 3 (surgical patients) Relative risk of outcome (95% CI) 1.96) 1.21) 1.1 76 .19 (1. 3. 5.21) 1. 3 (medical patients) Pulmonary failure 0 vs.2 5.Figure 18. 1 (ICUs) 0 vs.72 (1. 2. 3 (ICUs) 1 vs.36. 2 (surgical patients) 1 vs.34 (1. 1. 1. Quartiles 0 1 2 3 ICU <6 8.43) 1.32.4 >10.12.1 Medical Patients <4 4.10) 1. 1.75 (1. 4. 3 (surgical patients) 2 vs.14.21) 2. 3. 1. 1. 1. 2.

74 (-4.53 (-3.04 (0. 1.36) 0.87.53 (-4.90. 0. 0.42) -5 0 Difference in outcome rate 5 77 . Patient outcome rates corresponding to an increase in nurses’ education and experience (results from individual studies) Outcomes (units) 1 year increase in experience Pressure ulcers (medical-surgical) Falls (combined) Falls (medical-surgical) Complications (ICU) Urinary tract infection (medical-surgical) 1% increase in nurses with BSN Pressure ulcers (medical-surgical) Failure to rescue (ICU) Falls (combined) Falls (medical-surgical) Complications (ICU) Urinary tract infection (medical-surgical) Difference in outcome rate (95% CI) -1.61.67.38.61) 0.44 (-2.17 (0.38) 0. 3.42. 0.04 (-0.67) -1.13 (-1.87) -0. 1.10) -0. 2. 4.00.31) 1.44 (-1.Figure 19.-0.02) 0.04 (-0.02.-0.07) -0.31. 4.02.33) 0.06.74 (-1.

0 86.5 17.1 39.5 12.1 7.0 15.8 13.1 10.8 6.0 78. and proportion of temporary and full-time nurse hours Number of Studies % RN % licensed nurses % of nurses with BSN Experience in years % overtime hours % temporary nurses % full-time nurses 48 8 9 12 2 12 3 Mean 69.3 Median 71.4 81.6 11.0 41.9 2.1 11. nurse education.7 10.0 Standard Deviation 17.Table 18. The distribution of nurse skill and experience mix.0 78 .2 78.7 16.

29 Ritter-Teitel76 Blegen 29 79 . ICU.387 0.35 0.10. 0.01 -0. -0.02 0. Calculated changes in rates of patient outcomes corresponding to an increase by 1% in the proportion of RNs Author. specialized Combined.308 -0.111 0. 0.02. % -0. 0.008 0. Hospital Unit Analytic Unit Hospital Krakauer191 Combined 190 Combined Hartz Hospital and Patient 28 Combined Cho Aiken52 Combined Tourangeau140 Combined 28 Combined Cho 28 Combined Cho 28 Combined Cho 28 Combined Cho 28 Combined Cho Hospital and unit 26 Combined Needleman Patient 33 Combined Unruh 33 Combined Unruh 33 Combined Unruh Patients Medical Medical Medical Medical Medical Surgical Medical Medical Medical Medical Medical and surgical Combined Combined Combined Medical and surgical Medical and surgical Medical Surgical Combined Combined Medical Medical Combined Medical Medical Medical Medical and surgical Outcome Mortality Mortality Mortality Mortality Mortality Surgical wound infection Urinary tract infection Pneumonia Pressure ulcers Falls Sepsis Mortality Pulmonary failure Cardiopulmonary resuscitation Nosocomial infection Urinary tract infection Nosocomial infection Surgical wound infection Pneumonia Urinary tract infection Pressure ulcers Falls Falls Pressure ulcers Falls Falls Mortality Difference in Rate.20 0.019 0. 0. specialized Medical and surgical Medical and surgical Urinary tract infection Nosocomial infection 0.546 0. ICU.08 -0.19 -0.449 95% CI -0. 0. -0.07 0.015 0.22 -1. 0. 0.302 -8.02.4. -0.04 0.12 -0. 0. 0. 0.024 -0.09. 0.16. 0. 1.001.72 -0.03.095 -0.02 -0. 0.002 0.004 0.13 0. 0.02 -0.16 -0.06 -0.16.004 -0.Table 19.02.027 0.033 -0.001 -0.01 -0.05 Blegen Medical and surgical Nosocomial infection -6. -0. 0.24.06.08.082 -0.020 -0.01 -0.03. 0.5 Hope22 Hope22 Simmonds192 33 Unruh Unruh 33 Unruh 36 Zidek Zidek36 33 Unruh Seago166 166 Seago Seago154 Unit 29 Blegen Ritter-Teitel76 Stratton193 29 33 Medical and surgical Medical and surgical Specialized Combined Combined Combined Combined Combined Combined Combined Combined Combined Combined. -0. -4.83. specialized Medical and surgical Combined. 0.04.051 0.107 -0. 0.007.25 -6.039 0.58. 0.01.057 0.004.065 0.22. 0.06 -0.07.009 0.01.08 0. 0.004 0.01. -0.085 -0.01 0. 0.44 Ritter-Teitel 76 Medical and surgical Medical and surgical Medical and surgical Pressure ulcers Falls Pressure ulcers -0.20 -0.124 0.01 -0.006 -5.04.001 0.09 -0.000 0. -0.02.28. -4.02.017 -0.13.007 0.047 -1. specialized Medical and surgical Medical and surgical Combined. ICU. 0.001.086 0.001 -0.32.94. ICU.02 -3.05.

13. 0.015 95% CI -0. % -0. Calculated changes in rates of patient outcomes corresponding to an increase by 1% in the proportion of RNs (continued) Author.048 0.37 Donaldson Medical and surgical Falls -0. 0.Table 19. 0.12.01 80 .17.06 -0.48 Medical Medical and surgical Falls Pressure ulcers -0. 0.51. Medical and surgical units Step-down. Analytic Unit 29 Blegen Potter75 Donaldson64 64 Hospital Unit Combined.059 -0. Medical and surgical units Patients Medical and surgical Falls Outcome Difference in Rate. specialized ICU Step-down.121 -0. ICU.

0.01. 0.02) 0.14 (-0.49 0 Difference in outcome rate .03) 0.07.Figure 20.05 (0.01 (-0.01 (-0.19.01.49 *consistent across the studies (heterogeneity NS) 81 . 0. 0.21) 0.02 (0. 0.01) 0.08 (-0.02.03) -0.03 (0.07) 0.06.02 (0. 0.01) 0.05.49) -0. 0. 0.33. 0.01 (0. 0.01) 0.10 (0.04) 0.02 (0.03 (-0.05. 0. 0.05) 0. 0.01 (-0.06 (0. 0.02.02.03.39.10 (0.02) 0.-0.03) 0.12) 0.06) -0.03.01 (0.01. Calculated changes in rates of patient outcomes corresponding to an increase by 1% in the proportion of RNs (pooled analysis) Outcomes (number of studies) ICUs Falls (3) Nosocomial infection (3) *Sepsis (2) *Pressure ulcers (3) Medical patients CPR (2) Falls (10) Urinary tract infection (8) Hospital acquired pneumonia (6) Nosocomial infection (7) Sepsis (4) Pressure ulcers (11) Surgical patients *Urinary tract infection (6) *Hospital acquired pneumonia (4) Nosocomial infection (2) Sepsis (2) Surgical wound infection (2) *Pressure ulcers (3) Difference in outcome rate (95% CI) -0. 0.15) -.04.02. 0.13) 0.02 (0.

01) 1.Figure 21.00.02) 1.18) Medical patients Urinary tract infection (4) Hospital acquired pneumonia (5) Falls (2) Nosocomial infection (2) 1.00 (1.00) Surgical patients Surgical wound infection (3) 1. 1. 1.58) . 1.00 (0. 1.00 (1.98.8 1 Relative risk of outcome 1.00 (0. 1.99.00 (0.63.85.00 (1.00) 1.00.00) 1. 1. 1.2 82 .01 (1.02) 1.00 (1.00.97.00. 1.03) 1.00) 1. Relative risk of patient outcomes corresponding to an increase by 1% in the proportion of RNs (pooled analysis) Outcomes (number of studies) All studies Hospital acquired pneumonia (7) Falls (2) Pulmonary Failure (2) Nosocomial infection (2) Sepsis (3) Relative risk of outcome (95% CI) 1.00 (0. 1.00. 1.00 (0.

1.74.00.98.85 (0.49. 2.64 (0.09) 0.98 (0.84 (0.65. 0.05) 0.70 (0. 2.83) 0.02 (0. California hospitals) Needleman (surgical.44 (0.00) 0.54.69 (0.87 (0.45.00 (1.78) 1.85 (0. 1.92) 0.90) 0. 1.06) 0.73 (0.89) 0.00) 0. 1.71.10) 0. California hospitals) Needleman (surgical.73 (0. 0.70. 0.26) 1.00) 0.59 (0.01) 1.Figure 22.84) 0. 1. 0. 1.70.69 (1.99 (0.96. 0.00) . 1. 0.03) 0.36 (0.35) 0.60 (0.99 (0. 1. 1.99 (0.46.70.13 1 Relative risk of outcome 3 83 .73 (0. 0.63 (0.48) 0.48. Relative risk of hospital related mortality and failure to rescue corresponding to an increase by 1% in the proportion of RNs (results from individual studies and pooled estimates) Author (patients) Failure to rescue Needleman (surgical) Needleman (medical) Needleman (surgical) Needleman (medical) Needleman (surgical) Needleman (medical) Needleman (medical) Needleman (surgical) Needleman (surgical) Subtotal Mortality Shortell (combined) Hoover (combined) Needleman (combined) Person (medical) Estabrooks (medical) Needleman (medical) Needleman (surgical) Needleman (medical) Needleman (surgical) Needleman (medical.68.14. 1.29 (0. 1.20.47.78) 0.99.04) 0.02. 0. 1. California hospitals) Subtotal Relative risk of outcome (95% CI) 0.44.96 (0.45.81) 0. California hospitals) Needleman (medical. 1.47) 1.67.96) 0. 1.71.

89) 0.12. 1.56) 0.08 (0.60. 1.60) 0. 1. 0.68) 0.43. 0.00 (0.52 (0.31.06.43 (0. 0.14 (0.98.05.47) 0. 0.96) 0.94 (0.81 (0.86 (0.56.71.99) 1. 0.30 (0.36 (0. Relative risk of patient outcomes corresponding to an increase by 1% in the proportion of RNs (results from individual studies and pooled estimates) Author (patients) Pulmonary failure Needleman (surgical) Needleman (surgical) Needleman (surgical) Needleman (surgical) Needleman (surgical) Subtotal Shock Needleman (medical) Needleman (surgical) Needleman (medical) Needleman (surgical) Needleman (medical) Needleman (medical) Needleman (surgical) Needleman (surgical) Needleman (combined) Subtotal Relative risk of outcome (95% CI) 1.38 (0.72) 0.34) 0. 0.03 1 2 Relative risk of outcome 84 . 1.02) 0.98.46. 1.02) 0. 0. 1.17 (0. 1.65) .28.16. 0. 0.76 (0.59) 1.00 (0.41.84 (0.Figure 23.14.75) 0.43) 0.21.34 (0.93) 0.

58. 2.78) 0.71) 1. 1.69.36.64.11) 1. 1.81 (0.29) 0.09. 1.94.20.18.60 (0. 1.02) 0.27 (0.52.08. 5. 0.58) 0.06 (0. 1.17) 0.55) 0.06 (0.68 (0.39 (0.51.00 (0. 10.00. 1.17.97) 0. 1.71) 0.48) 1.65 (0.23.39. 0.Figure 24.11) 0.03) 1.87 (0.29. 1. 0.00.96) 0.27 (0. 0.51) 0.68 (0. 1.98.00.71 (0.78 (0.00 (0.1 Relative risk of outcomes 1 .00. 1.55 (0. 0.05 (0. Relative risk of treatment complications corresponding to an increase by 1% in the proportion of RNs (results from individual studies and pooled estimates) Author (patients) Complications Needleman (surgical) Needleman (surgical) Needleman (medical) Needleman (medical) Needleman (surgical) Needleman (surgical) Falls Cho (combined) Upper gastrointestinal bleeding Needleman (combined)) Needleman (medical) Needleman (surgical) Needleman (medical) Needleman (surgical) Needleman (medical) Needleman (medical) Needleman (surgical) Needleman (surgical) Pressure ulcers Needleman (combined) Needleman (surgical) Needleman (medical) Needleman (medical) Needleman (surgical) Needleman (surgical) Thrombosis Needleman (medical) Needleman (surgical) Needleman (medical) Needleman (medical) Needleman (surgical) Needleman (surgical) Effect size (95% CI) 3.36. 02 10.12) 0.57) 0.74 (0.56.02 (0. 4.57 (0.86) 0.04 (0.04) 85 .91) 0.83) 0. 4.75 (0.40) 1.53) 0.91) 0.01 (0.27) 0. 1.64) 0.00. 0.76) 1.66. 1. 1.44 (0.89 (0. 2.32.45 (0. 0.40.66. 0.68) 0. 0.28 (0.09.93 (0.

00 1. 1.42 0.74.47 0.54 0.76 0.88 0.22 0.69 0.47. 1.45 0.19. 1.65.34.09.80.66.95 0.00 0.42.67. 0.66 0.20 0. 1. 0.87 0.99 0.32 0. 0. 0. 1.42.18.91 0.98 0.90.74.54 0.01 0. 0.03 0.68. 1.42.64.27. 1.46 0. 0.02 0. 1.39. 1.66 0.63 0.03 0. 0.40 0.75.96 0.99. 0. 0.47 0.53 0.80.99 0. 0.44. 1.76 0. 2. 0.60 0.63 0.81 86 .72 0. 1.45.61 0.60 0. 0. 0.86 0.92 0.28. 0.48.10 1. 1.76 0. 0. 0. 1. 1.00 0.57 0.19.68.49 0.10. 1. 0.10.80 0. 1.77 0.00 1.59 0.50. 0.92 0.46 0.09 0.70. 2.00.00 0. 0.85 0.81 0.82 0.70 0.49.00 0.81 0.64.81 0.00 0. 0.74 0.90 0.40 1. 0. 0. 1.97 0.58 0.90 0.85 0.74 0.73 0.37. 0.98 0. Relative risk of patient outcomes corresponding to an increase by 1% in licensed nurse hours Outcomes Author (patients) Failure to rescue 27 Needleman (medical) Needleman27 (surgical) 27 Needleman (medical) Needleman27 (surgical) 27 Needleman (medical) Needleman27 (medical) 27 Needleman (surgical) Needleman27 (surgical) 27 Needleman (medical) Needleman27 (surgical) 27 Needleman (surgical) Needleman27 (surgical) 7 Needleman (medical) Needleman27 (medical) 27 Needleman (medical) 63 Cheung (medical) Mortality Berney30 (surgical) 27 Needleman (medical) Needleman27 (surgical) 27 Needleman (medical) Needleman27 (surgical) 27 Needleman (medical) Needleman27 (medical) 27 Needleman (surgical) Needleman27 (surgical) 27 Needleman (medical) CPR Needleman27 (surgical) 27 Needleman (surgical) Needleman27 (surgical) 27 Needleman (medical) Needleman27 (medical) Pulmonary failure Needleman27 (surgical) 27 Needleman (surgical) Needleman27 (surgical) 27 Needleman (surgical) Shock Needleman27 (medical) 27 Needleman (surgical) Needleman27 (medical) 27 Needleman (surgical) Needleman27 (medical) 27 Needleman (medical) Needleman27 (surgical) 27 Needleman (surgical) Needleman27 (medical) 27 Needleman (surgical) Needleman27 (surgical) 27 Needleman (surgical) Needleman27 (medical) 27 Needleman (medical) 27 Needleman (medical) Relative Risk 95% CI 0. 1.30.99 0.16 0. 1.90 0.66.60 0. 1.94 0.40 0. 0.27 0.59 0. 0.12.27 0.09 0.42 0.95.08.09 0.21 1. 0.86 0.22.90 0.69 0.66 0.63.01 0.48.89 0.27.81 1.40.50.08 0.61 0.21.18.00 0. 1.04 0.59 0.97 0.Table 20.19.81 0.87 0. 1.78 0.

11 1.25 0.66 0. 1. Relative risk of patient outcomes corresponding to an increase by 1% in licensed nurse hours (continued) Outcomes Nosocomial Infection Cheung63 (medical) Pneumonia Needleman27 (medical) Needleman27 (surgical) 27 Needleman (medical) Needleman27 (surgical) 27 Needleman (medical) Needleman27 (medical) 27 Needleman (surgical) Needleman27 (surgical) 27 Needleman (medical) Needleman27 (surgical) 27 Needleman (surgical) Needleman27 (surgical) 27 Needleman (medical) Needleman27 (medical) 27 Needleman (medical) Surgical wound infection Needleman27 (surgical) Needleman27 (surgical) 27 Needleman (surgical) Sepsis Needleman27 (medical) 27 Needleman (surgical) Needleman27 (surgical) 27 Needleman (surgical) Needleman27 (medical) 27 Needleman (medical) 27 Needleman (medical) 30 Berney (surgical) Urinary tract infection Needleman27 (medical) Needleman27 (surgical) 27 Needleman (medical) Needleman27 (surgical) 27 Needleman (medical) Needleman27 (medical) 27 Needleman (surgical) Needleman27 (medical) 27 Needleman (surgical) Needleman27 (surgical) 27 Needleman (surgical) Needleman27 (medical) 27 Needleman (medical) Needleman27 (medical) 30 Berney (medical) Berney30 (surgical) Complications Needleman27 (surgical) 27 Needleman (medical) Needleman27 (surgical) 27 Needleman (medical) Needleman27 (medical) 27 Needleman (surgical) Needleman27 (surgical) Relative Risk 1. 0.32.35 0.99. 0.42.52 0.39 1.62 0. 1. 0. 0.77 0. 1.74 0.83 95% CI 1.48 1.70 0.30.01 1.59 0.04 4.89 0. 0.42 0. 0.85. 0.87 0. 10.11 1.Table 20. 1.43 1.69 0.64 0.88 0.71.39.67 0.00. 0.70.61 0. 3. 0.32.49 0.48 0. 1.86 1. 0. 2.56 1.80 1.39.79 0.37. 1.38.49 87 .79 0.74.47.83 0.85 0.24 1. 1.33 1. 1.60 0.28.44 1.13 0. 1. 1.20.86 0.85.87 0.93 1.40.01 0.56 0.71 0.24.00.13 0.56 0.01 1.60 0.10 0.46. 0. 1. 0.62 1.01 0.07 0.04 0.31.44.59 0.32.65.38.32 0. 1.00 0. 0.35 0.94 0. 0.00.68.52 0.84 0.53.99. 32.47.00.00 2.62 1.00 1.36.98 0.68 0. 1.03 0.41.82 0. 1.26.00 0. 5.91 0.51 0. 1.01 0. 0. 1. 5.41.94 0. 1.97.12.48 0.96 0. 0.30.95 0.13 1.76 0.34.98 0.76.66 0.37 0. 1.93 1.71.78 0.75.53.32. 2. 1.80 0.59 0.00 1.67. 0. 0. 0.59 1.02.00 0.83 0.61 0.86 1.36 0. 1.16 0.44.61 0.61 0.44 0.94 0.37 0. 2. 2.69 0.54 0. 1.

42.79 0.83 0.63 0.00.90 0.39 1.00. 2.00.12.00 1.18 88 . 0.29 1. 1.46. 1.23. 4.74.07.71 1.40.78 0.46. 0.55 0. 0.04.94 0.55 0. 1.72 0.54 1. 0.02 0.53 0.28 1.06 0. 1.89 0. 1.28.07 0.96 0.45.35 0. 1.00 0. Relative risk of patient outcomes corresponding to an increase by 1% in licensed nurse hours (continued) Outcomes Gastrointestinal bleeding Needleman27 (medical) 27 Needleman (surgical) Needleman27 (medical) 27 Needleman (surgical) Needleman27 (medical) 27 Needleman (medical) Needleman27 (surgical) 27 Needleman (surgical) Needleman27 (surgical) 27 Needleman (surgical) Needleman27 (surgical) 27 Needleman (medical) Needleman27 (medical) 27 Needleman (medical) 30 Berney (medical) 30 Berney (surgical) Pressure ulcers Cheung63 (medical) Needleman27 (medical) 27 Needleman (surgical) Needleman27 (surgical) 27 Needleman (medical) Needleman27 (medical) 27 Needleman (surgical) Needleman27 (surgical) 27 Needleman (medical) Needleman27 (surgical) 27 Needleman (surgical) Needleman27 (surgical) 27 Needleman (medical) Needleman27 (medical) Thrombosis Needleman277 (medical) Needleman27 (surgical) 27 Needleman (medical) Needleman27 (surgical) 27 Needleman (medical) Needleman27 (Medical) 27 Needleman (surgical) 27 Needleman (surgical) Relative Risk 0.22.60 1.26.98 0.07 0.03 0.66 1. 0. 0.14. 0.73 1. 1.58 0.68 0. 1.41 0.95 0. 1. 2.78.77 0. 1.15 0.40.97 1.19 0.96 1.49 0.00.18.90 0. 0.01 1.01 1. 1. 2.16 0.15.15 0.38 0. 1.71 0. 1.66 0.56.84. 1.66. 1.70.96 0. 1.69.94 0.15.59. 3.00 0.08 0.78 0. 2.72 0.11 0.12 0.52 0.87 0.11 95% CI 0.09 0.81 0.68 0.71 0.68.96 0.48.Table 20.66 1.79.02.01 1. 1.40 0.03 1.07 0.57 0.92.77.74 0. 2.49.24.77 0.37 0.58 0.52 1. 1. 2. 1. 1.83 0. 1.28. 1.

08) 0.16) 0.69) 0. 1. 0.86) 0.98 (0.64. 1.40.97) 0.2 1 Relative risk of outcome 2 89 . 1. 1.30.90 (0. 1.74.94) 0.81 (0. 1.74.90 (0.45 (0. 1.49. 0.81 (0.86 (0.64.09) 0.00 (1.50.83 (0.82 (0.58 (0.67. 0. 1.73 (0.37.22. 0.46.89.80. 0.80 (0.97 (0.65.81 (0.75.87) 0.01) 0.68.00) 0. 0. 0.96) 0. 1.99) 0.00) 0.99 (0.47) 0.66. 1.03) 0.70.76 (0. 0.71 (0.90 (0.80.01) 0. 1.00) 0. 1.68. 1.90 (0. 1.95.99) 0.88 (0.91 (0.81 (0.96 (0.00) 1.98) . 1.34.69 (0.61) 0.98) 0.95.09) 0.95) 0.00.27) 0.09) 0. Relative risk of hospital related mortality and failure to rescue corresponding to an increase by 1% in the proportion of licensed nurses Patient populations are in parentheses Author (patients) Failure to rescue Needleman (medical) Needleman (surgical) Needleman (medical) Needleman (surgical) Needleman (medical) Needleman (medical) Needleman (surgical) Needleman (surgical) Needleman (medical) Needleman (surgical) Needleman (surgical) Needleman (surgical) Needleman (medical) Needleman (medical) Needleman (medical) Cheung (medical) Subtotal Mortality Berney (surgical) Needleman (medical) Needleman (surgical) Needleman (medical) Needleman (surgical) Needleman (medical) Needleman (medical) Needleman (surgical) Needleman (surgical) Needleman (medical) Subtotal Relative risk of outcome (95% CI) 0.Figure 25. 0.42. 0. 1. 1.54 (0.89 (0.66.03) 0.78. 0.92) 0.70 (0.

92) 1.08.98.53) 0.66 (0.41) 0.19.10 (0.45.59 (0. 0.53 (0.47) 1.46 (0.22 (0.77) 0.42 (0.20 (0.40 (0. 0. 0.63) 0. 0.85) 0. 2.59 (0.00) 0.74) 0.42.02 (0.42. 0.59 (0. 0. 2.81) 0.50.49 (0. 1.21 (0.42 (0. 0.27.76) 0.48. 0.18 (0.10. 0. 0. 0.49.86) 0.04) 0.74) 0.00) 0.27 (0.40 (0. 0.63.66 (0.18.59 (0. 1. 0.18.10. 0.54 (0.76) 0. 1.27.Figure 26.71) 1. 1.57) 0.32) 1. 0.46.87) 0.85) 0. 0.00 (0.19. 0.61) 1 1 3 Relative risk of outcome 90 .59 (0.61) 0.40 (0.59 (0.78) 0.39. 0.28. Relative risk of patient outcomes corresponding to an increase by 1% in the proportion of licensed nurses Patient populations are in parentheses Author (patients) CPR Needleman (surgical) Needleman (surgical) Needleman (surgical) Needleman (medical) Subtotal Pulmonary failure Needleman (surgical) Needleman (surgical) Needleman (surgical) Needleman (surgical) Subtotal Shock Needleman (medical) Needleman (surgical) Needleman (medical) Needleman (surgical) Needleman (medical) Needleman (medical) Needleman (surgical) Needleman (surgical) Needleman (medical) Needleman (surgical) Needleman (surgical) Needleman (surgical) Needleman (medical) Needleman (medical) Needleman (medical) Subtotal Relative risk of outcome (95% CI) 0.60) 1.12.09.99.46 (0.48.19.81) 0. 0. 1.63) 0. 1.66 (0.21.44.

57. and clustering of patients and hospitals. 95 percent CI 0.10. provider characteristic.htm 91 .92.52.gov/clinic/tp/nursesttp.93) than did those using cross-sectional designs (RR 0. Another test would be the difference in effect size between longitudinal and cross-sectional designs. and staffing. We also examined the role of the study characteristics on the association between nurse ratios and patient outcomes. The risk of nurse-sensitive patient outcomes was comparable with those for mortality independent of study design.10. analytic units.93 A persistent question is whether this association reflects a causal relationship. The evidence across 14 studies consistently suggests that the risk of hospital related mortality was 9 percent lower in ICUs. LPN/LVN. Studies that attempted to assess temporality in the association between nurse staffing and failure to rescue had a lower relative risk per RN FTE per patient day ratio (RR 0.91-0. We tested the following study characteristics that could modify the association between nurse ratios and patient outcomes: quality scores. size and volume. One test of such a causal relationship should be that higher staffing levels should produce stronger effects for nurse sensitive outcomes than for more general outcomes. and nurse satisfaction with job and provided care. UAP) licensed and the same four for nursing hours with 16 outcomes expressed as rates and 19 expressed as relative risks for a total of 280 (eight effect modifiers times 35 outcomes).20 physician practice patterns. The relative risk of failure to rescue was reduced by 16 percent in surgical patients and hospital-acquired pneumonia by 30 percent in ICUs. the adjustment for patient comorbidities. supporting the presence of an association rather than a cause. and 16 percent lower for surgical patients for each additional RN FTE per patient day (Figure 27). The authors adjusted for patient comorbidities at patient and hospital levels and for provider characteristics including hospital teaching and profit status. RN. Hospitals that invest in more nurses may also invest in other actions that improve quality. The proportion of significant interactions was considerably lower for relative risks.ahrq.51. only the LPN effects were significant more the 30 percent of the time. We examined the association of four aspects of nurse ratios (total. patient satisfaction with overall and nursing care. The former should more directly reflect the effects of changing staffing patterns by holding more constant other hospital variables.Table G30). Only a small proportion of tested models showed a significant influence of study design on the association with nurse staffing and patient outcomes (Appendix G∗.199 Several lines of evidence suggest that overall hospital commitment to a high quality of care in combination with effective nurse retention strategies leads to better patient outcomes. rates substantially higher than those for mortality.198. and collaboration with nurses8. 6 percent lower for medical patients. patient populations.Chapter 4.93).84. hospital units. Discussion Association or Cause The present review and meta-analysis confirm previous contentions that increased nurse staffing in hospitals is associated with better care outcomes.9 may affect ∗ Appendixes and Evidence Tables for this report are provided electronically at http://www. Among the possible interactions.57-59 Hospital volume. assessment of temporality in the association. Empirical evidence suggests that magnet hospitals provide high quality care and report better patient outcomes in relation to nurse staffing. HMO penetration. technology index.5254.27. 95 percent CI 0.75-0.

Professional practice environments in hospitals. Marginal Effects Previous systematic reviews did not estimate the effect size of different nurse staffing measures. and perhaps could not.61 observed vs.55. the observed risk of mortality was 61 percent compared to expected 85 percent (1. Case mix. was usually handled as a mean number averaged across all patients in a unit or hospital.161. although it would greatly complicate the study designs.201.93 Associations were considered to be clinically important when a 10 percent difference in staffing levels was associated with significant changes in outcomes. The absence of information on medical care is another important shortcoming of these studies.92 When attempting to find optimal nurse staffing ratio and hours.patient outcomes. These studies best approximate that correction by examining different types of units.53-57.152.152.165. Patient outcomes are affected by patient characteristics.92. Detailed information on comorbidities and disease severity was not included. The effect size of this nonlinear association was tested to detect the overall trend and relative and absolute changes in patient outcomes among nurse staffing categories using quartiles of the distribution.164. it could lead to bias. The absence of these measures can have varied effects depending on whether one believes they represent noise or bias.15.56 Magnet hospitals had lower patients per RN ratios. Comparing the lowest with the highest quartiles of patients per RN per shift ratio. The risk increases quickly as the patients per RN per shift ratio rises above four to five. 1. The studies reviewed here did not. an assumption that seems feasible.26 Hospital mortality shows a decline with increasing staffing. Such bias should result from more staff going to patients who need more care and hence would decrease the effects seen. Moreover. Case mix differences may hide areas where nurse staffing makes a bigger difference if it is not associated directly with staffing levels. Such averages can hide a lot of different mixtures. better nurse manager ability and support.85 expected) if the slope was applied to the differences in the ratio. any bias would result from hospitals that invested in more staffing also pressing for better medical care. bias needs to be separated from noise. but if it is.202.164. when addressed.66. the nature of core medical treatments was not addressed.93 One study26 examined the overall linear trend in adverse events corresponding to a one unit increase in nurse staffing and differences in the rates of patient outcomes among the lowest and highest quartiles of the nurse staffing distribution to find an optimal staffing pattern.78. but the decline is not linear. The mean increase of 7 percent for each additional patient per RN per shift can be misleading.21. the effect size could not be estimated reliably because of differences in the studies and possible curvilinear associations. we would expect the 92 . but it seems unlikely that it would be inversely correlated. Here too.203 The quality of the nurse professional practice work environment correlated with patient safety outcomes in several studies.201 Hospitals with better professional nurse practice environment had improved RN staffing ratios. There is no strong basis to assume that the quality of medical care is necessarily correlated with the level of staffing.204 The outcomes of hospital care are the result of many factors. With that assumption.15. address many salient issues. These factors are associated with nurse retention and better patient outcomes in several reports. which serve patients in varying levels of severity.200. and collegial nurse-physician relations. which enable nurses to control their practice through governance also contribute to nurses’ job satisfaction and positive perceptions of nurse autonomy. Likewise.21. the goodness of fit of the linear slope varied across the distribution of nurse to patient ratio.

Applicability of the study was estimated according to a sampling of eligible hospitals and patients with the highest applicability in studies with random population based sampling and random hospital-based sampling and the lowest in the studies with convenient and self-selected sampling. Few multi-hospital studies used random effects models to incorporate geographical differences in the estimation. race.62 The other relies on a less precise ratio of total nurse staffing to patient volume derived from administrative databases63-65 averaging annual nurse-to patient ratios20 at the hospital or unit level.18.11.49. We compared means of nurse staffing in the studies we included in the meta-analysis with published means26 and did not detect substantial differences. comorbidities.19 including only productive hours worked in direct care. Nurse Staffing and Patient Outcomes in Hospitals The majority of the studies found that hospitals with more RNs working with patients had a lower level of patient adverse events related to health care. Therefore. However.33. and all confounding factors the authors reported. provider characteristics. We compared the direction and the strength of the association from the studies at patient level analysis that could carefully adjust for patient and nurses characteristics (better internal validity but lower applicability) and large multi-centers studies obtained hospital averages from administrative databases (low internal validity but better applicability). Table 21 estimates the effect size in terms of the number of patient adverse events that could be avoided by adding 8 RN hours a patient receives during 24 hours in a hospital. We compared the direction and the strength of the association from the studies that used different definitions of nurse staffing and patient outcomes (rates and relative risk). One looks superficially at hours of care provided by different types of nursing staff averaging FTEs of different nurse categories at the hospital level.risk of mortality to be 19 percent lower when the workload of patients per RN per shift decreased from four to two patients. We included summarized quality scores and the fact of adjustment for the each of confiding factors in the meta-regression and sensitivity analysis. socioeconomic status).61.94 37 percent of the included studies reported random sampling and assessments of sampling bias. We used several ways to analyze strengths and limitations of the individual studies. but in fact it was only 6 percent lower. To examine statistically the influence of study quality on tested associations we compared pooled estimates weighted by the sample size and weighted by the quality of the studies and did not detect substantial differences. the report of the Institute of Medicine74 suggested that a larger proportion of hospitals have poorer nurse staffing than published in scientific research. If these associations were causal. Table 22 shows the proportion of patient adverse events that could theoretically be avoided by reducing the number of patients assigned to an RN during an 8-hour shift. Staffing Measures Two general measures of nurse staffing were studied. and clustering of patients and clinics. We graded the adjustment for patient characteristics (age. the effect size of nurse staffing on patient outcomes from the present report can be generalized only to hospitals with similar nurse staffing patterns. We analyzed the internal validity of the studies by the validation of measured nurse staffing. Geographical variations in nurse distributions144 and rates of fatal adverse events148 may impact the effect size of nurse staffing on patient outcomes.28. patient outcomes. The patients 93 .

then increasing staffing by 1 RN FTE per patient day would mean a decrease to 1. back-of-the-envelope transformation would be that 1 RN FTE per patient day would translate to 8 RN hours per patient day or three patients per RN per shift. the maximal reduction in relative risk of hospital-related mortality and adverse events occurred when no more than two patients were assigned to an RN in ICUs and in surgical units.109 These reasons may help to explain why the effect size varied across nurse staffing measures. and hospital acquired pneumonia with the optimal association at 2-2. the individuals charged with actually managing staffing are more likely to think in terms of patients per nurse. However. pooled analysis.93.8 RN hours per patient day (~3 patients per RN per shift). 94 . “productive hours per patient day” may underestimate nurse staffing levels when a large proportion of worked hours was not spent on direct patient care.9. The comparison of the effect size on patient outcomes among quartiles of the RN FTE per patient day ratio and nurse hours per patient day detected the same pattern (Table 24). The majority of studies reviewed in this report focused on registered nurses working in acute care hospital settings. The effect size varied depending on the nurse staffing measure. Confirming the previous observations. If the average is 7. We did not find consistent evidence that a further increase in RN FTE per patient day ratio can provide better patient safety.67 They do not account for the time nurses spend in meetings. they expressed staffing levels in terms of RN FTEs per patient or similar measures.139 we detected a curvilinear association between the RN FTE per patient day ratio and hospital related mortality. The association between patient outcomes and different definitions of nurse staffing suggest several reasons why nurse hours do not always provide a valid estimation of nurse-to-patient ratios.5 patients per nurse. and more than 11 nurse hours were spent per one patient day in ICUs and more than 7-8 hours in surgical and medical patients. Nurse hours per patient day reflect average staffing across a 24-hour period and do not reflect fluctuations in patient census. Therefore. Skill mix may not directly reflect the hospital’s commitment to quality of care and financial strategies.29.60. A simple. The reduction in relative risk of hospital related mortality is 16 percent for 1 RN FTE per patient day and 1 percent for an additional RN hour per patient day in surgical patients. and administrative work.66.5 patients per RN per shift in ICUs and surgical patients. Evidence on the association between LPN/LVN and UAP personnel is limited and controversial. educational activities. Future research should address the role of skill mix and the contributions of LPNs/LVNs.206 Because many of the studies of nurse staffing were based on administrative data. and UAPs on quality of care.13 and periods of the year. scheduling patterns during different shifts. The authors designed the studies to evaluate the effect of nurse staffing on patient outcomes sensitive to RN rather LPN/LVN and UAP work.per RN per shift ratio was more frequently used and provided greater evidence of the effect. the expected reduction should be more than observed in the studies that examined the risk of mortality in relation to nurse hours (Table 23). Inconsistency in nurse staffing operational definitions and methods to measure with an unknown “gold standard” to assess staffing patterns at the patient levels may bias the results of the studies and consequently. nosocomial and bloodstream infections. Assuming that every additional RN per FTE patient day would provide approximately 8 additional RN hours per patient day. but both showed generally the same trends.

The addition of one unit of nursing care may vary depending on the baseline rate.Care Setting Nurse staffing had a different effect in different care settings. Consistent with previous studies. A nurse is not necessarily a nurse.214 Several randomized clinical trials reported a significant improvement in nurse performance and patient outcomes as a result of quality improvement initiatives.000 hospitalized. But other factors may also be relevant. The independent effects of individual nurse competence in interaction with nurse staffing are not well understood and were not the subject of the present review. neonatal) and by the type of patients (medical vs. Such consistent and large improvements in patient safety from increasing the RN FTE per patient day ratio in surgical patients and in ICUs suggest heath care administrators can improve quality of care in these categories of patients using optimal staffing ratios. the estimation of quality of care may include patient satisfaction with nursing and overall medical care and improved quality of life.27 the present metaanalysis found consistent evidence that surgical patients would demonstrate a greater cost-benefit from improved nurse staffing. implementing the results of the present review to improve the quality of hospital care. surgical. Because these studies rarely include data on case mix and other factors that help to explain outcomes.2 percent in all patients (medical and surgical). Included studies did not provide the information on the quality of medical and surgical treatment. they cannot be used to infer differences in skill levels. However.207 Other Factors The primary independent variable examined here is the volume of nursing. Increasing the care of surgical patients by one RN FTE per patient day would eliminate 16 percent of failure to rescue (26 saved lives per 1. We evaluated differences in the association between nurse staffing variables and patient outcomes by the type of hospital units (ICU. organization.26. The importance of nurses’ professional competence and performance have been discussed with regard to developing standards of nurse performance to encourage high quality of care.27 We found a greater reduction in the relative risk of hospitalrelated mortality (16 percent) in surgical patients for an additional one RN FTE per patient day compared to a reduction of 6 percent in medical patients. tempered by some attention to the education level.213. Usually we work in just the opposite direction inferring skill from outcomes after other factors have been accounted for. and leadership undoubtedly play a role but are much more difficult to assess. Future research should address patient positive outcomes. the reduction in nurse workload would save six surgical compared to five medical patients per 1. For example. surgical).70-73 There are also questions about the association between nurse experience and patient outcomes. ICUs have higher staffing levels than typical hospital units. The effect of an additional nurse hour might be quite dissimilar in that context.206 Skill. Numbers alone do not likely explain all that happens.215-224 The majority of studies focused on adverse patient events and mortality. we need to remember that complex interventions in combination with nurse staffing strategies provided better patient benefits. Given a higher baseline mortality in surgical patients.000 hospitalized) compared with 9. 95 . medical. However. 208-212 Implementing evidence-based clinical pathways that involve nurse and physician education and collaboration may increase the effectiveness of nursing work and improve patient outcomes.

patient satisfaction. and quality of life (QOL). A recent trend in hospitals is having Rapid Response Teams (RRTs). The team can be called by any nurse in the hospital if the nurse assesses that the patient’s condition is changing such that it could potentially result in a negative outcome.225 Patient acuity-based staffing requirements adjust staffing for patient diagnosis and comorbidities but do not regulate shift-to shift fluctuations in nurse staffing that have an important influence on quality of care. This team is usually comprised of an experienced critical care nurse.6 Policymakers can consider several approaches to regulate nurse staffing.226 Pay-for performance has been proposed to provide incentives for quality of care.226 To maintain a reasonable staffing level. Policy Implications The case for causation has yet to be made. discharges. fixed minimum nurse-to patient ratios implemented in several states did not provide the expected patient safety benefits. defining the best level of nurse staffing requires addressing cost-effectiveness analysis225 that was beyond the present report. unit-based nurse educators. These types of nursing hours are not included in the studies or considered as nurse staffing measures. respiratory therapist. The estimation of the threshold in terms of marginal costs and benefits depends on value placed on survival. if one accepts the results presented as suggesting a causal relationship between nurse staffing and outcomes. and a physician. Nurses also have access to consultation from advanced practice nurses. Another factor not considered in the studies is the number and type of support personnel available to nurses to assist them with care of patients. The effect sizes depend on rich staffing ratios. The patient flow (admissions. which are different among hospitals and states. Mandatory nurse to patient ratios without legislative agreement to increase reimbursement may result in administrative decisions to reduce support staff positions and investments to other quality initiatives.compliance with prescribed treatments. 175. and nurse managers. Moreover.227 but its effect on quality of care is not known. the number of patients a nurse cares for is not a true measure of the “work” of the nurse. the next question is one of practicality. Indeed.226 Ideally we should monitor every hospital in the United States to see how differences in policies and financial performance affect the cost effectiveness of staffing and its effect on quality of health care. This significant factor was not addressed in any of the studies reviewed and should be considered as a nurse staffing measure for future studies. but its effect on cost effectiveness is not well understood.226 Finally. which are not feasible in most hospitals. charge nurses. the increasing nurse shortage may force hospitals to reduce capacity rather than increase staffing. patient functional status.205 Moreover. 96 . Nevertheless.113. and education in association with provided care including nurse staffing. assistant nurse managers. transfers from other units) can result in nurses providing care for many more patients in a day than what is reflected in the RN hour per patient day or nurse to patient ratio. they are not in a position to assume substantial cost burdens. Because hospitals are paid a fixed rate under diagnosis related groups (DRGs) that does not reflect the quality of care they provide. no consensus exists about patient classification systems. transfers to other units. Our calculations suggest that it is difficult to set fixed nursing standards.225.227-230 Public disclosure of nurse staffing was introduced in one state. Possible staffing decisions to improve quality of care would involve comparing existing staffing with changes in staffing needed to achieve desirable patient outcomes. return from surgeries.

and the coverage of salient variables that could affect quality is weak. The quality of the studies is modest by standard measures. Nonetheless. Hence. such as medical care. The association was somewhat stronger with nursesensitive outcomes than with more generic ones like mortality. A commitment to a high quality care at hospital level may provide better patient outcomes in relation to nurse staffing. but we cannot conclude these relationships are causal. especially medical care. The associations may include other structure and process factors in causal pathway to patient effective and safe care. let alone controlled trials. Adjustments for case mix rely on averages across units or hospitals. there is consistent evidence of an association between the level of nurse staffing and patient outcomes but no clear case for causation. it may be possible to take advantage of natural experiments where nurse staffing levels are changed holding other factors constant. 97 . Recommendations for Future Research While it is not feasible to think about research designs that might be more interventional. they cannot be interpreted as a basis for recommending specific staffing levels. the present review found consistent statistically and clinically significant associations between nurse staffing and adjusted relative risk of hospital related mortality. The distinction is still far from clear. Future observational studies will need to take cognizance of the many other factors that can affect the outcomes of interest.In conclusion. Larger multi-center studies will be needed. Strength of the Evidence Taken as a whole. There are no interventions. Future work will need to target specific questions and collect and analyze enough information to isolate the effects of nurse staffing levels. failure to rescue. The nature of the study designs precludes any efforts to establish a causal relationship. and other patient outcomes sensitive to nursing care. and the organization of nursing units and staffs. but it was also stronger with cross-sectional rather than longitudinal designs. is not tested. it is unlikely that all the salient variables can be addressed in any one study. patient characteristics. The effect size is greater in surgical patients and in ICUs. The effect on quality of other salient input.

0. 0. 0.91 (0.27. 0.79.Figure 27.80.86.62.88) 0.59) 0. 0.40 (0.67) 0.95) 0. 0.84 (0.72 (0.96) 0.60.70 (0. Relative risk of outcomes corresponding to an increase by RN FTE/patient day consistent across the studies Relative risk of outcome (95% CI) 0.49 (0. 0. 0.86) Settings (number of studies) ICUs Mortality (5) CPR (3) Pulmonary failure (4) Unplanned extubation (5) Hospital acquired pneumonia (3) Medical complications (3) Medical patients Mortality (6) Surgical patients Mortality (8) Failure to rescue (5) 0.56.94 (0.84) 0.72 (0.90) . 0.88) 0.25 9 Relative risk of outcome 98 .84 (0.94.36.

medical patients Hospital acquired pneumonia Failure to rescue CPR ICUs Mortality Hospital acquired pneumonia Pulmonary failure Unplanned extubation CPR Nosocomial Infection Surgical patients Mortality Failure to rescue Surgical wound infection CPR Number of Avoided Events/1. overall Mortality. Not to a Primary Diagnosis All patients Mortality. The number of patient adverse events that could be avoided by additional 8 RN hours a patient receives during 24 hours in a hospital Patients’ Condition Related to Health Care.000 Hospitalized Patients (95% CI) 9 (6-12) 3 (2-4) 5 (4-5) 5 (1-8) 24 (14-34) 2 (1-2) 5 (2-8) 7 (3-10) 7 (5-9) 6 (4-8) 2 (1-2) 10 (6-13) 6 (4-8) 26 (17-35) 7 (1-8) 1 (1-2) 99 . hospital level analysis Mortality.Table 21.

32. 88. 3.4.6 (3.2.9) 24.9) 25.7) 75. >5 <2 vs.9 (38.0) 71. >5 3 vs.8. 4 3 vs.4 (5.9) 46.4 (8.8 (13. 40. 41.2) 40.0 (49.8.4 (16.6 vs.1) 100 .1.4 (34.0) 42.6 vs.3) 44.7 (30.6.9) 68. 3.9) 42.4.6 vs.7.6 (12. 3 1 vs.3 (17. 4 Percentage of Patient Adverse Events that Could be Avoided by Reducing the Number of Patients per RN (95% CI) 5. 38.2) 20.7. 33. 71. 4 <2 vs.4) 34.4) 48.7 (31.4 (10. 3 <2 vs.3 <1. 3 <2 vs.4.6 (11.0) 49.8) 57.0) 93.9. 3. 3.1 (45.0 (20.2) 18. 76.4. >4 <1. 62. 3. 64.3 1 vs.7.1. 79. 4-6 2-3.5 (6.8.5 vs.9.3) 25.2.6 vs.1 (33. 69. 44. 50.9) 34. 3 3.7 (30. The proportion of patient adverse events (%) that could be avoided by reducing the number of patients assigned to an RN during an 8-hour shift Patients’ Conditions Related to Health Care.8) 20.2 (29.6 vs.8.9) 28.2.6. 3 4 vs.3 1 vs.6 vs.3.4 (16.4) 25.7) 18.3 <1. 78.3) 35.7) 42.8 (13. 52.8) 56.7 (8.3 vs.8 (28. 33. 63.2.5.3) 38.8. 3. >4 ≤2 vs.3 (18.1. >5 <2 vs.6 vs. 28. Not to a Primary Diagnosis ICUs Mortality Sepsis Sepsis CPR CPR CPR Medical complications Medical complications Medical complications Pulmonary failure Pulmonary failure Pulmonary failure Unplanned extubation Unplanned extubation Unplanned extubation Unplanned extubation Surgical patients Mortality Mortality Mortality Mortality Mortality Hospital acquired pneumonia Nosocomial infection Surgical wound infection Sepsis Sepsis Sepsis CPR CPR Failure to rescue Failure to rescue Failure to rescue Failure to rescue Failure to rescue Pulmonary failure Pulmonary failure Unplanned extubation Unplanned extubation Unplanned extubation Number of Patients Assigned to 1 RN During a Shift <3 vs. 80. 4-6 ≤2 vs. 3.0 (30.5 vs.3 1 vs. 44.3 (9. 60.7. 3-4 <1.6. 4 <2 vs. 42. 3 <2 vs. 4 3 vs.6 (5. 64. 79.1.4. >5 <2 vs.1 (33.0.0) 39.3) 30. 3 <2 vs. 26.5 (17.9 (28.3.6.3 1 vs. 62.2 (6. 38. 7. >4 <1.4) 19.6 (65.0.9) 63. 82. 45.4 (26. 30. 3.4 (6. 57.Table 22.1. 98.6) 44.8 (22.2. >6 4 vs. >5 <2 vs.6) 44.5 (53.6) 61. >6 4-6 vs.3 <1. 3 1 vs.2.2.3 (39.6.1 (13.4) 46.25. 41. 4 <2 vs. >5 4 vs. >4 <1. >5 4 vs.8) 24.6) 25. 56.3 1 vs.2. 40. 24.1) 60. >6 2-3.

92 0.00 0. 1.90.11 0. 1.00.99. 1.05 0. 1.94 Urinary tract infection rate 2 1 1 1.94. 1.98 0. 0.90. 0.88 95% CI 0.29 .00 0.04 0.94 0.02 0.68 1.91 0.17.88 0.84.96 0.34 4 1 1 1 1 5* 2* 1 1 2 1 3 1 1 2 5 6 4 1 2 4 2 1 1 2 101 0.95.05 0.42 Patient falls.06 RR 0. 1.Table 23.56 0.76 0. 1. 0. injuries 1 1 1 Pressure ulcers 1 Nosocomial infection rate 3 1 Failure to rescue 6 0.73.88 0.00 0. 6.05.97.80. 6.99.26 1.07 N 1 7* 3 1 1 4* 3 2 1 2 2 1 Increment 1 nurse hour/patient day 1 RN hour/patient day 1 LPN hour/patient day 1 UAP hour/patient day 1 licensed hour/patient day 1 nurse hour/patient day 1 RN hour/patient day 1 LPN hour/patient day 1 UAP hour/patient day 1 licensed hour/patient day 1 nurse hour/patient day 1 RN hour/patient day 1 LPN hour/patient day 1 UAP hour/patient day 1 licensed hour/patient day 1 nurse hour/patient day 1 RN hour/patient day 1 LPN hour/patient day 1 UAP hour/patient day 1 licensed hour/patient day 1 nurse hour/patient day 1 RN hour/patient day 1 LPN hour/patient day 1 UAP hour/patient day 1 licensed hour/patient day 1 nurse hour/patient day 1 RN hour/patient day 1 LPN hour/patient day 1 UAP hour/patient day 1 licensed hour/patient day 1 nurse hour/patient day 1 RN hour/patient day 1 LPN hour/patient day 1 UAP hour/patient day 1 licensed hour/patient day 1 nurse hour/patient day 1 RN hour/patient day 1 LPN hour/patient day 1 UAP hour/patient day 1 licensed hour/patient day RR 1. 1.93 0. 0.94. 0.99 1.92 0. 1 0.89.64.99 Surgical bleeding 1 1.41.12 0.00 1.02 0.92 1. 2.99 0.12.47 Length of stay 5 1 0.78.99 95% CI 0. 0. Relative risk of mortality and nurse sensitive patient outcomes corresponding to one unit increase in nurse staffing ratios and hours (pooled estimates) Outcome Mortality N 14 4 1 Increment 1 RN FTE/patient day 1 patient/LPN/shift 1 patient/UAP/shift 1 patient/licensed nurse 1 RN FTE/patient day 1 patient/LPN/shift 1 patient/UAP/shift 1 patient/licensed nurse 1 RN FTE/patient day 1 patient/LPN/shift 1 patient/UAP/shift 1 patient/licensed nurse 1 RN FTE/patient day 1 patient/LPN/shift 1 patient/UAP/shift 1 patient/licensed nurse 1 RN FTE/patient day 1 patient/LPN/shift 1 patient/UAP/shift 1 patient/licensed nurse 1 RN FTE/patient day 1 patient/LPN/shift 1 patient/UAP/shift 1 patient/licensed nurse 1 RN FTE/patient day 1 patient/LPN/shift 1 patient/UAP/shift 1 patient/licensed nurse 1 RN FTE/patient day 1 patient/LPN/shift 1 patient/UAP/shift 1 patient/licensed nurse 0. 233.

0.36.Table 23.62. 1. 0.67 102 Hospital acquired pneumonia 4 2 1 Postoperative infection 1 1 Cardiac arrest/shock 3 Complications (medical) 3 * significant heterogeneity between studies 0.00 0.93.72 0.94 0.99.86 1 2 1 .98 5 4 3 2 4 2 1 1 2 1. Relative risk of mortality and nurse sensitive patient outcomes corresponding to one unit increase in nurse staffing ratios and hours (pooled estimates) (continued) Outcome Upper gastrointestinal bleeding N Increment 1 RN FTE/patient day 1 patient/LPN/shift 1 patient/UAP/shift 1 patient/licensed nurse 1 RN FTE/patient day 1 patient/LPN/shift 1 patient/UAP/shift 1 patient/licensed nurse 1 RN FTE/patient day 1 patient/LPN/shift 1 patient/UAP/shift 1 patient/licensed nurse 1 RN FTE/patient day 1 patient/LPN/shift 1 patient/UAP/shift 1 patient/licensed nurse 1 RN FTE/patient day 1 patient/LPN/shift 1 patient/UAP/shift 1 patient/licensed nurse 1 RN FTE/patient day 1 patient/LPN/shift 1 patient/UAP/shift 1 patient/licensed nurse 1 RN FTE/patient day 1 patient/LPN/shift 1 patient/UAP/shift 1 patient/licensed nurse 1 RN FTE/patient day 1 patient/LPN/shift 1 patient/UAP/shift 1 patient/licensed nurse 0. 1.29 0.94 RR 95% CI N 1 3 1 1 2 2 1 2 1 1 2 2 2 1 1 Increment 1 nurse hour/patient day 1 RN hour/patient day 1 LPN hour/patient day 1 UAP hour/patient day 1 licensed hour/patient day 1 nurse hour/patient day 1 RN hour/patient day 1 LPN hour/patient day 1 UAP hour/patient day 1 licensed hour/patient day 1 nurse hour/patient day 1 RN hour/patient day 1 LPN hour/patient day 1 UAP hour/patient day 1 licensed hour/patient day 1 nurse hour/patient day 1 RN hour/patient day 1 LPN hour/patient day 1 UAP hour/patient day 1 licensed hour/patient day 1 nurse hour/patient day 1 RN hour/patient day 1 LPN hour/patient day 1 UAP hour/patient day 1 licensed hour/patient day 1 nurse hour/patient day 1 RN hour/patient day 1 LPN hour/patient day 1 UAP hour/patient day 1 licensed hour/patient day 1 nurse hour/patient day 1 RN hour/patient day 1 LPN hour/patient day 1 UAP hour/patient day 1 licensed hour/patient day 1 nurse hour/patient day 1 RN hour/patient day 1 LPN hour/patient day 1 UAP hour/patient day 1 licensed hour/patient day RR 95% CI Post surgical thrombosis 1 Atelectasis and pulmonary failure 5 1 1 1.70. 233.00. 0.95.01 0.05 0.45 1.67.84 0. 1.37 Accidental extubation 5 0. 1.00 1.85.93 0.49 0. 0.72 0. 0.01 0.08 0.60.81 0.

0. 8 1. attributable to nurse staffing proportion of events. 0.04.88 0. % 7.3 2.11 1.07 1. ICUs Mortality.9 6.2 60. 0.8.05.7 6.56 4.67. 21 103 .3. 0. Consistent across the studies.04 6.5 3. 1. 2 3.3.92 0.89 1. ICUs Mortality.89 0. 0. hospital level analysis Mortality. 1. 64 0.98.86.9 0.9.4.5 1. 0.9 24 16 84.5 6.07. 15. 2.94. 0.2 9. 12.49 0.8.6 12.76 0.94.1 4.6 31. 18.2 16 5. 2 6. 8. 13 3. 10.98 0.87 0. 10 3.59 0.56.82.4.96 0.4.1.99 0. 5 0.79. 3.89 0.6 30.24.16 1.08 1.2.6 37.Table 24.3 50.07.4 14. 1. and number of avoided events per 1.5 19.3 0.67 0. 47. 0.62. 9 4. 0. 0. 11. 6 6. 40.29 1.0 13. 0. 5.84 0.7 33. 33. 1.1 6.46.84 0. 8 2.4 34. 0.4 0. 0.82 0.4 73. 1 0.55.2.6 0.7 20.9 27.4 0.86 7.3 19.91 0.7. 0. surgical patients Mortality.9.96 0. 2 9. 15.17 0.5.45 1.7 0.36.94 0. 40.1 21.000 Hospitalized 5 3 5 6 5 0 1 1 2 12 6 5 1 37 1 1 2 7 7 6 2 10 7 26 7 4 14 Outcome Nurse Staffing Studies RR 95% CI Attributable to Nurse Staffing Fraction.5 2.08 0. 8 4. medical patients Hospital acquired pneumonia Failure to rescue Pulmonary failure Unplanned extubation CPR Medical complications Hospital acquired pneumonia Pulmonary failure CPR ICUs Hospital acquired pneumonia Pulmonary failure Unplanned extubation CPR Nosocomial Infection Relative change in LOS Surgical patients Failure to rescue Surgical wound infection Sepsis Relative change in LOS Increase by 1 patient/RN/shift Increase by 1 RN FTE/patient day Increase by 1 RN FTE/patient day Increase by 1 RN FTE/patient day Increase by 1 RN FTE/patient day Increase by 1 RN hour/patient day Increase by 1 RN hour/patient day Increase by 1 RN hour/patient day Increase by 1 patient/RN/shift Increase by 1 patient/RN/shift Increase by 1 patient/RN/shift Increase by 1 patient/RN/shift Increase by 1 patient/RN/shift Increase by 1 patient/RN/shift Increase by 1 RN FTE/patient day Increase by 1 RN FTE/patient day Increase by 1 RN FTE/patient day Increase by 1 RN FTE/patient day Increase by 1 RN FTE/patient day Increase by 1 RN FTE/patient day Increase by 1 RN FTE/patient day Increase by 1 hour in total nurse hours/patient day Increase by 1 RN FTE/patient day Increase by 1 RN FTE/patient day Increase by 1 RN FTE/patient day Increase by 1 RN FTE/patient day Increase by 1 RN FTE/patient day 6 5 5 8 6 5 9 10 3 3 4 5 3 3 4 5 5 3 4 5 3 3 4 5 1 5 3 1.09 1.8 0.31 0.6. 2. 11 17. 4 2.72 0.1.1 54.94 0.62. 8.6 44.6 63. 0.98 0. 22.3 97. 35 1. 11 45. 0.3. 4. 8 38. 8 1.62. 0.84 0.99 1. 0. 1 0. 2 1. 1.27. 3 11.64 0.94 0. 1. 0.8. 14 4. surgical patients Mortality. 6 21. 10 5. 0.99.84 0. 9.5 7.08.99. 1.67 1.5. 13 2.000 hospitalized patients Number of Avoided (excessive) Events/1.5 37.27.69 1.03.53 1. 0.94 0.81 0.1 6 27. 0 0. 23. medical patients Mortality.99 0.72 0. 1 1. 1 1.5 36 31 95%CI 95%CI All Patients Mortality Mortality. 8 4.03.4. significant association between nurse staffing and patient outcomes (results from pooled analysis).95 0.4.15 0. 1 1.94.9.09 0.99 0.8.7.6 17. 5 2.8 14.

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36(5):25967.19(2):103-5.27(3):317-35. Smith DM. Hartz AJ. Lippincotts Case Manag Jan-Feb 2004.5(1):28. J Nurs Adm Nov 2003. Grillo-Peck AM. Kuhn EM. The Magnet Nursing Services Recognition Program. Shamian J. 214. J Nurs Care Qual Apr-Jun 2006. Clinical pathway implementation improves outcomes for complex biliary surgery. Neilands TB. Krakauer H. Pitt HA. Kramer M. N. et al. Health Serv Res 1992. Frizzell C.14(3):57-61. Murray KP. 2000. Hospital characteristics and mortality rates.126(4):751-6.31(4):210-6. Sexton JB.34(8):44-7. Hughes EF. 190. 202. Maguire P. In: Nelson SG. Nursing workload and its relationship to vancomycin-resistant enterococci colonization in chronic dialysis patients. The complexities of care: nursing reconsidered. Broome CD. 198. Melberg SE. Ottawa: Dissertation. Clinical Health Sciences. 200. 189. Nurs Manage Nov 1997.13(6):367-72. Bowman HM. The correspondence of patient satisfaction and nurse burnout.321(25):1720-5. et al. J Nurs Manag Sep 2004. Klein D. et al. Laschinger H. Skellan KJ. 192. 209. Essentials of a magnetic work environment: part 3. Evaluation of the HCFA model for the analysis of mortality following hospitalization. et al. discussion 6-8.36(4):352-7. Nursing Aug 2004.188. Leiter MP. BMC Health Serv Res Apr 11 2005. 213. 193.318(17):1100-7. Risner PB. 199. Havens DS. N Engl J Med Dec 21 1989. Schmalenberg C. Research on nurse staffing and its outcomes: The challenges and risks of grasping at shadows. J Vasc Nurs Sep 1996.50(6):356-62. Spence Laschinger HK. Nurs Res NovDec 2001.28(11):47-8.5(1):46. [PhD].47(10):1611-7. 197. Assessing patient category/dependence systems for determining the nurse/patient ratio in ICU and HDU: a review of approaches. 191. Calligaro KD. Towards excellence in quality patient care: a clinical pathway for myocardial infarction. Clarke SP. Landstrom GL. Thomas EJ.100(3):26-35. Factors influencing satisfaction and anticipated turnover for nurses in an academic medical center. J Nurs Adm May 2006. Bowman J. Donaldson N. 194.Y: ILR Press. J Nurs Adm Apr 2005. Sereika SM.21(2):124-32. Nurse staffing and patient perceptions of nursing care. 212. Revising the Essentials of Magnetism tool: there is more to adequate staffing than numbers. Bailey RC. 74.35(4):188-98. 195.9(2):77-83. quiz 33-4. J Qual Clin Pract Jun 1999. et al.12(5): 299-308. 211. Denver: Dissertation. Bolton LB. length of stay. 206. Magnet hospital characteristics. The relationship between pediatric nurse staffing and quality of care in the hospital setting. and reimbursement. competition. BMC Health Serv Res Jun 10 2005. Shortell SM. Gow P. Dougherty MJ. Davidson LJ. Work-related disability in Canadian nurses. et al. Hewison A. 2006:161-84. Ithaca. et al. Aiken LH. Thomas EJ. and ownership on mortality rates among hospital inpatients. Stratton KM. Simmonds KA. et al. Effects of changing skill mix. Role of nursing personnel in implementing clinical pathways and decreasing hospital costs for major vascular surgery. Pierce L. Schmalenberg C. 201. Correction: The effect of executive walk rounds on nurse safety climate attitudes: A randomized trial of clinical units [ISRCTN85147255]. [PhD]: Dissertation. Adomat R. Armstrong KJ. Nurs Econ Nov-Dec 1995. Kramer M. Am J Nurs Mar 2000. et al. 2005. 112 . 196. Surgery Oct 1999. hospital organizational variables and nurse staffing on hospital patient outcomes. Miller P. Leiter MP. Heart failure disease management: impact on hospital care. The impact of nursing work environments on patient safety outcomes: the mediating role of burnout/ engagement. Soc Sci Med Nov 1998. O'Brien-Pallas L. 203. The impact of managed care penetration. et al. Aydin CE. Broome ME. J Nurs Adm Apr 2001. N Engl J Med Apr 28 1988. J Nurs Scholarsh 2004. S. Congest Heart Fail Mar-Apr 2003. Sexton JB. The effects of regulation. [MSc]. 204. University of Mississippi Medical Center. Shader K. 205. University of Calgary.33(11):607-14. quiz -6. Whitman GR. Hoover KW. University of Colorado. Structural empowerment. Discher CL. The effect of executive walk rounds on nurse safety climate attitudes: a randomized trial of clinical units [ISRCTN85147255] [corrected]. Staffing and pattern of mechanical restraint use across a multiple hospital system. 208. Harvie P. and patient safety culture: making the link. ed. Sloane DM. Van Doren ES. Thomson D. et al. The effect of a partnership model on quality and length of stay. Structure and process variables affecting outcomes for heart failure clients.9(1):21-6. 2004. 210. 207. Krakauer H. et al. Neilands TB.

Danchaivijitr S.22(1):1-20. et al. Swanson B. Garcia de Lucio L. Tsai WW. 221.37(4):18-22. Int J Nurs Stud Feb 2004. Prevention of indwelling central venous catheter sepsis. Rehabil Nurs Nov-Dec 1995. Spetz J. et al. 113 . Jerant AF. Azari R. Developing a patient classification system for the pediatric rehabilitation setting. access to.5(1):38-43.92(9):40-3. Public policy and nurse staffing: what approach is best? J Nurs Adm Jan 2005. Effects of education on the prevention of pressure sores.15(1):18-26.24(10):17-23. Suthisanon L. et al. et al.22(4):4652. J Clin Nurs Jul 2005.78 Suppl 1:S1-6. Part 2. et al. Am Heart Hosp J Fall 2003.32(2):425-31. Nurs Times Feb 28-Mar 5 1996. Rodriguez Z.41(2):191-8.1(2):70-5. J Nurs Adm Oct 1994. 224. The effect of staff nurse participation in a clinical nursing research project on attitude towards. J Nurs Adm Apr 1992. White KM. 4. 223. 220. 228. 222. et al. Patient classification systems and staffing. 216. Am J Crit Care Sep 1992. Dunbar LJ. Ferguson TBJ. 230. Tsai SL. Castorr A. Effectiveness of nursing involvement in bedside monitoring and control of coagulation status after cardiac surgery. Tranmer JE. 219. Lam M. Garcia Lopez FJ. Cronin-Stubbs D. Going beyond patient classification. Policy spotlight: staffing plans and ratios.35(1):14-6. Prescott PA. Marin Lopez MT. Continuous quality improvement in medicine: validation of a potential role for medical specialty societies. 227. 218. Training programme in techniques of self-control and communication skills to improve nurses' relationships with relatives of seriously ill patients: a randomized controlled study. J Med Assoc Thai Jul 1995. Chai SK. Diehl BC. Med Pediatr Oncol Jun 1996. Evaluation of computer-assisted multimedia instruction in intravenous injection. Nurs Manage Apr 2006. Jitreecheue L. Assessment of nursing management and utilization of nursing resources with the RAFAELA patient classification system--case study from the general wards of one central hospital.1(4):264-72. et al. support of and use of research in the acute care setting. Nursing intensity. Griffiths P. Appl Nurs Res Feb 1992. J Adv Nurs Aug 2000. 226. Horn M. Rainio AK. Clinical outcomes for nurse-led inpatient care.14(6):674-84. DeGroot HA. Lochhaus-Gerlach J. Zeler KM. 229. A randomized trial of telenursing to reduce hospitalization for heart failure: patient-centered outcomes and nursing indicators. 225. Phillips CY. Daghistani D.20(6):328-32. Salamonsen RF. The effects of a training program on nurses' functional performance assessments.215.26(6):405-8. Ohinmaa AE. Practice and process. Dean-Baar S. Home Health Care Serv Q 2003. Martinez C. Can J Nurs Leadersh Jan-Feb 2002. McPharlane TJ. 217.

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List of Acronyms/Abbreviations AHRQ ANA AONE BSN CDC CI CPR DHHS DRGs FTE HPD ICD-9 ICU IEN JCAHO LOS LPN LVN MOOSE MS NIOSH NQF NS PhD QOL RRT RN RR TEP UAP UTI Agency for Healthcare Research and Quality American Nurses Association American Organization of Nurse Executives Bachelor of Science in Nursing Centers for Disease Control and Prevention Confidence Interval Cardiopulmonary Resuscitation Department of Health and Human Services Diagnosis Related Groups Full Time Equivalent Hours per Patient Day International Classification of Diseases (9th revision) Intensive Care Unit Internationally Educated Nurse Joint Commission on Accreditation of Healthcare Organizations Length of Stay Licensed Practical Nurse Licensed Vocational Nurse Meta-analysis Of Observational Studies in Epidemiology Master of Science National Institute for Occupational Safety and Health National Quality Forum Not Significant Doctor of Philosophy Quality of Life Rapid Response Team Registered Nurse Relative Risk Technical Expert Panel Unlicensed Assistive Personnel Urinary Tract Infection 115 .

Analytic Framework Appendix G: Evidence Tables .Nurse Staffing and Quality of Patient Care Appendixes Appendix A: Exact Search Strings Appendix B: List of Excluded Studies Appendix C: Technical Expert Panel Members and Affiliation Appendix D: Sample Abstraction Forms Appendix E: Quality of the Studies Appendix F.

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4) A-1 .Appendix A: Exact Search Strings Search Strategy for Questions 1. GPO) • Digital Dissertations • Internet (www. access. Government Publications (U. 4) “Clinical competence” [MeSH] (Q 1-2) “Health care quality. 4) “Patients” [MeSH] (Q1-2.marcive.google. 2. 2. hospital” [MeSH] (Q 1-4) “Nursing administration research” [MeSH] (Q 1-4) “Nursing audit” [MeSH] (Q 1-2.S. and 4 The following data bases were searched: • Med Line (PubMed) • CINAHL • The Cochrane Database of Systematic Reviews • The Cochrane Central Register of Controlled Trials • EBSCO Research Database • BioMed Central • Government agencies and nurse’s associations’ websites are searched to identify unpublished reports of the conducted surveys and regulatory documents of nursing hospital staffing: • United States Department of Health and Human Services • Agency for Healthcare Research and Quality • National Database of Nursing Quality Indicators • National Center for Health Workforce Analysis • American Nurses Association • American Academy of Nurse Practitioners • Government publications. and evaluation” [MeSH] (Q1-2. 4) “Health care category” [MeSH] (Q1. 2. 4) “Length of stay” [MeSH] (Q1-2.com) with the key words identical MeSH terms • Manual search of the references in articles to identify eligible studies published before 1990 The following MeSH terms and key words (in databases other than Medline) and their combinations were used to search the data bases from 1990 through June 2006: “Nurses” [MeSH] (Q 1-4)* “Nursing staff. 4) “Nursing education research” [MeSH] (Q 1-2. • Database http://www. 4) “Health services research” [MeSH] (Q1. 4) “Outcome assessment (health care)” [MeSH] (Q1-2.com/webdocs • Catalog of U.S. 4) “Patient satisfaction” [MeSH] (Q1-2.

4) "Models. research in peer reviewed journal. published between 1990-2006) Shift work staffing policy variable 58 eligible for review 51 excluded: • 41 Not relevant (not related to variable of interest) • 1 Integrative review not related to study variable • 2 Conference abstract • 2 Nursing home • 3 Not peer reviewed journal • 2 Inadequate data presentation 7 included Overtime staffing policy variable 20 eligible for review 14 excluded: • 9 Not relevant (not related to variable of interest) • 1 Inadequate data presentation • 4 Not peer reviewed journal 6 included A-2 . 2. nursing” [MeSH] (Q 4) “Labor unions” [MeSH] (Q 4) “Malpractice” [MeSH] “Hospitals” [MeSH] (Q4) Nurse to patient ratio (keyword) (Q1-3) “Skill mix” [MeSH] (Q3) “Part time employment [MeSH] (Q3) “Foreign nurses [MeSH] (Q3) “Registry personnel” [MeSH] (Q3) Overtime (keyword) (Q3) Flexible scheduling (keyword) (Q3) Shift work (key word) (Q3) * The numbers in parentheses refer to the question for which this term was relevant Search Strategy for Question 3 (Inclusion criteria for all studies: North American hospitals. 4) “Personnel staffing and scheduling” [MeSH] (Q1-3) “Patient centered care” [MeSH] (Q4) “Nurse patient relations” [MeSH] (Q1-2.“Hospital units” [MeSH] (Q1. 4) “Hospital patient relations” [MeSH] (Q1-2.

218 2.730 28.Full and part time staff use variable 28 eligible for review 22 excluded: • 15 Not relevant (not related to variable of interest) • 6 Not peer reviewed journal • 1 Inadequate data presentation 6 included Foreign educated nurses variable 20 eligible for review 14 excluded • 12 Not relevant (not related to variable of interest) • 1 Not research • 1 Not peer reviewed journal 6 included Agency/contract nurses variable 21 eligible for review 16 excluded: • 10 Not relevant (not related to variable of interest) • 1 Nursing home • 2 Inadequate data presentation • 3 Not peer reviewed journal 5 included Total studies on staffing policy variables 147 eligible for review 117 excluded: • 87 Not relevant (not related to variable of interest) • 2 Conference proceedings • 1 Integrative review not related to variable of interest • 3 Nursing home • 17 Not peer reviewed journal • 6 Inadequate presentation of data • 1 Not research 30 included Literature Search Strings MeSH terms The National Library of Medicine via PubMed: “Nurses” [MeSH] "Nursing staff. hospital"[MeSH] "Nursing administration research”[MeSH] "Nursing audit"[MeSH] Studies 51.092 1.349 A-3 .

484 7.806 3.507 22.773 994 1.105 43. humans "Personnel administration. humans "Length of stay"[MeSH] NOT review NOT letters NOT editorials Limits: English. humans "Nursing education research "[MeSH] NOT review NOT letters NOT editorials Limits: humans "Clinical competence"[MeSH] NOT review NOT letters NOT editorials Limits: humans "Health care quality.840 70.369 4. and evaluation"[MeSH] "Health services research"[MeSH] "Outcome assessment (health care)"[MeSH] "Health care category"[MeSH] "Personnel administration.491 77.937 A-4 . and evaluation"[MeSH] NOT review NOT letters NOT editorials Limits: English.596 48.621 286.378 1.523 82.798.370 25. humans "Patients"[MeSH] NOT review NOT letters NOT editorials Limits: English. hospital"[MeSH] NOT review NOT letters NOT editorials "Nursing administration research "[MeSH] NOT review NOT letters NOT editorials "Nursing audit"[MeSH] NOT review NOT letters NOT editorials Limits: English. humans ("Safety management"[MeSH] OR "risk management"[MeSH]) NOT review NOT letters NOT editorials Limits: English. access.438. humans "Health services research"[MeSH] NOT review NOT letters NOT editorials Limits: humans "Outcome assessment (health care)"[MeSH] AND "health services research" [MeSH] NOT review NOT letters NOT editorials Limits: humans "Health care category"[MeSH] NOT review NOT letters NOT editorials Limits: English.513 3.968 35.295 43.090. hospital"[MeSH] "Patients"[MeSH] "Length of stay"[MeSH] "Patient satisfaction"[MeSH] "Hospital units"[MeSH] "United States/epidemiology"[MeSH] "Personnel staffing and scheduling"[MeSH] "Models.181 1.736 48.320.573 4.640 64.601 23.520 9. humans Studies 3. hospital"[MeSH] NOT review NOT letters NOT editorials Limits: English. humans "Nurses"[MeSH] NOT review NOT letters NOT editorials "Nursing staff.486 15 2.723 22.382 28. nursing"[MeSH] "Foreign professional personnel"[MeSH] ("Safety management"[MeSH] OR "risk management"[MeSH]) ("Safety management"[MeSH] OR "risk management"[MeSH]) Limits: English.450 2. access.872 33.MeSH terms "Nursing education research"[MeSH] "Clinical competence"[MeSH] "Health care quality.285 33.

humans "Nurses"[MeSH] NOT review NOT letters NOT editorials AND "health care quality. humans "Epidemiologic studies"[MeSH] Limits: English. humans "United States/epidemiology"[MeSH] NOT review NOT letters NOT editorials Limits: English. humans "Models. nursing"[MeSH] NOT review NOT letters NOT editorials Limits: English. humans "Nurses"[MeSH] NOT review NOT letters NOT editorials AND "clinical competence" Limits: English. humans "Nurses"[MeSH] NOT review NOT letters NOT editorials AND "patients"[MeSH] Limits: English. humans "Epidemiologic studies"[MeSH] AND "clinical competence"[MeSH] Limits: English. humans "Hospital units"[MeSH] NOT review NOT letters NOT editorials Limits: English. humans "Nurses"[MeSH] NOT review NOT letters NOT editorials AND personnel staffing and scheduling Limits: English.060 1. humans "Nurses"[MeSH] NOT review NOT letters NOT editorials AND "patient satisfaction" Limits: English.169 728.335 4.544 1. humans "Epidemiologic studies"[MeSH] AND "nursing administration research "[MeSH] Limits: English. humans "Personnel staffing and scheduling"[MeSH] NOT review NOT letters NOT editorials Limits: English.210 731 99 210 187 2. humans "Nurses"[MeSH] NOT review NOT letters NOT editorials AND "personnel administration. humans "Epidemiologic studies"[MeSH] AND "nursing staff. humans "Epidemiologic studies"[MeSH] AND "nurses"[MeSH] Limits: English. humans "Epidemiologic studies"[MeSH] AND "nursing audit"[MeSH] Limits: English.849 27. humans "Epidemiologic studies"[MeSH] AND "health care quality. humans "Foreign professional personnel"[MeSH] NOT review NOT letters NOT editorials Limits: English.210 A-5 .731 57. hospital" Limits: English.481 5. hospital"[MeSH] Limits: English.MeSH terms "Patient satisfaction"[MeSH] NOT review NOT letters NOT editorials Limits: English. humans "Nurses"[MeSH] NOT review NOT letters NOT editorials AND "outcome assessment (health care)" Limits: English. and evaluation"[MeSH] Limits: English.375 396 6 49 2 1 0 2 2 2 728. and evaluation"[MeSH] Limits: English. humans "Nurses"[MeSH] NOT review NOT letters NOT editorials AND "health services research" Limits: English. access. humans Studies 20. humans "Nurses"[MeSH] NOT review NOT letters NOT editorials AND "length of stay" Limits: English. humans "Epidemiologic studies"[MeSH] AND "nursing education research "[MeSH] Limits: English. access.

271 57 5. hospital"[MeSH] Limits: English. humans "Nursing staff. nursing" Limits: English. hospital"[MeSH] AND "safety management"[MeSH] Limits: English.395 A-6 . nursing" Limits: English. humans "Nursing staff. hospital"[MeSH] AND "patient satisfaction"[MeSH] Limits: English. humans "Epidemiologic studies"[MeSH] AND "nurses"[MeSH] AND "patients" [MeSH] Limits: English. hospital"[MeSH] AND "length of stay"[MeSH] Limits: English. humans "Epidemiologic studies"[MeSH] AND "nurses"[MeSH] AND "outcome assessment (health care)"[MeSH] Limits: English. humans "Safety management"[MeSH] AND "clinical competence"[MeSH] Limits: English. hospital"[MeSH] AND "patients"[MeSH] Limits: English.MeSH terms "Epidemiologic studies"[MeSH] AND "health services research "[MeSH] AND "nurses"[MeSH] Limits: English. humans "Safety management"[MeSH] AND "health services research"[MeSH] Limits: English. humans "Outcome assessment (health care)"[MeSH] AND "nursing staff. humans "Epidemiologic studies"[MeSH] AND "models. humans "Epidemiologic studies"[MeSH] AND "nurses"[MeSH] AND "length of stay"[MeSH] Limits: English. hospital" [MeSH] Limits: English. humans CINAHL . access. humans "Safety management"[MeSH] AND "models.Cumulative Index to Nursing & Allied Health Literature: “Personnel staffing and scheduling" “Nursing staff. humans "Safety management"[MeSH] AND "health dare quality. hospital"[MeSH] AND "safety management" Limits: English. humans "Epidemiologic studies"[MeSH] AND "nurses"[MeSH] AND "personnel administration.253 465 111 27 344 9. humans "Epidemiologic studies"[MeSH] AND "nurses"[MeSH] AND "patient satisfaction"[MeSH] Limits: English. humans "Epidemiologic studies"[MeSH] AND "nursing staff. humans "Safety management"[MeSH] AND "nursing audit"[MeSH] Limits: English. hospital/manpower” "Length of stay" “Patient safety” Studies 85 108 0 23 38 56 190 1 506 192 324 188 17 18 125 3. humans "Nursing staff. humans "Nursing staff.269 14. humans "Safety management"[MeSH] AND "nursing administration research "[MeSH] Limits: English. and evaluation"[MeSH] Limits: English. humans "Safety management"[MeSH] AND "outcome assessment (health care)"[MeSH] Limits: English.

MeSH terms “Nurses” “Personnel staffing and scheduling" or “nursing staff, hospital/manpower” AND "length of stay" or “patient safety” “Personnel staffing and scheduling" or “nursing staff, hospital/manpower” AND "length of stay" or “patient safety” limit on English, NOT review or letter The Cochrane Library: "Nursing staff, hospital” and “outcome assessment (health care)” “Nurse” AND “patient” BioMed Central : "Nursing staff, hospital” AND “patient safety” "Nursing staff, hospital” AND “patient outcomes” Nursing staff, hospital AND health services research Nursing staff, hospital AND adverse events Google scholar: “nursing staff, hospital” AND “patient outcomes” NOT longterm care, published after 1990 Catalog of U.S. Government Publications (U.S. GPO): Nursing Staff, Hospital LexisNexis™ Government Periodicals Index: "Nurses and nursing" AND "Hospitals" Digital Dissertations: Nurse AND patient Nursing staff, hospital Nurse AND staffing AND hospital AND patient Agency of Health Care Research and Quality: Nurse staffing and Patient

Studies 72,321 1,025 86

0 4 0 0 287 79 1,700

9 25 1,863 0 20 893

Positive Likelihood of MeSH Terms and Keywords (*) to Identify Studies Eligible for Questions 1, 2, and 4 Algorithm: Sensitivity = TP/(TP+FN) Specificity = TN/(FP+TN) Positive Likelihood = SENS/(1-SPEC) Negative Likelihood = (1-SENS)/SPEC Study status Keyword Present Keyword absent Eligible TP FN 96 Excluded FP TN 2,762 Total

2,858

A-7

A. Highest Positive Predictive Likelihood MeSH terms and keywords Sensitivity, % *Burnout professional 3.13 Decubitus ulcer/epidemiology 6.25 Nurses/*supply & distribution 3.13 United States Centers for Medicare and Medicaid Services 5.21 Accidental falls s & numerical data 9.38 *Mortality 2.08 Comorbidity 2.08 Medicare/*statistics & numerical data 2.08 Nursing service 2.08 Urinary tract infection 2.08 California/epidemiology 5.21 Health services research/methods 3.13 *Anesthesiology 1.04 *Economic competition 1.04 *Economics 1.04 *Outcome and process assessment (health care) 5.21 Acquired immunodeficiency syndrome 1.04 Bacteremia/epidemiology 1.04 Bacteremia/epidemiology/etiology 1.04 Burn units/*manpower 1.04 Contract services/organization & administration 1.04 Cross infection/*prevention & control 2.08 Cross infection/epidemiology 1.04 Cross infection/epidemiology/*etiology/ prevention & control 1.04 Delivery of health care/*organization & administration 1.04 Disease outbreak 1.04 Economics hospital 1.04 Education nursing 1.04 Health maintenance organizations 1.04 Health maintenance organizations *organization & administration 1.04 Hospital restructuring 1.04 Hospitals pediatric 1.04 Hospitals university 1.04 Hospitals urban 1.04 Hospitals/*standards 1.04 Hospitals/classification 1.04 Hospitals/*standards/statistics & numerical data 1.04 Iatrogenic disease 1.04 Insurance claim 1.04 Positive Specificity, % Likelihood 99.96 86.31 99.93 86.31 99.96 86.31 99.93 99.86 99.96 99.96 99.96 99.96 99.96 99.89 99.93 99.96 99.96 99.96 99.82 99.96 99.96 99.96 99.96 99.96 99.93 99.96 99.96 99.96 99.96 99.96 99.96 99.96 99.96 99.96 99.96 99.96 99.96 99.96 99.96 99.96 99.96 99.96 71.93 64.73 57.54 57.54 57.54 57.54 57.54 47.95 43.16 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77

A-8

MeSH terms and keywords Intensive care units neonatal/economics Intensive care units pediatric/*organization & administration Medicare Nurses' aides/supply & distribution Nursing staff hospital/*economics/organization & administration Nursing staff hospital/*education/*standards Nursing staff hospital/organization & administration/statistics Outcome assessment Pediatrics Pennsylvania/epidemiology Personnel management Pneumonia/epidemiology Postoperative complications/epidemiology Quality of health care Quality of health care/*classification Restraint physical Safety management Surgical procedures operative/*statistics & numerical data United States Agency for Healthcare Research and Quality Urinary tract infections/epidemiology/etiology Workload/ psychology Workload/standards *Hospital mortality Cross Infection/epidemiology Medication error Iatrogenic disease Morbidity Nursing care/psychology Probability Odds ratio United States/epidemiology *Educational standards *Treatment outcome Catheterization Databases factual Diagnosis related groups/statistics & numerical data Education nursing baccalaureate

Sensitivity, % 1.04 1.04 2.08 2.08 1.04 1.04 1.04 1.04 1.04 1.04 1.04 1.04 1.04 1.04 1.04 1.04 1.04 1.04 1.04 1.04 2.08 2.08 13.54 3.13 6.25 2.08 2.08 2.08 2.08 5.21 14.58 1.04 1.04 1.04 1.04 1.04 2.08

Positive Specificity, % Likelihood 99.96 28.77 99.96 99.93 99.93 99.96 99.96 99.96 99.96 99.96 99.96 99.96 99.96 99.96 99.96 99.96 99.96 99.96 99.96 99.96 99.96 99.93 99.93 99.49 99.86 99.71 99.89 99.89 99.89 99.89 99.67 99.02 99.93 99.93 99.93 99.93 99.93 99.86 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 28.77 26.72 21.58 21.58 19.18 19.18 19.18 19.18 15.98 14.92 14.39 14.39 14.39 14.39 14.39 14.39

A-9

MeSH terms and keywords Hospital units/*organization & administration/ standards Hospitals public Hospitals teaching Length of stay/epidemiology Maryland Matched-pair analysis Minnesota/epidemiology Nursing service Nursing staff hospital Patient isolation Personnel hospital Referral and con Sentinel surveillance Workload/psychology *Outcome assessment (health care ) Nurses' aides/* *Education nursing Nursing staff hospital/*organization & administration/standards Accidental falls Chronic disease Health services research/*method Hospital costs/*statistics & numerical data Hospital restructuring Hospitals teaching/standards Hospitals teaching/statistics & numerical data Mortality Nursing assessment/organization & administration Nursing staff hospital/*organization & administration/*standard Nursing staff hospital/economic/psychology/* supply & distribution Ontario/epidemiology Patient discharge Personnel staffing and scheduling/*legislation & jurisprudence/*standards Personnel staffing and scheduling/*standards/ statistics & numerical data Poisson distribution Psychology industrial Quality of health care/standards Risk adjustment

Sensitivity, % 1.04 1.04 1.04 1.04 2.08 1.04 1.04 2.08 1.04 1.04 1.04 1.04 1.04 1.04 15.63 2.08 1.04 1.04 1.04 2.08 1.04 1.04 1.04 1.04 1.04 1.04 1.04 1.04 1.04 1.04 1.04 1.04 1.04 1.04 1.04 1.04 1.04

Positive Specificity, % Likelihood 99.93 99.93 99.93 99.93 99.86 99.93 99.93 99.86 99.93 99.93 99.93 99.93 99.93 99.93 98.84 99.82 99.89 99.89 99.89 99.78 99.89 99.89 99.89 99.89 99.89 99.89 99.89 99.89 99.89 99.89 99.89 99.89 99.89 99.89 99.89 99.89 99.89 14.39 14.39 14.39 14.39 14.39 14.39 14.39 14.39 14.39 14.39 14.39 14.39 14.39 14.39 13.49 11.51 9.59 9.59 9.59 9.59 9.59 9.59 9.59 9.59 9.59 9.59 9.59 9.59 9.59 9.59 9.59 9.59 9.59 9.59 9.59 9.59 9.59

A-10

MeSH terms and keywords Sensitivity, % Statistics 1.04 Personnel staffing and scheduling/*statistics & numerical data 5.21 Multivariate analysis 9.38 Diagnosis related 3.13 *Quality indicators, health care 5.21 Logistic models 9.38 Pennsylvania 4.17 Hospital mortality 7.29 Continuity of patient care/standards 1.04 Medication error 1.04 Models theoretical 1.04 Outcome and process assessment (health care)/*organization & 1.04 Ownership 1.04 Patient education 1.04 Patient readmission 1.04 Personnel staffing and scheduling/economics/* standards 1.04 Personnel staffing and scheduling/statistics & numerical data/*trends 1.04 Risk 1.04 Administration/utilization 1.04 Acute disease/nursing 3.13 Linear models 3.13 Research support 23.96 Research support 4.17 *Licensure nursing 1.04 American Hospital Association 1.04 Confidence intervals 1.04 Feasibility studies 1.04 Hospital bed capacity 1.04 Least-squares analysis 1.04 Likelihood function 1.04 Medical staff hospital/statistics & numerical data 1.04 Nurses 1.04 Nursing staff hospital/*standards/supply & distribution 1.04 Population surveillance 1.04 Postoperative care 1.04 Proportional hazard 1.04 Salaries and fringes 1.04 Tennessee 1.04 Health care survey 6.25

Positive Specificity, % Likelihood 99.89 9.59 99.46 98.95 99.64 99.38 98.84 99.46 99.02 99.86 99.86 99.86 99.86 99.86 99.86 99.86 99.86 99.86 99.86 99.86 99.57 99.53 96.16 99.31 99.82 99.82 99.82 99.82 99.82 99.82 99.82 99.82 99.82 99.82 99.82 99.82 99.82 99.82 99.82 98.91 9.59 8.93 8.63 8.46 8.09 7.67 7.46 7.19 7.19 7.19 7.19 7.19 7.19 7.19 7.19 7.19 7.19 7.19 7.19 6.64 6.24 6.06 5.75 5.75 5.75 5.75 5.75 5.75 5.75 5.75 5.75 5.75 5.75 5.75 5.75 5.75 5.75 5.75

A-11

MeSH terms and keywords Benchmarking Case-control study Outcome and process assessment (health care) Sampling studies Workload/*statistics Midwestern United States Health services

Sensitivity, % 4.17 4.17 3.13 2.08 2.08 3.13 10.42

Positive Specificity, % Likelihood 99.28 5.75 99.24 5.48 99.42 5.39 99.60 5.23 99.60 5.23 99.38 5.08 97.94 5.05

B. MeSH Terms and Keywords in Eligible Studies (Sensitivity >0) Positive Predictive Likelihood 4.80 4.80 4.80 4.80 4.80 4.80 4.80 4.72 4.62 4.60 4.50 4.43 4.43 4.43 4.32 4.11 4.11 4.11 4.11 4.11 4.11 4.11 4.11 4.11 4.11 4.11 3.84 3.84 3.81 3.60

MeSH terms *Models statistics Alberta Critical pathway District of Columbia Nursing staff hospital/*legislation & jurisprudence/*supply & Patient care planning Patients Length of stay Regression analysis Intensive care units Length of stay/standards Quality indicators health care Hospital bed capacity Length of stay/economics Cohort studies *Patients Bed occupancy Consumer satisfaction Hospital costs/standards Hospital-patient relations Hospitalization Intensive care units/*organization & administration Medical errors Patient satisfaction Southeastern union Nursing supervisory American Nurses' Association Personnel turnover Outcome assessment (health care) *Length of stay A-12

Sensitivity 1.04 1.04 1.04 1.04 1.04 1.04 1.04 10.42 9.38 4.17 5.21 4.17 2.08 2.08 3.13 1.04 1.04 1.04 1.04 1.04 1.04 1.04 1.04 1.04 1.04 2.08 2.08 2.08 9.38 1.04

Specificity 99.78 99.78 99.78 99.78 99.78 99.78 99.78 97.79 97.97 99.09 98.84 99.06 99.53 99.53 99.28 99.75 99.75 99.75 99.75 99.75 99.75 99.75 99.75 99.75 99.75 99.49 99.46 99.46 97.54 99.71

MeSH terms *Models organizational Choice behavior Forms and records Nurses' aides/*organization & administration Safety Risk assessment *Patient care team Education nursing Hospital bed cap Hospitals public Medical staff hospital/standard Missouri Nursing staff hospital/education*organization Physician-nurse relations Hospital restructuring/*organization & administration Patient satisfaction/*statistics & numerical data Predictive value Risk factors *Intensive care *Personnel staff Health policy Nursing care/*organization Nursing service Safety management Administration/standards *Quality of health care Quality of health care Nursing administration research Severity of illness *Efficiency organization Hospitals/*standards Length of stay/*statistics & numerical data Stress psychological Personnel staffing and scheduling/standards Personnel turnover Acute disease *Clinical competition Clinical nursing Connecticut Night care/*manpower Nursing staff hospital/psychology/supply & distribution

Sensitivity 1.04 1.04 1.04 1.04 2.08 2.08 1.04 1.04 1.04 1.04 1.04 1.04 1.04 1.04 2.08 2.08 3.13 15.63 1.04 1.04 1.04 1.04 1.04 1.04 1.04 10.42 8.33 14.58 4.17 1.04 1.04 1.04 1.04 3.13 3.13 2.08 3.13 1.04 1.04 1.04 1.04

Specificity 99.71 99.71 99.71 99.71 99.42 99.38 99.67 99.67 99.67 99.67 99.67 99.67 99.67 99.67 99.35 99.35 98.99 94.71 99.64 99.64 99.64 99.64 99.64 99.64 99.64 96.16 96.92 94.61 98.44 99.60 99.60 99.60 99.60 98.77 98.73 99.13 98.70 99.57 99.57 99.57 99.57

Positive Predictive Likelihood 3.60 3.60 3.60 3.60 3.60 3.38 3.20 3.20 3.20 3.20 3.20 3.20 3.20 3.20 3.20 3.20 3.08 2.96 2.88 2.88 2.88 2.88 2.88 2.88 2.88 2.71 2.71 2.70 2.68 2.62 2.62 2.62 2.62 2.54 2.47 2.40 2.40 2.40 2.40 2.40 2.40

A-13

MeSH terms Numerical data Nursing care/*standards *Quality assurance health care Absenteeism Nursing staff hospital/organization & administration Pain measurement Case management Nursing care/statistics Outcome assessment Nursing staff hospital/economic Internal-external control Organizational case studies Prevalence *Nursing staff Total quality management Treatment outcome Costs and cost assessment Patient discharge Health services Models organizational Ontario *Personnel management Nursing research Nursing staff hospital/*supply distribution Aged Pilot projects Personnel staffing and scheduling/*standards *Occupational health Evidence-based Hospital costs Statistics nonparametric Incidence *Professional autonomy Hospital bed capacity Hospital units Research support *Leadership Educational status Distribution Retrospective studies Risk management Administration

Sensitivity 2.08 3.13 1.04 1.04 1.04 1.04 1.04 1.04 1.04 2.08 1.04 1.04 2.08 1.04 1.04 2.08 1.04 1.04 2.08 2.08 2.08 1.04 1.04 16.67 14.58 4.17 7.29 1.04 1.04 1.04 1.04 2.08 1.04 1.04 1.04 23.96 1.04 1.04 3.13 5.21 1.04 1.04

Specificity 99.09 98.62 99.53 99.53 99.53 99.53 99.49 99.49 99.49 98.91 99.46 99.46 98.88 99.42 99.42 98.81 99.38 99.38 98.73 98.73 98.73 99.35 99.35 89.54 90.55 97.28 95.22 99.31 99.31 99.31 99.31 98.59 99.28 99.28 99.28 83.09 99.24 99.24 97.68 96.13 99.20 99.20

Positive Predictive Likelihood 2.30 2.27 2.21 2.21 2.21 2.21 2.06 2.06 2.06 1.92 1.92 1.92 1.86 1.80 1.80 1.74 1.69 1.69 1.64 1.64 1.64 1.60 1.60 1.59 1.54 1.53 1.53 1.51 1.51 1.51 1.51 1.48 1.44 1.44 1.44 1.42 1.37 1.37 1.35 1.34 1.31 1.31

A-14

MeSH terms Prospective studies California Workload *Decision making Analysis of variance Data Michigan Longitudinal studies Nurse-patient relations Organizational innovation Age 80 and over Male Job satisfaction Quality assurance administration/psychology Patient satisfaction United States Cross-sectional Cost control Patient care team Time factors Factor analysis Power (psychology) *Patient satisfaction Canada Nursing evaluation on research Middle age Nurse administrators Texas Female Evaluation studies Personnel staffing and scheduling Child Data collection *Job satisfaction *Inpatients *Personnel staff Cost-benefit Humans Efficiency organization Comparative study Adult Infant

Sensitivity 7.29 3.13 7.29 1.04 3.13 1.04 1.04 3.13 4.17 4.17 4.17 25.00 6.25 1.04 1.04 6.25 15.63 7.29 1.04 1.04 4.17 1.04 1.04 4.17 1.04 6.25 14.58 1.04 1.04 25.00 1.04 7.29 4.17 2.08 3.13 1.04 7.29 1.04 71.88 1.04 6.25 14.58 1.04

Specificity 94.28 97.54 94.24 99.17 97.50 99.17 99.13 97.36 96.45 96.45 96.38 78.17 94.42 99.06 99.06 94.32 85.37 93.16 98.99 98.99 95.87 98.95 98.95 95.80 98.91 93.41 84.43 98.88 98.88 72.88 98.84 91.64 95.22 97.57 96.31 98.77 91.24 98.62 2.75 98.59 90.84 77.62 98.37

Positive Predictive Likelihood 1.27 1.27 1.27 1.25 1.25 1.25 1.20 1.18 1.17 1.17 1.15 1.15 1.12 1.11 1.11 1.10 1.07 1.07 1.03 1.03 1.01 0.99 0.99 0.99 0.96 0.95 0.94 0.93 0.93 0.92 0.90 0.87 0.87 0.86 0.85 0.85 0.83 0.76 0.74 0.74 0.68 0.65 0.64

A-15

MeSH terms Sensitivity Medical staff hospital 1.04 Nursing audit 1.04 Attitude of health 5.21 Child preschool 1.04 Inpatients/*psychology 1.04 Job description 1.04 Organizational care 2.08 Professional autonomy 1.04 Reproducibility 1.04 Adolescent 2.08 Hospitals teach 1.04 *Nursing staff hospital 4.17 Nurse's role 2.08 *Nurse's role 1.04 Personnel staffing and scheduling/*organization & administration 3.13 Personnel staffing and scheduling/*legislation & jurisprudence 1.04 Social support 1.04 Clinical competence 1.04 *Models nursing 2.08 Clinical compete 1.04 Questionnaires 6.25 Infant newborn 1.04 Interprofessional relations 1.04 Needs assessment 1.04 Models nursing 1.04

Specificity 98.33 98.30 91.31 98.23 98.19 98.12 96.20 98.04 98.04 96.05 97.97 91.67 95.58 97.72 93.12 97.61 97.61 97.57 95.11 97.47 82.48 97.07 96.85 96.02 95.37

Positive Predictive Likelihood 0.63 0.61 0.60 0.59 0.58 0.55 0.55 0.53 0.53 0.53 0.51 0.50 0.47 0.46 0.45 0.44 0.44 0.43 0.43 0.41 0.36 0.36 0.33 0.26 0.22

C. MeSH Terms and Keywords in Excluded Studies (Sensitivity = 0) MeSH Terms *Absenteeism *Accidental fall *Accidental falls/economics *Accidents *Accidents occupational *Accidents occupational/prevention & control/statistics & numerical data *Accreditation *Aftercare/statistics & numerical data *Allied health personnel *American Nurses Association *Ancillary services hospital/statistics & numerical data *Automatic data processing

A-16

*Automation *Bed occupancy *Bed occupancy/economics *Benchmarking *Bereavement *Burnout professional/epidemiology/etiology/psychology *Burnout professional/etiology/prevention & control *Burnout professional/etiology/ prevention & control/psychology *Burnout professional/prevention & control/psychology *Caregivers *Case management *Cause of death *Clinical nursing research *Clinical protocols *Communication *Communication barriers *Consumer satisfaction *Continuity of patient care *Contract services *Contract services/economics *Cost of illness *Cost-benefit analysis *Counseling/education/standards *Credentialing *Cross infection *Cross infection/nursing/transmission/virology *Cross-cultural comparison *Data collection *Data interpretation statistical *Death *Decision making *Decision support *Decision support systems management *Decision support techniques *Decision trees *Delivery of health care *Diagnosis-related groups *Diagnostic errors *Disease transmission professional-to-patient *Documentation *Drug combinations *Drug compounding *Drug delivery systems *Drug labeling *Drug therapy computer-assisted *Economics hospital A-17 .

*Economics nursing *Education medical continuing *Education nursing baccalaureate *Education nursing continuing *Educational measurement *Efficiency *Emergency medicine/organization & administration*emergency nursing *Emergency nursing/organization & administration *Emergency service hospital *Emergency service hospital/organization & administration *Employee discipline *Employee incentive plans *Employee performance appraisal *Employment *Episode of care *Ethics *Ethics business *Ethics clinical *Ethics institutional *Ethics nursing *Evidence-based medicine *Expert testimony/*legislation & jurisprudence *Foreign professional personnel *Foreign professional personnel/education/psychology *Foreign professional personnel/standards *Health care rationing *Health care reform *Health care surveys *Health education *Health education/methods *Health facility closure *Health facility environment *Health facility environment/ethics/organization & administration*health facility merger *Health knowledge attitudes practice *Health manpower *Health services accessibility *Health services needs and demand *Health services statistics & numerical data *Health services research *Hospital administration *Hospital communication systems/organization & administration *Hospital costs *Hospital design and construction*hospital information systems *Hospital information systems/organization & administration *Hospital restructuring *Hospital units A-18 .

*Hospital-patient relations *Hospitalization *Hospitalization/economics *Hospitalization/statistics & numerical data *Hospitals *Infection control practitioners *Inpatients/education/psychology *Inpatients/psychology *Inpatients/psychology/statistics & numerical data *Intensive care units/manpower *Intensive care units/statistics *Interpersonal relations *Inter professional relations *Joint Commission on Accreditation of Healthcare Organizations *Labor unions *Labor unions/trends *Legislation hospital *Legislation nursing *Length of stay/legislation & jurisprudence/statistics & numerical data *Liability legal *Linear models *Malpractice *Medical errors/adverse effects *Medical staff hospital *Medical staff hospital/education/psychology *Medical staff hospital/psychology/statistics & numerical data *Medication errors/adverse effects *Medication errors/classification *Medication errors/methods/nursing/prevention & control/statistics & *Medication errors/statistics & numerical data *Models nursing *Models organizational *Monitoring intra operative/methods/nursing *Nurse administrators *Nurse administrators/education/psychology *Nurse administrators/organization & administration/psychology *Nurse practitioners *Nurse practitioners/economics *Nurse's role/psychology *Nurse-patient relations *Nurseries hospital *Nurses *Nurses' aides *Nurses' aides/education *Nurses' aides/education/organization & administration/psychology*nursing *Nursing administration research A-19 .

*Nursing assessment *Nursing assessment/methods/standards *Nursing audit *Nursing care *Nursing care/manpower *Nursing care/organization & administration/psychology *Nursing care/psychology/standards *Nursing care/psychology/statistics & numerical data *Nursing diagnosis *Nursing methodology research *Nursing process *Nursing process/standards *Nursing records *Nursing research *Nursing service hospital *Nursing staff *Nursing staff hospital *Nursing staff hospital/economics/standards *Nursing staff hospital/economics statistics & numerical data *Nursing staff hospital/economics/supply & distribution *Nursing staff hospital/education *Nursing staff hospital/education/organization *Nursing staff hospital/education/organization & administration *Nursing staff hospital/education/psychology *Nursing staff hospital/education/psychology/supply & distribution *Nursing staff hospital/education/standards *Nursing staff hospital/education/supply & distribution *Nursing staff hospital/legislation & jurisprudence/supply & distribution *Nursing staff hospital/organization & administration/standards *Nursing staff hospital/organization & administration/statistics & *Nursing staff hospital/organization & administration/supply & *Nursing staff hospital/psychology *Nursing staff hospital/psychology/standards *Nursing staff hospital/psychology/statistics & numerical data *Nursing staff hospital/psychology/supply & distribution *Nursing staff hospital/statistics & numerical data *Nursing staff hospital/supply & distribution *Nursing staff hospital/utilization *Nursing staff/education/organization & administration/psychology *Nursing theory *Nursing practice *Nursing supervisory *Nursing team *Nutrition assessment *Nutrition/education *Outcome assessment (health care)/economics (health care) A-20 .

*Outcome and process assessment (health care)/methods *Outcome and process assessment (health care)/statistics & numerical data *Personnel administration hospital *Personnel management/*methods *Personnel selection *Personnel selection/*organization & administration *Personnel selection/trends *Personnel staffing and scheduling/*legislation & jurisprudence *Personnel staffing and scheduling/ economics/legislation & *Personnel staffing and scheduling/legislation & jurisprudence *Personnel staffing and scheduling/organization *Personnel staffing and scheduling/organization & administration *Personnel staffing and scheduling/standards *Personnel staffing and scheduling/statistics & numerical data *Personnel turnover *Personnel turnover/statistics & numerical data *Personnel turnover/statistics & numerical data/ trends *Professional-patient relations *Program development *Program evaluation *Programmed instruction/standards *Progressive patient care *Qualitative research *Quality indicators health care/standards *Quality of health care/legislation & jurisprudence *Quality of health care/legislation & jurisprudence/statistics & numerical *Quality of life *Restraint physical *Restraint physical/adverse effects *Resuscitation *Risk assessment *Risk management *Risk management/methods/organization & administration *Safety *Safety management *Salaries and fringe benefits *Staff development *Staff development/methods *Total quality management *Work schedule tolerance *Work schedule tolerance/psychology *Workload *Workload/economics *Workload/psychology *Workload/statistics & numerical data *Workplace A-21 .

*Workplace/organization & administration/psychology *Workplace/psychology Academic medical centers/*manpower Academic medical centers/*organization & administration Academic medical centers/*organization & administration/*statistics & Academic medical centers/economics/*manpower/organization & administration Academic medical centers/economics/standards/statistics & numerical data Academic medical centers/manpower Access to information/*legislation & jurisprudence Accidental falls/*prevention & control Accidental falls/* statistics & numerical data Accidental falls/economics/statistics & numerical data Accidental falls/prevention & control Accidental falls/prevention & control/*statistic/prevention & control/*statistics & numerical data Accidental falls/prevention & control/*statistic/*statistics & numerical data Accidents occupational/*prevention & control Accidents occupational/*statistics & numerical data Accidents occupational/economics/*prevention & control/statistics Accidents occupational/economics/prevention & control/*statistics Accidents occupational/prevention & control Accidents/*statistics & numerical data Accreditation Accreditation/*legislation & jurisprudence Accreditation/*methods Accreditation/*standards Administrative personnel Adverse drug reaction reporting systems Adverse drug reaction reporting systems/*statistics & numerical data Adverse drug reaction reporting Systems/*utilization Adverse drug reaction reporting systems/standard Adverse drug reaction reporting Systems/statistics & numerical data Adverse drug reaction reporting systems/utilization Allied health personnel Allied health personnel/*psychology Allied health personnel/*supply & distribution Allied health personnel/*utilization Allied health personnel/economics/statistics & numerical data Allied health personnel/organization & administration Allied health personnel/psychology Allied health personnel/standards/supply & distribution Allied health personnel/statistics & numerical data/supply & distribution Allied health personnel/supply & distribution American Nurses' Association/organization & administration Analgesia/*nursing A-22 .

Analgesia/methods/*nursing Analgesia/nursing/*standards Analgesia/nursing/*utilization Ancillary services hospital/*trends Ancillary services Bed occupancy/classification Bed occupancy/economics Bed occupancy/statistics & numerical data Bed rest/*adverse effects/nursing Bed rest/adverse effects/nursing Benchmarking/*methods Benchmarking/*methods/standards Benchmarking/*organization & administration Benchmarking/methods Benchmarking/organization & administration Benchmarking/standards Burnout professional Burnout professional/*diagnosis/*psychology Burnout professional/*epidemiology/*psychology Burnout professional/*epidemiology Burnout professional/*etiology Burnout professional/*etiology/psychology Burnout professional/*etiology/psychology Burnout professional/*prevention & control Burnout professional/*prevention & control/*psychology Burnout professional/*prevention & control/psychology Burnout professional/*psychology Burnout professional/classification/diagnosis/etiology/*prevention Burnout professional/complications/*epidemiology Burnout professional/diagnosis/*epidemiology/prevention & Burnout professional/diagnosis/*epidemiology/psychology Burnout professional/diagnosis/epidemiology/*psychology Burnout professional/diagnosis/epidemiology/psychology Burnout professional/diagnosis/etiology/*prevention & control Burnout professional/diagnosis/etiology/prevention & control/*psychology Burnout professional/diagnosis/physiopathology/*prevention & Burnout professional/epidemiology Burnout professional/epidemiology/*etiology Burnout professional/epidemiology/etiology/*psychology Burnout professional/epidemiology/etiology/prevention & Burnout professional/epidemiology/etiology/psychology Burnout professional/epidemiology/psychology Burnout professional/etiology/prevention & control Burnout professional/etiology/prevention & control/psychology Burnout professional/etiology/psychology Burnout professional/prevention control

A-23

Burnout professional/prevention & control/*psychology Burnout professional/prevention & control/psychology Burnout professional/psychology Cardiac surgical procedures/*adverse effects/*nursing Cardiac surgical procedures/*nursing Cardiac surgical procedures/*nursing/standards Cardiac surgical procedures/adverse effects/mortality/*nursing Cardiac surgical procedures/economics/*nursing Cardiac surgical procedures/nursing Cardiology service hospital/*manpower Cardiology service hospital/economics/manpower/*organization & Cardiopulmonary resuscitation/*education/*methods/nursing Cardiopulmonary resuscitation/education/*nursing Cardiovascular diseases/*nursing Case management Case management/*trends Case management/organization & administration* Causality Cause of death Censuses Centralized hospital services Centralized hospital services/*organization & administration Cerebrovascular accident/*nursing/rehabilitation Cerebrovascular accident/classification/nursing Cerebrovascular accident/nursing Cerebrovascular disorders/*nursing Cerebrovascular disorders/*nursing/*rehabilitation Cerebrovascular disorders/*nursing/rehabilitation Certificate of need/legislation & jurisprudence Certification/*organization & administration Certification/*standards Cesarean section/*nursing/psychology Clinical competence/*legislation & jurisprudence/*standards Clinical competence/*legislation & jurisprudence/standards Clinical competence/*standards Clinical competence/*statistics & numerical data Clinical competence/legislation & jurisprudence Clinical competence/legislation & jurisprudence/*standards Clinical competence/legislation & jurisprudence/standards Clinical competence/standards/*statistics & numerical data Clinical competence/statistics & numerical data Clinical nursing research/*methods Clinical nursing research/*organization & administration Clinical nursing research/method Clinical nursing research/organization & administration/*standards Clinical protocols

A-24

Clinical protocols/standards Collective bargaining Collective bargaining/*legislation & jurisprudence Collective bargaining/*organization & administration Collective bargaining/organization & administration Confounding factors (epidemiology) Confusion/*nursing Confusion/*nursing/psychology Confusion/etiology/nursing/*psychology Conscious sedation/*nursing Conscious sedation/adverse effects/*nursing Conscious sedation/nursing/*psychology Consumer satisfaction/*statistics & numerical data Continuity of patient care Continuity of patient care/*organization & administration Continuity of patient care/*standards Continuity of patient care/organization & administration Continuity of patient care/organization & administration/statistics & Contract services Contract service/*organization & administration Contract services/*standards Contract services/legislation & jurisprudence Contract services/statistics & numerical data/*utilization Contracts Coronary disease/*nursing Coronary disease/*nursing/surgery Cost control/methods Cost control/trends Cost of illness Costs and cost analysis/*methods Costs and cost analysis/economics Costs and cost analysis/statistics & numerical data Critical care/*manpower/methods Critical care/*manpower/standard Critical care/*methods Critical care/*organization & administration Critical care/economics/*manpower Critical pathways Critical pathway/*standards Cross infection/*epidemiology/*etiology Cross infection/*epidemiology/microbiology Cross infection/*epidemiology/transmission Cross infection/*microbiology Cross infection/diagnosis/drug therapy/*prevention & control/*transmission Cross infection/economics/*epidemiology/*etiology/prevention & control Cross infection/epidemiology/*microbiology/*transmission

A-25

Cross infection/epidemiology/*microbiology/prevention & Cross infection/epidemiology/*microbiology/transmission Cross infection/epidemiology/*prevention & control Cross infection/epidemiology/*prevention & control/virology Cross infection/epidemiology/etiology/*prevention & control Cross infection/epidemiology/microbiology/*prevention & Cross infection/epidemiology/microbiology/*transmission Cross infection/etiology Cross infection/etiology/*prevention & control Cross infection/microbiology/*prevention & Cross infection/microbiology/*prevention & control/transmission Cross infection/mortality/*prevention & control Cross infection/nursing/*prevention & control/*psychology Cross infection/prevention & control Cross infection/prevention & control/*transmission Data collection Data collection/*methods/*standards Data collection/ methods/standards Data collection/*methods/standards/*statistics & numerical data Data collection/methods Data collection/ methods/*standards Data collection/methods/standards Data display Data interpretation statistical/statistics & numerical data Day care/manpower/*organization & administration/statistics & numerical Decision making Organizational decubitus ulcer *classification/nursing/pathology Decubitus ulcer/*economics/epidemiology/*therapy Decubitus ulcer/*epidemiology/*prevention & control Decubitus ulcer/*etiology/*prevention & control Decubitus ulcer/*etiology/nursing/*prevention & control Decubitus ulcer/*nursing Decubitus ulcer/*nursing/*psychology Decubitus ulcer/*prevention & control Decubitus ulcer/economics/ epidemiology/*prevention & control Decubitus ulcer/epidemiology/etiology Decubitus ulcer/epidemiology/etiology/*prevention & control Decubitus ulcer/etiology Decubitus ulcers/prevention & control Decubitus ulcer/etiology/*prevention & control Decubitus ulcer/nursing/*prevention & control Delivery of health care Delivery of health care integrated Delivery of health care integrated/*manpower Delivery of health care integrated/*organization & administration Delivery of health care integrated/*standards

A-26

Delivery of health care integrated/organization & administration Delivery of health care/*economics Delivery of health care/*history Delivery of health care/*manpower Delivery of health care/*standards Delivery of health care/economics/standards/*trends Delivery of health care/organization & administration Delivery obstetric/*methods Delivery obstetric/*nursing/statistics & numerical data Diabetes mellitus/*nursing Diagnosis-related groups/*classification Direct service costs/*statistics & numerical data Direct service costs/statistics & numerical data Disease management Disease outbreaks/*prevention & control/statistics & numerical data Disease transmission professional-to-patient Disease transmission professional-to-patient/*prevention & control Disease transmission professional-to-patient/*statistics & numerical data Disease transmission professional-to-patient/prevention & control Disease transmission professional-to-patient/statistics & numerical data Drug administration schedule Drug monitoring/*nursing Drug monitoring/nursing/standards Drug monitoring/methods/nursing Drug monitoring/nursing/standards Economics nursing education continuing Education continuing/*methods Education nursing associate/*trends Education nursing baccalaureate/*methods Education nursing baccalaureate/*organization & administration Education nursing baccalaureate/*standards Education nursing baccalaureate/*trends Education nursing baccalaureate/standards Education nursing baccalaureate/statistics & numerical data Education nursing continuing Education nursing continuing/*manpower Education nursing continuing/*methods Education nursing continuing/*organization & administration Education nursing continuing/*standards Education nursing continuing/methods Education nursing continuing/methods/*standard Education nursing continuing/organization & administration Education nursing continuing/standards Education nursing continuing/statistics & numerical data Education nursing diploma programs Education nursing diploma programs/*standards

A-27

Education nursing graduate/*manpower Education nursing graduate/*organization & administration Education nursing graduate/*trends Education nursing/*organization & administration Education nursing/*statistics & numerical data Education nursing/economics Education nursing/economics/legislation & jurisprudence Education nursing/history Education nursing/methods Education nursing/standards Education nursing/standards/trends Education nursing/trends Efficiency organizational/standards Emergencies/*nursing Emergency nursing Emergency nursing/*education Emergency nursing/*education/*methods Emergency nursing/*education/standards Emergency nursing/*manpower Emergency nursing/*methods Emergency nursing/*methods/standards Emergency nursing/*organization & administration Nursing/*standards Emergency nursing/*standards/trends Emergency nursing/*statistics & numerical data Emergency nursing/education/*methods Emergency nursing/education/*methods/standards Emergency nursing/education/*organization & administration Emergency nursing/education/*standards Emergency nursing education/organization & administration Emergency nursing/manpower Emergency nursing/manpower/*standards Emergency nursing/manpower/standards Emergency nursing/standards Emergency service hospital/economics/*manpower Emergency service hospital/economics/*manpower/organization & Employee discipline Employee performance appraisal/*methods/standards Employment/*legislation & jurisprudence Employment/*organization & administration Employment/*psychology Epidemiologic studies Ethics nursing evidence-based medicine/*organization & administration Evidence-based medicine/organization & administration Evidence-based medicine/standards Foreign medical graduates

A-28

Foreign medical graduates/*legislation & jurisprudence/supply & Foreign medical graduates/psychology/statistics & numerical data Foreign professional personnel Foreign professional personnel/*education Foreign professional personnel/*education/*psychology/supply & Foreign professional personnel/*education/psychology Foreign professional personnel/*education/psychology/supply & distribution Foreign professional personnel/*education/supply & distribution Foreign professional personnel/*history Foreign professional personnel/*legislation & jurisprudence Foreign professional personnel/*legislation & jurisprudence/supply & Foreign professional personnel/*psychology Foreign professional personnel/*psychology/supply & distribution Foreign professional personnel/*standards Foreign professional personnel/*supply & distribution Foreign professional personnel/*utilization Foreign professional personnel/education Foreign professional personnel/education/*psychology Foreign professional personnel/education/*psychology/supply & distribution Foreign professional personnel/education/*supply& distribution Foreign professional personnel/education/legislation & Foreign professional personnel/education/psychology/*supply & distribution Foreign professional personnel/legislation & jurisprudence/supply Foreign professional personnel/standards Foreign professional personnel/standards/statistics & numerical Foreign professional personnel/supply & distribution Foreign professional personnel/utilization Government agencies Government agencies/organization & administration Government regulation Guideline adherence/*standards Health care coalitions/*organization & administration Health care costs Health care costs/standards Health care costs/statistics & numerical data Health care rationing Health care rationing/*methods Health care rationing/*organization & administration Health care reform Health care reform/*organization & administration Health care reform/*trends Health care reform/economics/*standards Health care reform/organization & administration Health care reform/trends Health care sector Health care sector/trends

A-29

Health insurance portability and accountability act Health insurance portability and accountability act/legislation Health maintenance organizations/manpower Health manpower Health manpower/*classification/statistics & numerical data Health manpower/*economics Health manpower/*statistics & numerical data/trends Health manpower/*trends Health manpower/statistics & numerical data/*trends Health manpower/trends Health personnel/*education Health services accessibility/*organization & administration Health services accessibility/*standards Health services accessibility/economics/standards Health services accessibility/organization & administration Health services accessibility/standards/*statistics & numerical data Health services misuse/*statistics & numerical data Health services misuse/economics/*statistics & numerical data Health services needs and demand/*organization & administration Health services needs and demand*statistics & numerical data Health services needs and demand/trends Health services research/*methods/*standards Health services research/*organization & administration Heart arrest/nursing Heart diseases/nursing Heart failure congestive/*nursing Heart failure congestive/classification/nursing Heart failure congestive/complications/*nursing Holistic nursing/*education/*organization & administration Holistic nursing/*organization & administration Holistic nursing/*standards Holistic nursing/education/*standards Holistic nursing/methods/*standards Hospital administration Hospital administration*/economics Hospital administration*/standards Hospital administration/*economics/*legislation & jurisprudence Hospital administration/*methods Hospital administration/*organization & administration Hospital administration/economic Hospital administration/education Hospital administration/manpower/*statistics & numerical data Hospital administration/methods Hospital administrators Hospital administrators/*organization & administration Hospital administrators/*supply & distribution

A-30

Hospital administrators/organization & administration/psychology Hospital administrators/psychology/*supply & distribution Hospital administrators/supply & distribution Hospital departments/*organization & administration Hospital departments/*organization & administration/statistics &numerical Hospital departments/*standards Hospital design and construction economics/*legislation & jurisprudence Hospital design and construction/standards Hospital distribution systems Hospital distribution systems/*standards Hospital distribution systems/organization & administration/ Hospital mortality/*trends Hospital mortality/trends Hospital planning/*organization & administration Hospital records Hospital restructuring/*manpower Hospital restructuring/*standard Hospital restructuring/*trends Hospital restructuring/manpower Hospital restructuring/manpower/*organization & administration Hospital restructuring/manpower/methods Hospital restructuring/manpower/organization & administration/*trends Hospital restructuring/manpower/standards Hospital restructuring/organization & administration Hospital restructuring/organization & administration/*standards Hospital restructuring/trends Hospital units/*economics/manpower Hospital units*/economics/organization & administration Hospital units/*legislation & jurisprudence/*manpower Hospital units/*manpower Hospital units/*manpower/organization & administration Hospital units/*organization & administration Hospital units/*standards Hospital units/*statistics & numerical data Hospital units/*supply & distribution Hospital units*/utilization Hospital units/classification/*standards Hospital units/classification/manpower Hospital units/economics/*organization & administration Hospital units/economics/manpower/organization & administration Hospital units/economics/organization & administration/*standards Hospital units/manpower Hospital units/manpower/*organization & administration Hospital units/manpower/*organization & administration/statistics & Hospital units/organization & administration Hospital units/organization & administration/*standards

A-31

Hospital units/organization & administration/*statistics & numerical data Hospital units/organization & administration/*trends Hospital units/standards Hospital/*manpower/standards/utilization Hospitalization/*statistics & numerical data Hospitalization/statistics & numerical data Hospitals Hospitals community Hospitals community/*legislation & jurisprudence Hospitals community/*manpower/organization & administration Hospitals community/*organization & administration Hospitals community/legislation & jurisprudence Hospitals community/manpower Hospitals community/manpower/organization & administration Hospitals community/organization & administration Hospitals community/organization & administration/*standards Hospitals community/standards Hospitals district/manpower Hospitals general/classification/*manpower Hospitals general/manpower Hospitals general/manpower/organization & administration Hospitals general/standards Hospitals general/statistics & numerical data Hospitals group practice/*manpower/utilization Hospitals maternity Hospitals maternity/manpower Hospitals municipal/*manpower Hospitals pediatric Hospitals pediatric/*organization & administration/standards Hospitals pediatric/*standards Hospitals pediatric/*standards/statistics & numerical data Hospitals pediatric/manpower Hospitals pediatric/manpower/*organization & administration Hospitals private Hospitals private/*manpower Hospitals private/economics/manpower Hospitals private/organization & administration Hospitals psychiatric/*manpower Hospitals psychiatric/manpower/*statistics & numerical data Hospitals psychiatric/manpower/statistics & numerical data Hospitals psychiatric/organization & administration/*standards Hospitals public/*manpower Hospitals public/*organization & administration Hospitals public/*organization & administration/statistics & numerical Hospitals public/*standards Hospitals public/*statistics & numerical data

A-32

Hospitals public/economics/manpower Hospitals public/manpower/*standards Hospitals public/manpower/organization & administration Hospitals public/organization & administration Hospitals public/organization & administration* Hospitals public/organization & administration/standards Hospitals public/organization & administration/standards/*utilization Hospitals public/standards Hospitals public/utilization Hospitals rural Hospitals rural/*organization & administration Hospitals special/organization & administration/standards Hospitals state/manpower/*statistics & numerical data Hospitals state/manpower/statistics & numerical data Hospitals teaching/*organization & administration Hospitals teaching/*organization & administration/utilization Hospitals teaching/*standards Hospitals teaching/*statistics & numerical data Hospitals teaching/economics/manpower/organization & administration Hospitals teaching/manpower Hospitals teaching/manpower/*organization & administration/standards Hospitals teaching/manpower/*standards Hospitals university Hospitals university/*economics/utilization Hospitals university/*manpower Hospitals university/*standards Hospitals university/economics Hospitals university/economics/organization & administration Hospitals university/manpower Hospitals university/manpower/organization & administration/statistics & Hospitals university/manpower/statistics & numerical data Hospitals urban Hospitals urban/*manpower Hospitals urban/manpower/*standards Hospitals veterans/*standards/statistics & numerical data Hospitals veterans/manpower Hospitals veterans/manpower/*standards Hospitals/*manpower Hospitals/*manpower/trends Hospitals/*statistics & numerical data Hospitals/classification/*manpower/statistics & numerical data Hospitals/statistics & numerical data Iatrogenic disease/prevention & control Infection control/methods/standards Infection control/organization & administration/*standards Infection/epidemiology/etiology/inpatients

A-33

Inpatients/*classification Inpatients/*education Inpatients/*legislation & jurisprudence/*psychology Inpatients/*psychology Inpatients/*psychology/statistics & numerical data Inpatients/*statistics & numerical data Inpatients/classification Inpatients/education/*psychology/inpatients/history/psychology Intensive care units neonatal/economics/*manpower Intensive care units neonatal/economics/manpower/utilization Intensive care units neonatal/manpower Intensive care units neonatal/manpower/*organization & administration Intensive care units neonatal/manpower/*statistics & numerical data Intensive care units pediatric Intensive care units pediatric/*economics/manpower Intensive care units pediatric/economics/manpower/utilization Intensive care units pediatric/manpower/*organization & administration Intensive care units pediatric/organization & administration/*standards Intensive care units/*economics Intensive care units/*legislation & jurisprudence/*manpower Intensive care units/*manpower/*utilization Intensive care units/*manpower/organization & administration Intensive care units/*manpower/organization & administration/statistics & Intensive care units/*manpower/standards Intensive care units/economics/*manpower Intensive care units/economics/manpower Intensive care/manpower/*organization & administration Intensive care/methods/*standards Interdisciplinary communication Internal medicine/manpower/*standards Internal medicine/organization & administration Interpersonal relations Intervention studies on accreditation of healthcare Joint Commission on Accreditation of Healthcare Organizations Labor unions Labor unions/*organization & administration Labor unions/organization & administration Legislation nursing Length of stay/*economics Length of stay/economics/*statistics & numerical data Length of stay/trends Licensure nursing Licensure nursing/*legislation & jurisprudence Licensure nursing/legislation & jurisprudence Licensure nursing/statistics & numerical data Malpractice

A-34

Malpractice/*economics/*legislation & jurisprudence Malpractice/*legislation & jurisprudence Malpractice/legislation & jurisprudence Malpractice/legislation & jurisprudence/*statistics & numerical data Managed care programs Managed care programs/*economics Managed care programs/*organization & administration Managed care programs/economics Managed care programs/manpower Managed care programs/standards Maternal-child nursing Maternal-child nursing/*manpower Maternal-child nursing/*organization & administration Maternal-child nursing/*standards Maternal-child nursing/*trends Maternal-child nursing/education/*methods Maternal-child nursing/education/*organization & administration Maternal-child nursing/education/organization & administration Maternal-child nursing/manpower/*standards Maternal-child nursing/methods/*standards Medical errors/*adverse effects/*prevention & control Medical errors/*nursing/prevention & control/*statistics & numerical data Medical errors/*nursing/statistics & numerical data Medical errors/nursing/prevention & control/*statistics & numerical data Medical staff hospital/*economics/supply & distribution Medication errors/*nursing/standards/statistics & numerical data Medication errors/methods/nursing/*prevention &control Neonatal nursing/*manpower/*methods Neonatal nursing/*organization & administration Neonatal nursing/*standards Neonatal nursing/education/*organization & administration Night care/*organization & administration Nurse administrators/*education Nurse administrators/*education/*organization & administration/psychology Nurse administrators/*legislation & jurisprudence Nurse administrators/*organization & administration Nurse administrators/*organization & administration/*psychology Nurse administrators/*organization & administration/psychology Nurse administrators/economics/supply & distribution Nurse administrators/education Nurse administrators/education/*organization & administration Nurse administrators/education/*psychology Nurse administrators/education/organization & administration/*psychology Nurse administrators/education/organization & administration/psychology Nurse administrators/legislation & jurisprudence/psychology Nurse administrators/statistics & numerical data

A-35

Nurse clinicians Nurse clinicians/*organization & administration Nurse clinicians/*organization & administration/*psychology Nurse clinicians/*organization & administration/psychology Nurse clinicians/*organization & administration/standards Nurse clinicians/*standards Nurse clinicians/*supply & distribution Nurse clinicians/education Nurse clinicians/education/*organization & administration Nurse clinicians/education/*organization & administration/psychology Nurse clinicians/education/standards/supply & distribution Nurse clinicians/legislation & jurisprudence Nurse clinicians/organization & administration Nurse clinicians/psychology/*supply & distribution Nurse's role* Nurse's role/*psychology Nurse-patient relations/*ethics Nurses' aides Nurses' aides/*economics/education/supply & distribution Nurses' aides/*education Nurses' aides/*organization & administration/psychology Nurses' aides/*psychology Nurses' aides/*standards Nurses' aides/distribution Nurses' aides/education/*organization & administration Nurses' aides/education/*organization & administration/psychology Nurses' aides/education/*psychology Nurses' aides/education/*supply & distribution Nurses' aides/education/*utilization Nurses' aides/education/organization & administration Nurses' aides/education/organization & administration/psychology Nurses' aides/education/psychology Nurses' aides/education/supply & distribution Nurses' aides/legislation & jurisprudence Nurses' aides/legislation & jurisprudence/utilization Nurses' aides/organization & administration Nurses' aides/organization & administration/psychology Nurses' aides/psychology/*supply & distribution Nurses' aides/standards Nurses' aides/statistics & numerical data/*utilization Nurses/*organization & administration Nurses/*psychology Nurses/economics/organization & administration/utilization Nurses/economics/statistics & numerical data/*supply & distribution Nurses/psychology Nurses/psychology/*statistics & numerical data

A-36

Nurses/supply & distribution Nursing administration research/*education Nursing administration research/*methods Nursing administration research/*methods/standards Nursing administration research/*methods/statistics & numerical data Nursing administration research/*organization & administration Nursing administration research/methods Nursing administration research/methods/standards Nursing administration research/organization & administration Nursing assessment Nursing assessment/*ethics/methods Nursing assessment/*legislation & jurisprudence Nursing assessment/*methods Nursing assessment/*methods/*statistics & numerical data Nursing assessment/*methods/standards Nursing assessment/*organization & administration Nursing assessment/methods/standards/statistics & numerical data Nursing audit/*methods Nursing audit/*organization & administration Nursing audit/organization & administration Nursing care Nursing care/*classification Nursing care/*classification/methods Nursing care/*methods Nursing care/*methods/*psychology Nursing care/*psychology Nursing care/*psychology/*standards Nursing care/*standards/statistics & numerical data Nursing care/*utilization Nursing care/classification Nursing care/classification/*methods/standards/*statistics & numerical Nursing care/classification/*psychology/*standards Nursing care/manpower/methods/*statistics & numerical data Nursing care/methods/*psychology Nursing care/methods/organization & administration Nursing care/organization & administration Nursing care/psychology/standards Nursing care/statistics & numerical data Nursing diagnosis Nursing diagnosis/*standards Nursing diagnosis/*utilization Nursing education research Nursing evaluation research/*methods Nursing evaluation research/*methods/standards Nursing evaluation research/*organization & administration Nursing evaluation research/methods A-37 .

Nursing methodology research Nursing methodology research/*methods Nursing methodology research/*methods/*standards Nursing methodology research/*methods/standards Nursing methodology research/education/*methods Nursing methodology research/methods/standards Nursing process Nursing process/*organization & administration Nursing process/*statistics & numerical data Nursing process/classification/standards/*statistics & numerical data Nursing records Nursing records*legislation & jurisprudence Nursing records/*standards Nursing records/*standards/statistics & numerical data Nursing records/legislation & jurisprudence/*standards Nursing records/standards Nursing records/standards/statistics & numerical data Nursing records/statistics & numerical data Nursing research/*methods/standards Nursing research/*methods/statistics & numerical data Nursing research/*organization & administration Nursing research/education Nursing research/education/*organization & administration Nursing service hospital Nursing service hospital/*classification Nursing service hospital/*economics Nursing service hospital/*history/manpower/organization & administration Nursing service hospital/*manpower Hospital/*manpower/*standards Nursing service hospital/*organization & administration Nursing service hospital/*organization & administration/trends Nursing service hospital/classification/*utilization Nursing service hospital/classification/manpower/*organization Nursing service hospital/economics Nursing service hospital/economics/*organization & administration Nursing service hospital/economics/*standards Nursing service hospital/economics/*trends Nursing service hospital/economics/manpower/*organization & Nursing service hospital/manpower/*organization & Nursing service hospital/manpower/*organization & administration Nursing service hospital/manpower/*organization & administration/trends Nursing service Nursing staff Nursing staff hospital Nursing staff hospital/*economics Nursing staff hospital/*economics/*legislation & jurisprudence A-38 .

Nursing staff hospital/*economics/*supply & distribution Nursing staff hospital/*economics/legislation & jurisprudence Nursing staff hospital/*economics/legislation & jurisprudence/statistics Nursing staff hospital/*economics/organization & administration/trends Nursing staff hospital/*economics/psychology Nursing staff hospital/*economics/standards Nursing staff hospital/*economics/standards/supply & distribution Nursing staff hospital/*economics/supply & distribution Nursing staff hospital/*education Nursing staff hospital/*education/*legislation & jurisprudence Nursing staff hospital/*education/*organization & Nursing staff hospital/*education/*organization administration Nursing staff hospital/*education/*psychology Nursing staff hospital/*education/*psychology/supply & distribution Nursing staff hospital/*education/*supply & distribution Nursing staff hospital/*education/*supply & distribution/trends Nursing staff hospital/*education/organization Nursing staff hospital/organization & administration Nursing staff hospital/*ethics/organization & administration/*psychology Nursing staff hospital/*ethics/psychology Nursing staff hospital/*legislation & jurisprudence Nursing staff hospital/*legislation & jurisprudence/*standards Nursing staff hospital/*legislation & jurisprudence/statistics Nursing staff hospital/*legislation & jurisprudence/supply & distribution Nursing staff hospital/*organization & Nursing staff hospital/*organization & administration/*psychology Nursing staff hospital/*organization & administration/*statistics & Nursing staff hospital/*organization & administration/*supply & Nursing staff hospital/*organization & administration/psychology Nursing staff hospital/economics/*legislation & jurisprudence Nursing staff hospital/economics/*statistics & numerical data Nursing staff hospital/economics/*supply & distribution/utilization Nursing staff hospital/economics/*utilization Nursing staff hospital/economics/education Nursing staff hospital/legislation & jurisprudence Nursing staff hospital/legislation & jurisprudence/*organization & Nursing staff hospital/legislation & jurisprudence/psychology/*supply & Nursing staff hospital/organization & administration/*standards Nursing staff hospital/organization & administration/*utilization Nursing staff hospital/standards/*utilization Nursing staff hospital/standards/supply & distribution Nursing staff hospital/statistics & numerical data Nursing staff hospital/statistics & numerical data/*supply & distribution Nursing staff hospital/supply & distribution Nursing staff hospital/supply & distribution/*trends Nursing staff hospital/supply & distribution/*utilization A-39 .

Nursing staff hospital/trends Nursing theory Nursing practical Nursing practical Nursing practical methods Nursing practical/*legislation & jurisprudence Nursing practical/*manpower Nursing practical/*statistics & numerical data Nursing practical/economics/*manpower Nursing practical/education Nursing practical/education/*manpower Nursing practical/education/organization & administration Nursing practical/education/standards Nursing practical/legislation & jurisprudence Nursing practical/standards Nursing practical/statistics & numerical data Nursing supervisory/*economics Nursing supervisory/*legislation & jurisprudence Nursing supervisory/*methods Nursing supervisory/*organization & administration Nursing supervisory/*standards Nursing supervisory/economics Nursing supervisory/legislation & jurisprudence Nursing supervisory/methods Nursing supervisory/organization & administration Nursing supervisory/standards Nursing team Nursing team/*organization & administration Nursing team/organization & administration Nursing team/statistics & numerical data Nursing/*manpower Nursing/*manpower/trends Nursing/*organization & administration Oncologic nursing Oncologic nursing/*manpower Oncologic nursing/*methods/standards Oncologic nursing/*organization & administration Oncologic nursing/*standards Oncologic nursing/economics/education/*manpower Oncologic nursing/education Oncologic nursing/legislation & jurisprudence Oncologic nursing/manpower Oncologic nursing/manpower/*standards Oncologic nursing/methods/*standards Oncologic nursing/statistics & numerical data Orthopedic nursing/*organization & administration/standards A-40 .

Outcome assessment (health care)/economics/*statistics & numerical data Outcome assessment (health care) /methods Outcome assessment (health care)/organization & administration Outcome assessment (health care)/standards Outcome and process assessment (health care)/*statistics & numerical data Outcome and process assessment (health care)/economics Process assessment (health care)/methods Outcome and process assessment (health care)/organization & administration Pain postoperative/*nursing Pain postoperative/diagnosis/etiology/*nursing/*prevention & control Pain postoperative/diagnosis/etiology/*nursing/psychology Pain/*nursing Pain/*nursing/*therapy Pain/diagnosis/nursing Patient care Patient care planning Patient care planning/*classification Patient care planning/*economics/standards Patient care planning/*methods Patient care planning/*organization & administration Patient care planning/economics/statistics & numerical data Patient care planning/organization & administration Patient care planning/organization & administration/*standards Patient care team/*organization & administration Patient care team/*standards Patient care team/*statistics & numerical data Patient care team/economics Patient care team/economics/*organization & administration Patient care team/economics /statistics & numerical data/*utilization Patient care team/organization & administration Patient care team/standards Patient care/*economics Patient care/economics Patient readmission Patient readmission/*statistics & numerical data Patient readmission/economics Patient readmission/statistics & numerical data Patient transfer/manpower/*organization & administration/standards Patient transfer/methods/*organization & administration Patient transfer/methods/*standards Patient transfer/methods/organization & administration/*standard Patient-centered care Patient-centered care/*economics Patient-centered care/*ethics/organization & administration Patient-centered care/*manpower Patient-centered care/*manpower/*organization & administration A-41 .

Patient-centered care/*methods Patient-centered care/*organization & administration Patient-centered care/*organization & administration/*statistics Patient-centered care/*standards Patient-centered care/*trends Patient-centered care/economics/*manpower/standards Patient-centered care/history Patient-centered care/methods Patient-centered care/methods/*organization & administration Patient-centered care/methods/*standards Patient-centered care/organization & administration Care/standards Pediatric nursing Pediatric nursing/*education Pediatric nursing/*education/*organization & administration Pediatric nursing/*history Pediatric nursing/*legislation & jurisprudence Pediatric nursing/*manpower Pediatric nursing/*methods Pediatric nursing/*methods/standards Pediatric nursing/*organization & administration Pediatric nursing/*organization & administration/*standards Pediatric nursing/*standards Pediatric nursing/*statistics & numerical data Pediatric nursing/education Pediatric nursing/education/*manpower Pediatric nursing/education/*methods Pediatric nursing/education/*methods/standards Pediatric nursing/education/*organization & administration Pediatric nursing/education/*standards Pediatric nursing/history Pediatric nursing/manpower Pediatric nursing/manpower/standards Pediatric nursing/methods Pediatric nursing/organization & administration Pediatric nursing/statistics & numerical data Perioperative care/manpower Perioperative care/nursing/organization & administration Perioperative nursing Perioperative nursing/*education Perioperative nursing/*manpower Perioperative nursing/*manpower/standards Perioperative nursing/*manpower/statistics & numerical data Perioperative nursing/*methods Perioperative nursing/*organization & administration Perioperative nursing/*organization & administration/standards A-42 .

Perioperative nursing/*standards Perioperative nursing/education Perioperative nursing/education/*manpower Perioperative nursing/education/*methods Perioperative nursing/education/*methods/*standards Perioperative nursing/education/methods/standards Personal autonomy Personal satisfaction Personal space Personality Personality inventory Personnel administration hospital Personnel administration hospital/*legislation & jurisprudence Personnel administration hospital/*methods Personnel administration hospital/*methods/statistics & numerical data Personnel administration hospital/*standards Personnel administration hospital/*statistics & numerical data Personnel administration hospital/economics Personnel administration hospital/economics/*methods/trends Personnel administration hospital/legislation & jurisprudence/*standards Personnel administration hospital/methods Personnel administration hospital/standards Personnel administration hospital/standards/statistics & numerical data Personnel management/*legislation & jurisprudence Personnel management/*methods Personnel management/*organization & administration Personnel management/*standards Personnel management/*trends Personnel management/economics/*methods Personnel management/methods Personnel management/standards Personnel staffing and scheduling information Personnel staffing and scheduling information systems Personnel staffing and scheduling information systems/*organization & Personnel staffing and scheduling/*classification Personnel staffing and scheduling/*classification/organization & Personnel staffing and scheduling/*economics/organization & administration Personnel staffing and scheduling/*legislation & Personnel staffing and scheduling/*legislation & jurisprudence/standards Personnel staffing and scheduling/*organization Personnel staffing and scheduling/*organization & administration/standards Personnel staffing and scheduling/*statistics & numerical data/*trends Personnel staffing and scheduling/*statistics & numerical data/trends Personnel staffing and scheduling/economics/*legislation & jurisprudence Personnel staffing and scheduling/legislation & jurisprudence/standards Personnel staffing and scheduling/organization & administration/*standards A-43 .

Personnel staffing and scheduling/organization & administration/standards Personnel staffing and scheduling/organization & administration/statistics Personnel turnover/*statistics & numerical data Personnel turnover/*trends Personnel turnover/economics Personnel turnover/economics/*statistics & numerical data Personnel turnover/statistics & numerical data/*trends Personnel hospital/*statistics & numerical data Personnel hospital/classification/economics/*supply & distribution Personnel hospital/economics Personnel hospital/education/*standards Personnel hospital/education/psychology Personnel hospital/legislation & jurisprudence Personnel hospital/standards/*supply & distribution Personnel hospital/statistics & numerical data/*utilization Personnel hospital/statistics & numerical data/supply & distribution Philosophy nursing Pneumonia/classification/nursing Postnatal care/economics/manpower/*organization & postoperative care/*nursing/*standards Postoperative care/methods/nursing Postoperative care/nursing/*standards Postoperative care/nursing/psychology/statistics & numerical data Preoperative care/*preoperative care/economics/* Primary health care Primary health care/*manpower Primary health care/*organization & administration Primary health care/organization & administration Primary nursing care Primary nursing care/*manpower Primary nursing care/*methods Primary nursing care/*organization & administration Primary nursing care/manpower Primary nursing care/methods/*standard Primary nursing care/organization & administration Primary nursing care/organization & administration/*standards Primary nursing care/statistics & numerical data Process assessment (health care) Process assessment (health care) /organization & administration Process assessment (health care)/methods Professional competence Professional competence/*standards Progressive patient care Progressive patient care/*manpower Progressive patient care/*organization & administration Progressive patient care/classification/*standards Progressive patient care/organization & administration A-44 .

Qualitative research Quality assurance health care/*legislation & jurisprudence Quality assurance health care/*methods Quality assurance health care/*organization & administration Quality assurance health care/*statistics & numerical data Quality assurance health care/economics/trends Quality assurance health care/legislation & jurisprudence Quality assurance health care/methods Quality assurance health care/organization & administration Quality assurance health care/standards Quality assurance health care/statistics & numerical data Quality control Quality indicators health care Quality indicators health care/organization & administration Quality indicators health care/*statistics & numerical data Quality indicators health care/legislation & jurisprudence Quality indicators health care/standards Quality of health care/*legislation & Quality of health care/*statistics & numerical data Quality of health care/*trends Quality of health care/legislation & jurisprudence Quality of health care/organization & administration Quality of health care/organization & administration/standards Quality of health care/standards Rehabilitation nursing/*legislation & jurisprudence Rehabilitation nursing/*manpower/*methods Restraint physical Resuscitation Resuscitation orders Resuscitation/*education/standards Resuscitation/*standards/statistics & numerical data Risk management/*organization & administration Risk management/*organization & administration/statistics & numerical data Risk management/*standards Risk management/*statistics & numerical data Safety management/* Safety management/*methods Safety management/*organization & administration Safety management/*standards Safety management/legislation & jurisprudence Safety management/methods Safety management/methods/standards Safety management/organization & administration Safety/*legislation & jurisprudence Safety/standards Total quality management/*organization & administration A-45 .

Total quality management/organization & administration Unnecessary procedures/nursing/statistics & numerical data Urinary catheterization/*adverse effects/*nursing Urinary catheterization/adverse effects/*nursing Urinary catheterization/nursing/*standards Work schedule tolerance Workload/*classification/economics Workload/*legislation & jurisprudence Workload/*legislation & jurisprudence/*standards Workload/*legislation & jurisprudence/standards Workload/*psychology Workload/*psychology/statistics & numerical data Workload/*standards Workload/economics/statistics & numerical data Workload/legislation & jurisprudence Workload/legislation & jurisprudence/*standards/statistics & numerical data Workload/legislation & jurisprudence/standards Workload/legislation & jurisprudence/statistics & numerical data Workload/psychology/*statistics & numerical data Workload/statistics & numerical data Workplace Workplace/*organization & administration A-46 .

Anonymous. Mar 1996.22(6):76-78. Am J Nurs. 38. Hospital nixes pathways. Mercy Hospital and Medical Center. Comment. Apr 1995. Comment. Am J Nurs. 16. Aspens Advis Nurse Exec. Anonymous. 20. 14. Qual Lett Healthc Lead. Anonymous. of Labor study. Anonymous. Anonymous. Anonymous. Anonymous. Anonymous. traction! Nurs Stand.15(2):48. Guideline. American Academy of Pediatrics Committee on Hospital Care. Jun 1991. News. California. Mar 1992. Anonymous. 2. Anonymous. 31. Hosp Peer Rev.13(4):12. Arch Dis Child. Jan 1996. Nursing "cannibalistic" toward its elders.92(12):9. An HIV-infected nurse must be reinstated.13(6):10-11. Anonymous. 30. Hosp Case Manag. Intensive Care Med. Jun 1997. Jan-Feb 1995. Jun 1991.9(3):15. Measuring neonatal nursing workload. May 1993. 32. Mar 1996. News. 24. Anonymous. AARN News Lett. Am Nurse.27(2):20-21. Not eligible target population.93(5):850-854. Some guidelines for staffing in the absence of patient classification systems. 23. 6. Comment. Profiles Healthc Mark. Hosp Case Manag. Jul-Aug 1994. 5.24(10):8. Anonymous. 37. Anonymous.4(1):6.5(3):43-44. 21. 4. Anonymous. 23.50(4):11. Not eligible exposure. B-1 . A case in point: "catch-all" clause protects nurses' rights. Anonymous. Lamp. Anonymous. Focus Crit Care. 26. 34. Am Nurse. Italian Multicenter Group of ICU research (GIRTI). May 1994. MarApr 1995(64):2-7. 9.90(5):411. Humanising the shiftwork systems. Comment. Anonymous. San Diego. Not eligible target population. Legal cases. Feb 2-8 1994. Dec 1992. Sep-Oct 1996. Temporary or pseudo-permanent? Qld Nurse. Oct 1993.9(6):13. Anonymous.14(1):15-17. NLN Research & Policy PRISM Jun 1994. 38 hour week--your questions answered. Qld Nurse.3(11):176-177. Mich Nurse. Comment.2(12):181-185. Draft guidelines on preventable medication errors. Anonymous. Aug 1993. The challenge of operating within staffing budgets on the maternity unit at New England Memorial Hospital despite a fluctuating census. Comment. Sep-Oct 1997. OR Manager. 1112. Anonymous. 22. 27. A review of the use of DySSSy. 13. Anonymous. Comment. Review. Nurses' report card project under way. Florence.5(1):15-17. Anonymous. Dec 1995. 28. N J Med. Nov-Dec 1990. No association tested. boost staff morale and patient satisfaction. Testimonials help hospital recruit in. Not eligible target population. Anonymous. Flexible scheduling and part-time work. Mar 1997. 198-199.90(6):27-28. Oct 9 1996. Jun 1990. IOM issues nursing staffing report: some positive recommendations yet report fails to address immediacy of hospital staffing problems. 3. 35. keeps case management. Rebuilding a unit for seamless surgical care. Patient nurse dependency. NLN survey informs Dept. 18. No association tested.11(3):32. 7. Integrating an understanding of sleep knowledge into your practice (continuing education credit). Anonymous.43(1):11. 10. Am J Hosp Pharm.65(3):19. Infamous acuity system. Northern Neonatal Network. Legal cases.Appendix B: List of Excluded Studies 1. Anonymous. Anonymous. Stroke path calls for care when evaluating variances. Nov 1994. Letter. Jan-Mar 1995. How do you know if your paycheck is correct? Ky Nurse. Nurs Stand. Anonymous. Anonymous.52(3):22-25. suppl 181-184. Hosp Case Manag. Qld Nurse. Guideline. Four easy ways to lose a job in nursing. Anonymous. Comment. 8. Comment. Employees speak out.91(6):14. 15. Colorado case blurs line between board of nursing admin.49(3):640-648. Anonymous. Wound care team nips costly bed sore problems. Low nursing staffing levels causing stress. Qld Nurse. Comment. Apr 1994. 11. 19.28(2):8. Mar 1993. Dec 1997. Comment. Nursing. 12. slashes hospital expenses. Nov 1995. 26. 36. An issue of floating. Renal transplantees have special education needs. Nov-Dec 1994.18(3):195-196. Comment. Self-scheduling guidelines. Mar 1992.15(5):18. May-Jun 1992. Anonymous. Enterprise bargaining in the private sector. too. Health Care Cost Reengineering Rep. May 1993.29(5):3. Position statement on minimum staffing in NICUs. Comment. Mar 1995.8(11):suppl 1. 49-51. Staffing patterns for patient care and support personnel in a general pediatric unit. OR Manager. Lights.17(6):340-345. 29. law and criminal action.68(5 Spec No):539-543.2(2):4-8. Pediatrics. Qld Nurse. Qld Nurse.and out-of-state. Comment. Am J Nurs. 17.11(12):15-16. Medication incident reporting forms. Not eligible target population. Anonymous. 1991. Anonymous. And speaking of patient safety. Pediatric unit. Not eligible target population. SC. Comment.11(3):23. Time oriented score system (TOSS): a method for direct and quantitative assessment of nursing workload for ICU patients. Anonymous. Mandatory AIDS testing could create hospital staffing problems.8(19):47. Comment. 25. Comment. 33. Sister Susie. Nurs Manage. camera. Anonymous. Not eligible target population. Am Nurse. McLeod Regional Medical Center. Anonymous. Comment. Not eligible exposure. Neonatal Netw. Feb 1993. Legal cases. Anonymous.24(11):76-77. Not relevant.

Mar 1999. Rx for cutting labor costs: add more registered nurses. Patient Focus Care Satisf. 73. Fund to pay $10M: seeks contribution from nurse.94(18):49. suppl 1-4. Anonymous.18(1):35. Regan Rep Nurs Law. What can you do to assist float nurses who are assigned to your unit? J N Y State Nurses Assoc. Division of Nursing of HRSA. Crit Care Med. A unique focus group improves and promotes food services. Patient Focus Care Satisf. Feb 1998. 40.10(3):25-29.38(10):1. Telemetry unit moves from worst to best using redesign process. Mar 1999. Patient abandonment. 60. 68. 56. TX. EMTALA suit follows. Anonymous.94(11):1.72(10):16. Anonymous. Anonymous. 55. Hospital fails to diagnose CVA. 65 66. Issue: we never seem to have enough staffing on my unit. 41.39. Jan-Feb 1999. Review. Nursing. increased efficiency. Am Nurse. Nurs Outlook. Not eligible exposure.6(5):5962. Nov-Dec 1997. 47. costs. Anonymous.7(12):137-139.10(3):29-30. Feb 1999. 75.94(4):5.8(1):1-4. Anonymous. Anonymous. Comment. Patient Focus Care Satisf. 50. Apr 1997. as one nurse found out. Anonymous. Comment. 51. Are ED nursing staff levels under attack? Patient Focus Care Satisf. Foreign-educated nurses participate in the computerized clinical simulation testing (CST) pilot study. Anonymous. Winter 1998. Nov 1997. Not eligible target population.7(11):121-123. 42. Jun 1997. Cut pneumonia length of stay. Anonymous. Anonymous. Anonymous. Critical care services and personnel: recommendations based on a system of categorization into two levels of care. Mar 1997. Comment.39(10):. Anonymous. ED Manag. Defining provider roles. Legal cases. Comment. 68. Nov 1999. Anonymous. No association tested. Defining provider roles.24(2):29-30. Comment. Comment.45(4):190-191. Jan 2000. Health Care Food Nutr Focus. Comment. ED Manag. Chart. Cook County Hospital RNs take on restructuring. Nurs Stand. 74. Anonymous. Patient Focus Care Satisf. Patient Focus Care Satisf. Comment.7(1):9. May 6-12 1998.15(1):7. 63. Comment. Legal cases. Not eligible exposure. Dec 1999. Plus study finds health professionals not prepared to recommend donation. More work + changing roles = less satisfaction for providers and patients. Feb 1999.29(3):25. Anonymous. More RNs means fewer post-surgical complications. Mar 1998. Anonymous. 44. News. 49. Nurs Times. The "take a nurse to lunch" program. Patient commits suicide. 64. Sep-Oct 1999. 76. Dec 1999. Jun 1998. Anonymous. Massachusetts board reprimands DanaFarber nurses. readmissions. Mich Nurse. Anonymous. B-2 . 69. hospital.27(4):69. Anonymous. 53. No association tested. Anonymous. Cross-training programs offer scheduling flexibility. Regan Rep Nurs Law.29(6):52-53. No association tested. 45. Nursing. 72. What can we do? Ohio Nurses Rev. 77. pneumonia. Nephrol News Issues. Anonymous.72(3):9. Jan 1999. 970 P. Comment. Court rules 'no duty to consult with Dr. Dimens Crit Care Nurs. Houston. Anonymous. 67. Shortage spurs hunt for hospital staffing ratios. Hartford uses report cards to teach nurses to teach. Anonymous. Jan 22 1997. 46. Anonymous. Patient Focus Care Satisf. Apr 1998. Voices from Colorado.18(6):8-10.5(3):37-39. 52. Anonymous. Approaches to organising nursing shift patterns. Nursing staff levels under attack? Respond with data. Does an RN have the right to refuse to be floated to an area that she/he believes they are unqualified for? Chart.2(6):81-85. CVA (cerebrovascular accident) pathway cuts across seven hospital units. Comment. Legal cases. indirect nursing hours. May 1998. Dec 1999. Anonymous. Agency for Health Care Policy and Research. Hosp Case Manag. Conscious sedation raises safe staffing concerns.6(2):33-34. Anonymous. No association tested. News. Anonymous. Health Care Cost Reengineering Rep.6(12):137-139. Oct 1998. To err is human to forgive is divine. Comment. Appealing for compensation. Cutting RNs a false economy? Hosp Peer Rev. More RNs lower risk of UTIs. Nurs Manage.7(12):139-140. Anonymous. Mar 1998.7(12):133-136. Anonymous.000. Patient Focus Care Satisf.15(2):5-7. Anonymous. Anonymous.12(6):64-66. Mar 1999. Anonymous. Improving pain management for orthopedic patients at Hermann Hospital. Comment. Not eligible exposure. Comment. Jan 1998. Jul-Aug 1997.20(1):5. Jun 1998. Issues 1999. Comment. Health Care Cost Reengineering Rep. Jun 1997. Counter misleading data: adjust for patient acuity. Mar 1998. Mar 1999.' Case on point: Silves v. Anonymous.28(2):19. Comment. Apr 1997. Comment. Anonymous.31(5):6.3(1):1-5. 71. How do you know you're productive in PACU (postanesthesia care unit)? OR Manager.8(2):1821. Anonymous.2d 791-WA (1999). Oct 1997. Not eligible exposure. Hosp Secur Saf Manage. No association tested. Take California's word: nurse staffing levels do impact quality of care. 58.27(2):422-426. Dec 1998. Anonymous. 43. 48. National Institute for Nursing Research. Who should own case management within the continuum of care? Hosp Case Manag. Anonymous.14(4):24-25. Re Meds. No association tested. Regan Rep Nurs Law. nursing agencies settle for $700. Qual Connect. 70. 59. Patient acuity profiles can keep you on budget. Not relevant. American College of Critical Care Medicine of the Society of Critical Care Medicine. Comment. 62. Study reveals satisfaction with hospital experience major factor in decision to donate. 57. Legal cases. 61.11(18):32-33.39(10):1. 54. King. Comment. Feb 2000. Nurse staffing and quality of care in health care organizations research agenda of the Department of Health and Human Services. Legal cases. OR Manager.

42(2):4. Anonymous. 17. 88. Comment. Hosp Health Netw. Jul 2001. Comment. Vincent over mandatory overtime.9(5):78. 2001 salary survey results. Oct 2000. No association tested. Anonymous. Interview. Brief encounters costing the NHS dear. Hosp Peer Rev. Aug 2002. OR Manager. 90. News. California nurses win landmark victory.75(3):4-5. Jun 2001. 98.17(6):15. Off-shift choices help to keep nurses. Mar 2001. ED makes nurses happy by outsourcing calls. Sep 2002. Anonymous.96(12):3.32(4):12. 97. 106. Violent patients get the red card. Anonymous. B-3 .13(10):113-115. Tex Nurs. ED Manag. Not eligible target population. Mar-Apr 2000. Comment. Anonymous. 85. bill aims to eliminate overtime. Staffing shortages mean increased opportunities. Anonymous.9(6):353-356. Anonymous. Comment. 83. July 2001). Legal cases. Legal cases. Anonymous. Apr 2002. Anonymous. No association tested. Nurs Law Regan Rep.13(4):45-46. Guidelines for nurse staffing in intensive care: a consultation document (3rd draft. 86. JCAHO: nursing shortage puts patients at risk. Anonymous. 13-14. Anonymous. Anonymous. Nurs Times. Nurses rally to ban forced overtime. Jun 2002. 117.65(11):34hf32-35. Anonymous. The staffing shortage: dealing with the here and now.12(10):109-113. Jul 2001. Comment. Anonymous. Comment. Solutions to health care's labor shortages. Texas' nursing education system.21(8):8-9. Am Nurse. Apr 2000. Anonymous. Mandatory overtime bill caps off successful legislative year. Anonymous. Nov 2001. 111. Comment. Review. Nov 2001. News. Comment.17(6):1. 84. 91. Nurs Times. Prairie Rose.74(4):4-5. Comment. Anonymous. 109.33(6):3. Can it respond to this nursing shortage? Tex Nurs. Oct 2001.10(12):1-8.. Anonymous.26(6):83-85. others waiting lists. Anonymous. JCAHO: nurse shortage threat to patient safety.27(8):105-108. Anonymous. Jun 2001. 3. Rules proposal intended to clarify nurse staffing. Anonymous. Staff collaboration boosts adoption of best practices. OR Manager. 115. 104. Jun 21-27 2001. 116. Temp staff become a fixture in ORs. 11-12. Review.75(4):26. 87. Oct 2002. Nov-Dec 2001. Comment. 113.71(1):1. 2001 WL 563921 N. Apr 2001. Apr 2001. Anonymous. Jul 2001. 89.55(31):7-8. Anonymous.27(7):91-94. Jul 2002. Staffing watch. Interviews find some ORs have vacancies. Comment. OR Manager. Anonymous. Hosp Peer Rev. Optima Health Inc. Russ Coiles Health Trends. Health Care Strateg Manage. Comment. Anger over double HIV test.8(1):suppl 1-2.100(1):20. 114. Jul 2001.78. Anonymous. Mar 8-14 2001. Striving to become the employer of choice: the relationship of employee and patient satisfaction. Patient safety alert. safety. 80. 103. Feb 2000. News. Anonymous. Has the nursing shortage decreased health care quality? Hosp Peer Rev. 100. News. New study gauges scope of nursing shortage. 105. Anonymous. 93. 94. Anonymous. Nurs Times. Aug 13 2001. Not eligible exposure. Revolution. Nurs Law Regan Rep. Jan 2002.100(12):20-21. 99. News. Court told overwork led to breakdown. Hosp Case Manag. OR Manager. Sep 2002. Anonymous. 79.97(26):7. Anonymous. Aug 2001.13(11):suppl 1-4.14(1):8-12. 107. Comment. ED Manag. Healthcare Benchmarks Qual Improv.9(7):9-15. Anonymous.E.2d-NH. California releases proposed nurse-topatient ratios for acute care hospitals. Work environment a top issue in nurse retention. Anonymous. Are you losing staff to other facilities? Here's what ED managers need to do. Hosp Peer Rev.1(2):10. Nurses strike Tenet-owned St. Anonymous.18(9):8. 110. 120. 119. Closer link made between nursing shortage. Comment. Nursing. Mar 2329 2000. Healthc Leadersh Manag Rep. Nurse's unintentional error is not 'willful misconduct'. News. 81. Anonymous. 112. No association tested. Am J Nurs. Comment. News. Comment. Dec 2002. State of the nursing shortage. Healthc Leadersh Manag Rep. ED Manag.97(10):7. Rn. Senate confronts the nursing shortage.Suppl:16.27(9):117-119. Anonymous. 96. 95. Intensive Crit Care Nurs. 'It's about safe care'. Hosp Peer Rev. Anonymous. Anonymous. Occupational health. Anonymous. Jan 2001. 99. Nurs Times. Jan 2001. Comment. Comment. Mar-May 2002.9(10):suppl 1-3. NHS Direct will not cure ward-level staffing and skill-mix problems. May 2001. Perspectives. Anonymous. Linking staffing and quality issues. Anonymous. 108. In our hands and in our hearts: finding solutions to the staffing crisis. Crit Care Nurse. News. 118. Comment. 66. Has the nursing shortage decreased health care quality? Healthc Benchmarks. demands immediate attention. Staff safety. Comment. Case on point: Phelps v. Comment. Feb 2001.97(25):4. Jun 2001. For safety's sake. Anonymous. Dec 2000.9(7):1-7.20(6):12.26(1):1-2.17(7):6-7. Comment. Greater nursing staff levels result in better care for hospital patients. Am J Nurs. 82. 102. J Nurs Manag. Medication error. Legal cases. Jt Comm Perspect. 92. Sentinel event leads to safety checklist. Healthc Leadersh Manag Rep. Anonymous. OR Manager.42(8):1. Comment. Anonymous. Jun 28-Jul 4 2001. Jan 2000. Oct 2001. 74. Comment. Patient safety alert. 101.17(5):254-258. Nurses may be your best tool for improving quality of care. Nov 2001. Nov 2002. Med Health. Terminated nurse alleges hospital violated ADA. Salty language. Frustrated by the nursing shortage? Try these tactics instead of bonuses. ED Manag.17(2):20.

Apr 2002.57(7):8-9. Am Nurse. Rn.100(2):30. News. Aust Crit Care.E.15(1):6-7. Anonymous. 161. Jan 2003. 141. Comment. 131. Comment. 145.76(3):89.10(8):92-93. Comment. Pennsylvania Nurse Aug-Sep 2002. OR Manager.67(2):26hf21-26hf22. Staffing. Jul-Aug 2002. Dec 2002. Nurs Law Regan Rep. Sep 2003. Sep 2004. 133. Anonymous. 157. 144. Staffing the ED despite the nursing shortage. 129. Charter Pines Behavioral Ctr. Aug 2003.56(12):90. Senate and Assembly hold joint health committee hearing on nursing shortage and nurse staffing crisis. 134.'s death: RN's voluntary termination too remote in time. 14. Anonymous. 16-17. Anonymous. Making your mark. Comment. Perform Improv Advis. 125. Anonymous. Anonymous. Proposed staffing rules pass.18(9):1. 139.2d 881-NC. Anonymous. Dec 2002.44(6):2. Comment. Anonymous. Aug 2003. Nephrol News Issues. CA: Nurse errs in giving pitocin to stop labor: father's suit for emotional distress fails. Healthcare Benchmarks Qual Improv. Ky Nurse. OR staffing holds up. Anonymous. Guidance paper: refocusing the role of the midwife. 2003 WL 22463340 so. Sep 2002. Comment.45(5):1.21(5):13. Oct 2004. The business planning framework-nursing resources. 154. hospitals lure nurses with sign-on bonuses. Anonymous. Pelican news Mar 2004. Apr 8 2002. 160. ANA applauds federal legislation to mandate safe nurse-to-patient ratios. Aug 2002. Anonymous. 162. 153. 5. Nurs Manage. Review.8(8):85-87. Hodgen. Dec 2003. Nurses and pharmacists partner for patient safety.78(1):64. Comment. Comment. Anonymous. Anonymous. March results: 'nurse staffing--beyond the ratios'. OR Manager. Sep-Oct 2002. Levels of care: the impact of nursepatient ratios. Oct 2004. Sep 2002. Qld Nurse. The true cost of overtime. Comment. 151. 155. Healthc Financ Manage.76(7):8-10. Mod Healthc. 128. Review. Tex Nurs. 14-16 passi.60(1):20. News. Anonymous. Legal cases. Comment. News. Anonymous. Feb 2002. Synergy News Aug 2002:20-1. Nurs Law Regan Rep. staff morale. Anonymous. Anonymous.58(11):118. Anonymous. Developing a plan to improve the odds of retaining your staff. Apr 2002.16(5):63. Legal cases.44(7):3. Comment. Spotlight on nursing. 127128. Reducing junior doctors' hours will extend opportunities for nurses. Anonymous. Healthcare Benchmarks Qual Improv. 124.43(8):3. B-4 . Shifts go up for bid: hospitals see boost in patient care. Nurses identify barriers to educating patients about meds. 122. Anonymous. Jul 2004. Nurs Law Regan Rep. 138. Anonymous. Inadequate staffing linked to poor patient outcomes. Faced with staffing minimums. 158. Anonymous. Implementation begins. Case on point: Mobile Infirmary Medical Center v. 150. Mar-Apr 2002.28(9):122.44(4):3.4 million judgment. Tex Nurs. Mar 2002. Nov 2003. Nurs Times. Not eligible target population. Jan 2004. Comment. PSNA mandatory overtime survey summary. but coping with shortage is more challenging. Anonymous. Anonymous. 130.51(3):6. JulSep 2003. 152. etc. Comment. claim based on PTSD resulting from short staffing. Not peer reviewed. Research shows Michigan safe patient care initiatives save lives and money. Can Nurse. 11. 148. Anonymous. Anonymous.45(5):3. 48. Mar 2002. Anonymous. RN's comp. 159. Anonymous.19(2):10-12. Healthc Financ Manage. J Nurs Adm. Anonymous. 123. emphasizes the '5 Rs' of drug administration. Feb 2003. Feb 2004. Comment. Mich Nurse. Legal cases.100(30):15. NY: nurse learns of pt's doubt re surgery site: hospital liabile for operation on wrong hand. Jan 2003. Sep 2003. Comment. Mod Healthc. Comment. Not peer reviewed. News. 135. 584 S. Study shows 12-hour shifts increase errors. 140. Comment.32(6):1. Sep 2003.2d--AL.33(8):18. Not peer reviewed.35(3):1. Feb 2004. N J Nurse. Case on point: Smith-Price v. Jun-Jul 2004:8. 127. Nurse sued when child dies from error in interpreting drug dosage. Nursing. Letter.19(1):1. Anonymous. Web survey. Position statement on intensive care nursing staffing. Anonymous. Anonymous. Preliminary report. Legal cases. Nurs Law Regan Rep. Prof Nurse. Anonymous.. Comment. Patient Care Manag. 10-11. Healthcare Benchmarks Qual Improv. Focus on patient safety.19(11):6-7.11(9):105-106. Adverse events.32(14):35. Patient Care Manag. 126. IL: Discovery of disciplining of RN post pt. Hashing out California's staffing ratios. 156. 6. Jul 27Aug 2 2004.Suppl:44. Web survey. Legal cases. California patient care labor costs rise under staffing requirements.18(12):1. Anonymous. Veteran nurses give patients a quick look to avoid waits. Anonymous. 4-6. 147. Oct 2004. Anonymous.32(3):122. Anonymous. Anonymous. Tales from the trenches.33(9):20. Legal cases.44(4):2. Hosp Health Netw. Legal cases.121.34(2):1. Review. No association tested. RCM Midwives J. May-Jun 2003. Deplorable ICU nursing results in $2. AL: wrong epinephrine dose--cardiac arrest: Ct. Survey shows increasing vacancy rates. Anonymous. Am Nurse. Nov 2004. 136. mandatory overtime by RNs in Louisiana 2004 Louisiana Registered Nurse Population Survey. 142. 146.11(10):109-112. Nurs Law Regan Rep. 137. News. Dec 23 2002. Nurs Law Regan Rep. 46. Nurs Law Regan Rep. 5 resolutions for a happy 2003. Aug 2004. 132. Anonymous. A focus on lasting workplace solutions. Anonymous.5(4):128133. Do you address staffing effectiveness standards? Hosp Peer Rev. 149. Data trends. Tough times in healthcare. Anonymous. Federal safe staffing bill introduced. Comment. By the numbers. Not eligible target population. 143.

Healthcare Benchmarks Qual Improv.21(5):263-269. Bond S. Is a serious nurse shortage coming? Tex Nurs. 166.26(9):64A-64B. Murphy J. Sep-Oct 2004. OctDec 1993. 169. J Nurs Manag. 181. 187. News. May-Jun 1994. Thomas W.21(1):218-223. Adejumo O. Adomat R. Clinical specialty and organizational features of acute hospital wards. Flexible job options help maintain quality. Jul 2005.101(24):69. Jun 12-18 1991. Not eligible outcomes. Measuring nursing workload in intensive care: an observational study using closed circuit video cameras. Jan 2004. Adams B. Feb 2003. Discrepancy between patients' perspectives. Not relevant. Nurs Times. Haxton R. The relationship between number of nurses and ward organizational environment. Tewes M. Not eligible target population. Adams K. Not eligible exposure. Are we our own jail keepers? Revolution.5(38):52-53.11(5):293-298. No association tested. Wright S. Cancer Nurs.12(3):167-169.3(1):37-44. Bond S. Rasmussen JM. Healthcare Benchmarks Qual Improv. Apr 2005. May 11-17 2004.73(3):10-13. 186. staff's documentation and reflections on basic nursing care. et al. Not relevant. Up to one's eyes. Anonymous. 164. Nursing development? Nurs Stand. Legal cases. Profile: Barry Adams in his own words. AR:12-hour-shift RN falls on trip to cafeteria: workers' compensation benefits awarded to nurse.10(5):55. Plugging the gap--critical care skills are the current universal commodity. Oct 25-31 1995. Comment. Nurs Manage. Jun 14-20 2005. Nurs Econ.45(12):2. Not eligible target population.9(5):195-198. The relationship between use of varying proportions of part-time faculty and full-time nursing faculty perceptions of workload and collegial support. Henry MB. 176. Am J Crit Care. Comment. Scand J Caring Sci.23(6):12. May 2005. Not eligible target population. Agbo M. Interview by Janis Smy. 184. Interview. Young A. 173. 175. Adams KS. staff stability and features of ward organizational environment. Review. humor too: a model to incorporate humor into the healthcare setting. Comment. Nurs Forum. Making a difference. Ackley NL. Abbott ME. Comment. Not eligible target population. Bond S. Agnew T. Adams A. Women need flexible schedules and challenging assignments. J Adv Nurs. 167. 188. Sep 2003. Apr 2005. Ackerman MH. AACN standards for establishing and sustaining healthy work environments: a journey to excellence. 174.163. Health & Hospital Corporations.12(4):41-43. Anonymous. J Nurs Manag. Anonymous. unified goals: continuing education program for multinational nurses in a hospital in the Middle East.12(5):299-308. Nov-Dec 2000. Adams DA. 183. Exploring and encouraging through social interaction: a qualitative study of nurses' participation in self-help groups for cancer patients. Mar 1999. Anonymous.45(11):3. May 2003. Nurs Times. Nurse terminated for meds. J Adv Nurs. Not eligible target population. 194. Not eligible target population. Anonymous. 178. 193. 195.11(5):287-292. Dec 1997. Nurs Crit Care. International employment in clinical practice: influencing factors for the dental hygienist. Adams B. Zehrer CL.30(2):79-83. Adams DA. JCAHO's 2006 National Patient Safety Goals: handoffs are biggest challenge. Sep 1995. Van Dyke P. Anonymous. Comment. Adamsen L. 179. 172. Revolution. error: hospital attempts to deny access to records. Tar Heel Nurse. Anonymous. Interview. Staffing in acute hospital wards: part 1. Hosp Peer Rev. Sep 2004. Hewison A. Nurs Law Regan Rep. 191. Collaborative care: a professional model that influences job satisfaction. Staffing in acute hospital wards: part 2. 185.91(23):18. 165. Addressing barriers in headache care. Not eligible target population. Adam S. Relationships between grade mix. B-5 .11(1):8-9. 64G. Divergent backgrounds. Coffey N.1(1):10-11. Health Care Strateg Manage. Barrow S. 174. Not eligible target population. 2005 WL 697435--NY. Anonymous. 182. Not eligible exposure. Hicks C. 190. 168. Adams A. The relationship between use of varying proportions of part-time faculty and full-time nursing faculty perceptions of workload and collegial support. An opportunity to shape patient care. Comparison of a needleless system with conventional heparin locks. J Contin Educ Nurs. Nurs Times. Position paper on safe staffing. Jan-Feb 2000. International Journal of Dental Hygiene Feb 2005. Anonymous. Oct 1993. Comment.30(7):89-93.42(4):402-412. Jan-Feb 2002.14(3):187-197. Comment. 192. Accountable but powerless.28(4):9-16. Case on point: Chapman v. Humor won. Legal cases.100(19):26-27. Jun 2005. Sep 2003. Graham KM. Am J Infect Control. 170. 180. Abbott A. Nurs Law Regan Rep. Adams A. 171. Measuring the effects of a selfscheduling committee. J Nurs Manag. 177.26(1):28-36. Mar-Apr 1999. Adams B. 64D. Jun 7-13 1995. More than 40% of nurse errors not from medication. Editorial. Anonymous.67(1):20. 2000. Assessing patient category/dependence systems for determining the nurse/patient ratio in ICU and HDU: a review of approaches. Nurs Stand. Not relevant. Review. Jan-Feb 2005.1(6):30-31. Not eligible exposure. Abbott J. Adamsen L.14(2):120-129. May 2005. Lopresti F.26(6):1158-1167. Adomat R. 189. Health Aff (Millwood). Comment. Not eligible target population.

No association tested. Mar 29Apr 4 2001. Sloane DM. 209.10(1):1-3. Ahmed DS. Sloane D.196. 216. Sochalski J. 203. Clarke SP. Sep 1997.99(1 Pt 1):12. 208. Yancey V. Aiken LH. Int J Qual Health Care. Case reports. Competencies related to medication administration and monitoring. Hamrah PM. 220. Jan 1997.87(1):103-107. Weber AL. Sloane DM. Trends in international nurse migration. Nurses threaten to quit bank as rates are slashed. 206. Smith. Donmez L. Am J Public Health. Out-patients in vogue. Formative evaluation: implementation of primary nursing. Aiken LH. Nichols B.30(10):457-465. Jul 5-11 2001. Not eligible target population. Alexander C.5(24):16. Mar 2000. Sloane DM. Jan 1999. Cowen ME. Not eligible target population. Apr 1998.99(9):12. Jan-Feb 2005. Nurs Crit Care. Harp K. Chaturvedi S. 213. Hospital staffing. Allan D.93(3):7074. and patient mortality.12(4):476483. Scholes J. News. Nurs Times. Alberts MJ. 800m pounds: the government's incentive to end NHS reliance on agency nurses. Nov 1998. Guvendik L. 214. Ahmann E. wrong dose. A national comparison of dedicated and scattered-bed units. 205. Mar-Apr 2002. Sochalski J. Mar 814 2000. B-6 . Not eligible target population. Hospital nurse staffing. Aiken LH. Sloane DM. Alex J. 222. Nov 10-16 1999. Nurs Stand. Alasad JA. Nurs Stand. Aiken. Self-scheduling: two success stories. Comment. Improving family communications at the end of life: implications for length of stay in the intensive care unit and resource use. Not eligible target population. Silber JH. Am J Nurs. Sloane DM. Comment.24(5):467-469. 202. Sep-Oct 1998. Aiken LH.49(3):146-153. 219. Scott P. Critical care nurses' use of decisionmaking strategies. Am J Nurs. Griffin SC. May-Jun 2004. 199. 224. Organization and outcomes of inpatient AIDS care.14(8):23. Not eligible target population. 212. Evans B. Daylight exposure and the other predictors of burnout among nurses in a University Hospital. 228. 211. quiz 35-26.5(1):1-4. Aiken LH.23(3):69-77. 198. Hospital restructuring: does it adversely affect care and outcomes? J Nurs Adm. Nurs Stand. Ahmad MM. blended or disappearing--the image of critical care nursing. Aiken LH. Havens DS. Aiken LH. LDI Issue Brief. Examining assumptions underlying nursing practice with children and families. Can J Nurs Adm. Nursing overseas: caring in a divided community. Comment. Nurs Spectr (Wash D C). Clarke SP.27(4):865-869. Jul 2003. Lawrence J. Go with the flow. Kollef M. Sloane DM. Feb 2002. Allanach H. Ahmed DS. Clarke SP. Patrician PA. Nurs Times. Nurs Res. Nurs Stand. retrospective. Evidence of our instincts: an interview with Linda H. Jacobsen MJ. Not eligible target population.25(1):111-115. Not eligible target population. Not eligible exposure. News. Comment. J Clin Nurs. 197. Rao VP. Raps E. Satisfaction with inpatient acquired immunodeficiency syndrome care. Int J Nurs Stud. Cale AR. 217. Oct 2004. Ahrens T. and quality of care: Cross-national findings. Not eligible target population.97(27):9. Alderman C. Alimoglu MK. Klocinski JL. Aikens A. Sep 1999. 207. Cornes D. 229. Nurs Outlook. 225. 215. Marable K. Aiken LH. Lake ET.7(29):22-23. better patient outcomes: why isn't it obvious? Eff Clin Pract. Not eligible target population. Hospital nurses' occupational exposure to blood: prospective. 200. Comment. education.12(4):317-323. Sep 1997. Oct 2000. Akid M. 223. Oct 2003.14(1):513. Stroke. organization. National Acute Stroke Team Group. Havens DS.20(2):58-61. Interview by Alison P. Ahmed S. Aiken LH. Graham G. Colors of the spectrum. Not eligible exposure. Not eligible exposure.10(3):54-73. Aiken LH. 210. Fall 1993. LDI Issue Brief. Apr 7-13 1993.8(34):40. discussion 324.100(3):26-35. Nurs Times. Jul 2005. Powell M. Not eligible outcomes. Aiken LH. Blurred.25(3):15-28. Pay. Pediatr Nurs.14(25):41-47. Nov 27 1995. Akid M. Can J Nurs Res. Hospital staffing. May-Jun 2000. Jul 2003. Not eligible exposure. Not eligible target population. Sep 1999. No association tested. Surgical nurse assistants in cardiac surgery: a UK trainee's perspective. Palladino M. Comment. 227. Sloane DM.97(36):12-13. Fecik S.4(5):223-225. Mar 1993. Nurs Econ. The fatigue factor. Am J Nurs.42(5):549-555. Acute stroke teams: results of a national survey. 204. Comment. Measuring organizational traits of hospitals: the Revised Nursing Work Index. Int J Nurs Pract. Sloane DM. Aiken LH. and institutional reports. The impact of management of change projects on practice: a description of the contribution that one educational programme made to the quality of health care.50(5):187-194. Case reports. Med Care. Aiken LH. Jamieson DG. Lake ET. Albarran J. Review. Am J Nurs. More nurses. Right drug. Alcock D. and quality of care: cross-national findings. Agency/registry nursing. Clarke SP. Sep-Oct 2002. Krakowski F. organization. Editorial.97(13):10-11. Sep 6-12 2001. J Adv Nurs.10(5):235-241. Am J Crit Care. Sep-Oct 2001. Aitken LM. Not eligible target population. The art of the deal. Not eligible outcomes.29(11):2318-2320. Predictors of patients' experiences of nursing care in medical-surgical wards.9(2):1-4. The camera never lies. Akid M.35(9):948-962. The Magnet Nursing Services Recognition Program. Eur J Cardiothorac Surg. Not eligible outcomes. Published twice. Goodman J. Jan 2004. 221. May 18-24 1994. When long shifts harm patients. Hughes RL. Buchan J. Alcock D. Sayre C. Ellis J. 201. Whitmer K. Health Aff (Millwood). 226. Magnet nursing services recognition programme. 218.

Comment. Editorial. Mil Med. Occup Health Saf. Comparing the teaching effectiveness of part-time & full-time clinical nurse faculty. Shimaoka M. J Nurs Scholarsh. MacKintosh AM. Legal cases. 235. Sep 2-8 1992. Comment. A comparison of rotating-shift and permanent night nurses. This is news? Crit Care Nurse. Not eligible target population. Oct 1991.27(3):297-302. Knight CD. Takeuchi Y.57(3):211-216. 237. Nurs Inq. Interview. Job satisfaction among nursing staff in a military health care facility. Altman S. Not eligible target population. Not eligible target population.17(12):39-40. Alward RR. Angus J. Anderson TA.15(1):4. Reflect Nurs Leadersh. VanDerslice J. Legislating nurse-patient ratios: A controversial approach to improving patient care? J Emerg Nurs. Not Eligible exposure. Allen C. Editorial. J Adv Nurs. 251. Oct 1999. 244. Not eligible target population. Mellor D. 256. Not eligible exposure. Anshus JS. Dec 2001. and burnout amongst nurses. Accid Emerg Nurs. Nev Rnformation. Pallent S. Uniforms: a strange custom? Nurs Times. Aspens Advis Nurse Exec. Jul 2001. Letter. Not eligible target population. Feb 2003. Assessment of nurses' continuing education needs in Jordan. Ang R. J Perianesth Nurs. J Child Health Care. SalazarMartinez E.19(4):725-732. 263. Crit Care Nurse. and more buttons: are they professional? J Nurs Adm. Webster CS. Allen SK. Eadie DR. Momani M. Not eligible target population. Not eligible target population.9(7):suppl 1.26(6):5-11. Alleyne J. Ono Y. Comment. Not eligible target population. Weaver L.30(4):176-181. author reply 4-5. Jun 2005. 248.31(12):559-560. 2003. Altimier LB. Hori F. 260.30(11):59-62. West J Nurs Res. Nurs Manage. Fong LC.23(1):14-15. Student and faculty perceptions of teaching effectiveness of full-time and part-time associate degree nursing faculty. Maloney JP. Anderson C. Jennings BM. Perceptions of nurses with regard to doctor-patient communication. Oct 2000. A 'round-the-clock' profession: coping with the effects of shift work. Not eligible target population. Nov 1995. 255. Wittwer W. Sullivan B. Implementing evidence-based nursing practice: a tale of two intrapartum nursing units. Maloney JP. Int J Nurs Stud. Enteral feeding: a change in practice. Apr 1994. A descriptive. 258. Nov-Dec 2004.10(4):218-228.9(2):92-100. Alspach G. Mil Med. Dec 11-2004 Jan 7 2003. 242. Turner PS. Anderson LA. 232. Not eligible target population. Mil Med.11(1):19-24. al-Ma'aitah R. Comment. 231. Anderson S. The mentality of contraction. J Healthc Qual. Kraus-Weissman A. Allgood C.165(10):757761. When your work conditions are sicker than your patients. Editorial. 261.12(22):1312-1321. Apr 2001. Feb 2002. 250. 2005. Sanders JM. Interview. Using bar-code point-ofcare technology for patient safety. O'Brien-Pallas L. Alward RR.163(2):90-94. J Contin Educ Nurs. The effect of an intervention programme on interactions on a continuing care ward for older people. Zamora-Munoz S. Not eligible target population. Hodnett E. buttons. Occup Environ Med. Not relevant. Heffernan C. AllisonJones LL.4(4):160-162. Nov 1999. Winter 2000.88(36):51. Nurse staffing and patient outcomes. and provider workload at an army medical center. 14. Chart. Feb 1998. Not eligible target population. 259. Nurs Stand. The management of sickle cell crisis pain as experienced by patients and their carers. Alvarez del Rio A. 262.28(2):12. B-7 .37(1):73-79. Lazcano-Ponce E. Monk TH. 249.24(8):905-917. 236. Beard LW. O'Rourke K. Study links rotating shift work and nurses' risk of coronary heart disease. Cross-training in 3-D. Alspach G. Helms LB. Nursing leadership: the Singapore experience.161(1):48-53. Not relevant. Am J Emerg Med. Hart GK. Nursing Education Perspectives Sep-Oct 2004. Wilder K. Perton L. Dec 4-10 2002. Dec 2002. J Adv Nurs. Ando S. Not eligible outcomes. Clarke MM. Am Nurse. Arbitrator upholds RN's refusal to work unsafe assignment. Back belts pay off for nurses. 247. Thomas VJ. J Adv Nurs. Almeida SL. correlational study of patient satisfaction. Anderson S. Jan 1996. Amato M. Not eligible target population.35(1):34-41. Comment. 1990. Aust Crit Care. Allen CI. Hernandez-Avila M. Management of alcohol misuse in Scotland: the role of A&E nurses. Hospital readmission from home health care before and after prospective payment. Oct 2002. 253. 254. Recruitment problems in intensive care: a solution. May 1997. Not eligible target population. Anderson DJ. Not eligible target population. Foreman MD.25(5):238-43. Angeles-Llerenas A. Not eligible outcomes.94(5):1. 239. 234. Work context.230. Allen J.28(5):377-378. Implementing a new drug record system: a qualitative study of difficulties perceived by physicians and nurses. 243. Utilization of supplemental agency nurses in an Army medical center. provider satisfaction. Hattori Y. Mar 2002. Qual Saf Health Care. Jan 1996. 233. Andersen SE. Alward RR. Not eligible target population. 4. AllisonJones LL. Ambrose C. Hiruta S. Schramm CA. 241. 252. Adapting charting by exception to the perianesthesia setting.16(10):11721177. Hardy MA. Dec 2003. A systems approach to the reduction of medication error on the hospital ward. Jul-Aug 1999.29(1):26-28. 257. Anderson FD. personal control. Anderson FD. Hirt JB.14(5):260-269. Apr 1994. Associations of self estimated workloads with musculoskeletal symptoms among hospital nurses. Economic and quality of care issues with implications for scopes of practice--physicians and nurses. Br J Nurs. Anderson RM.14(1):114. 238. Mar 1996. Data clarification.25(3):11-12. 246. Buttons. Anderson MA. Jan 1996. Monk TH. 240. 264. 245. Haw S.65(1):59-62.4(4):18-19. Mar 2000. Comment.

Arvanitopulos BL. Not eligible exposure. Nazel MW. 283. and bias. Nurse retention: is it worth it? Nurs Econ. Improving care givers' satisfaction with information received during hospitalization. Sievers L. Epidemiology. Zaim S. Jan 1999. Jul 2000. 300. Predictors of psychological well-being of nurses in Alexandria. No association tested. 295.33(1):50-51. 280.32(2):292-300. Hoffman-Hogg L. Astelm J. Anthony MK. Del Rincon C. Jun 1997. Mar 2000. Toth W.265. Ashe N.9(4):20.27(1):21-27. Jan 2002. Lancet. Feb 2005. Medication errors. Not eligible target population. Manley M. Nurs Stand. Not eligible target population. Comment. Atencio BL. Jul-Aug 1999. Meet the travelers. Legal cases. Not eligible target population. J Nurs Adm. Bailey F.25(9):64-69. May 5 1990. Arndt M. 276. Not eligible exposure. 259. Revolution. Babus V. Comment.15(6):15-17. S C Nurse. Woodhouse D. Mar 2005. Downsizing-initiated job transfer of hospital nurses: how do the job transferees fare? J Health Hum Serv Adm. Gorenberg B. Manzo L. Staffing is a concern in telemetry. The validity and reliability of the measurement of the concept 'expressed emotion' in the family members and nurses of Hong Kong patients with schizophrenia. Nursing. Aquila A.105(5):97. Jan 1997. 284. Comment. Mion LC. Camino MK. Setting nurse-patient ratios: ANA bill calls for development of staffing systems in hospitals. Rosenberg C. Arthur D.6(2):9. J Gerontol Nurs.36(4):5-6. Bailey DA. Badovinac CC. Staffing: know your liability. Not eligible target population. Mechanical restraints.335(8697):1104-1105. Int J Nurs Pract. 289. 288. 281. Nurs Econ. Not eligible exposure. Feb 1990.Suppl:22. 290.7(6):371-373. Not eligible exposure. Not eligible target population. Sep 2001. No association tested. OR Manager. 299. Horsburgh ME. May 10-16 2000. 274. Child Care Health Dev.10(6):38. Get customer sensitive. Sep 2002. 291. 267. Francke AL. The Vascular Project: using data to improve processes and outcomes. Not eligible exposure. 273.17(4):194-200. 268. Baarda S. Bailey M. Arford PH. 269. response rates. B-8 . Nurs Manage. Arafa MA.31(7):19. Dec 1998.16(4):14-23. Managers' advice on OR staffing. Interview. Arroliga AC. May 2005.9(5):313-320. 292. Jun 1999.1(3):254-258. Not eligible exposure. A patient-centered model of care for hospital discharge. 272. Artz M. Mar-Apr 2005. A post-modern nursing model. Patient Educ Couns. 282. 296. Tuberculosis morbidity risk in medical nurses in specialized institutions for the treatment of lung diseases in Zagreb. Javalgi RG. Valdes MS. OctDec 2002. J Health Care Mark. Avigne J. Value = quality + cost. May-Jun 1999. Wilson S. 278.22(5):388-398. Comment.14(34):40-42. Sep 1996. Not eligible outcomes.20(2):113-116. Sep 1995. 275. Arsenault S. No association tested. Cohen J. Arts SE. Not eligible exposure.24(3):122-128. Anthony MK. Not eligible outcomes. Interview. Cameron SJ. Introduction of sedative. Slomka J. Am J Nurs. 287. Not eligible exposure. Int J Tuberc Lung Dis. Nurs Older People. 293. Armstrong-Stassen M. Comment. Res Nurs Health.19(3):80-86. The use of unlicensed assistive personnel and selected outcome indications. Research in practice: how drug mistakes affect self-esteem.28(3):707-713. Bailey BA. rehabilitation therapies. Wright C. Education and person-centred approaches to dementia care. Egypt. Aug-Sep 2001. and neuromuscular blocking agent guidelines in a medical intensive care unit: physician and nurse adherence. Not eligible target population. Oct 2000. Asch DA. Survey of nurses and patients shows a strong link between employee satisfaction and patient loyalty. Letter. How to float safely and effectively. 286.5(4):10-11.25(1):13-21. Bailey L. Rehabil Nurs. Hurdle JF. Arbesman MC. J Vasc Nurs. Austin S. Arranz P. LopezFando T.56(2):233-239. Oct 2004. Ibrahim NK.20(5):14-16. Happy employees lead to loyal patients. Crit Care Nurse.12(10):17-19. Nov 1-6 1995. Int J Ment Health Nurs. Baggot DM. Rn. Ramos JL. Liaison nursing for stroke patients: results of a Dutch evaluation study. A day in the life: a night to remember. May 2004.13(2):117-136. Use and success.21(6):369-375. Atkins PM.23(4):470-489. Hudson-Barr D. J Nurs Adm. Nurs BC. Comment. Attia A. Hutten JB. Oct 2003. You're pulling me where? Medsurg Nurs. and staffing adequacy as risk factors for falls in an elderly hospitalized population. 279. 270. Use of a coded postcard to maintain anonymity in a highly sensitive mail survey: cost. Bobek MB. The new hire/preceptor experience: cost-benefit analysis of one retention strategy.11(3):192-198.7(5):550-551. 298. Comment. Atkinson M. 285. Elizabeth and Alexandra's story. Nurs Manage. Armstrong M. Case reports. Medical errors--what we can do? One informed patient's recommendations. Spring 2001. Nurs Times. Bair N. News. Aug 2000. Apr 13-19 1994. 266. Occupational HIV infection risk. OR roundtable. Ulla SM. Hensinger B. Letter. Oct 1999. Allred CA. 277. 294. Feb 2001. Evaluation of a counseling training program for nursing staff. Anton D. Jan 2004. Nurs Stand. analgesic. Crit Care Med. Johnson MA.35(3):138-145. Case reports. Not eligible target population. The relationship of authority to decision-making behavior: implications for redesign. J Nurs Adm. Winter 1996. Archibald G. McHugh N. Mion LC. 299.21(6):262268. Nov 1995. Bair B. Nov-Dec 2003. Not eligible exposure. Caring for staff nurses. AWHONN Lifelines. 271. Aveyard B. Not eligible exposure. 297. Staff mix and public safety. 19. Marshall BS. Interventions for disruptive behaviors.90(15):27-30. Danielle Anton. Arbitrator: hospital must tie admissions to RN staffing. 301. J Adv Nurs. Parry J. Clin Nurs Res.

332. Oct 2004. Not eligible target population.24(3):56-60.2(4):28-30. 328. Not eligible outcomes. J Nurs Manag. Bartram T. Baxter B. Prahlow JA. 308. May 26-Jun 1 1993. Feb 28-Mar 5 1996. Barton J. 1997. Kettle AG. Br J Theatre Nurs. Bassett D. Radiation dose rates from patients receiving iodine-131 therapy for carcinoma of the thyroid. Have I been here before? Br J Theatre Nurs. Sep 1993. Bates J. Jul 2003. 320. 324. Not eligible exposure. Barton J. 1991. Mar 1993. May 1997. Oct 1998. Frost GL.92(9):32-33. Baxter B. Coakley AJ.16(2):110-119. International journal of nursing studies Feb 1993. The prevalence and nature of errors and near errors reported by hospital staff nurses. McCubbin M.18(6):932-937. Tebbie N.v. Comment.302. Dec 2001.17(3):293-304. The effects of a theory-based training program on nurses' self-efficacy and behavior for smoking cessation counseling. Hardy B. Barton J. Barzoloski-O'Connor B. Jun 10 2004. Costing services: comparing three i. 334. Not eligible target population. O'Doherty MJ. Investigating shift preferences. Scott LD. Meskimen K. Defective agency. Rogers AE. Barrington SF. Stacy RD. Baker H.49(5):1117-1120. Rules outside the rules for administration of medication: a study in New South Wales. Balas MC. Nurs Manage. Totterdell P. Comment. Edtna Erca J. One day it could be you.6(16):16. Apr-Sep 1995. Patient classification used as a tool for assessment of staff/patient ratios. Not eligible exposure. Nurs Times. Baulcomb JS.9(2-3):109-123. Not eligible exposure. Barton E. 333. Sanders D.23(2):123130. Review. J Contin Educ Nurs. Workwise: a job problem shared. McElligott M.20(2):62-68. 321.7(36):44-45. Nov 1994. Image J Nurs Sch. Smith LR.2(5):34-36. A topical metronidazole gel used to treat malodorous wounds. Ball C. Moving on from 'patient dependency' and 'nursing workload' to managing risk in critical care. 326. Totterdell PA. J Forensic Sci. Barnes J. Mar 8-14 2001. 304. 316. Barton J. Not eligible exposure. Smith L. Not eligible target population. Is flexible rostering helpful? Nurs Times. Not eligible target population. Bale S. 327. Nurs Pract. Spelten E. Barratt E.36(3):117-123.14(10):26-27. Is there an optimum number of night shifts? Relationship between sleep. 14-17. Jul 29 1996. Psychiatric caring. J Perinat Neonatal Nurs. Not eligible target population. 322. Part 5. Not eligible outcomes. Somer EJ. Harper P. Rosenbaum SH. Spelten ER. Feb 15-22 1995. Bates E. Intensive Crit Care Nurs. Nurses and medication. Nurs Stand. Not eligible target population.11(4):275-280. 303. 311. Arrington DM. Oct 1994. 313. J Adv Nurs. Not relevant.8(7):41-42. Bergmooser G. 307. Walker G. Bauer I. Nov 2004. Nurs Manage. Implementing developmentally supportive family-centered care in the newborn intensive care unit as a quality improvement initiative.24(1):13-16. Nursing shifts. 315. 329.00 a. Evans CB.30(1):65-80. et al. 314. Nurs Spectr (Wash D C). will travel. Aust Nurs J.30(1):51-55. Factors affecting the job stress and job satisfaction of Australian nurses: implications for recruitment and retention. Joiner TA.00-7. Not eligible target population. Smith LR. Apr 2001. Operating department staffing--a business manager's perspective. Comment.113(3):569-570. Hospitalized children with chronic illness: parental caregiving needs and valuing parental expertise. Not eligible target population. Baker K.) in a German hospital. Accidental insulin overdose. Not eligible target population. Tsourtos G. Apr 2004. Bamber M. Nurs Times. 323. Baker HM. Comment. Chest. Case reports. Spelten ER. Contemp Nurse. Banks N. Bania K. Barker P. Australia. Medication error: the big stick to beat you with.87(19):44-45. Nurses' perception of the first hour of the morning shift (6. A classification of nursing and midwifery shift systems. Jan 1999. Not eligible target population. Price P. B-9 .28(5):78.13(11):S4-11. A classification of nursing and midwifery shift systems. Not eligible exposure. Sep 2004. health and well-being. 319. Have license. May 8-14 1991. Nurs Stand. Feb 1996. Jun 2-8 2004. Balhorn J. Nov 24-30 1999.18(38):24-25. Wells CP. 317. Not eligible target population. Part-time working. Ballweg DD. Inpatient suicide in a general hospital psychiatric unit.29(2):155-158. Management of change through force field analysis. A consequence of inadequate resources? Gen Hosp Psychiatry. Batalis NI. A life in the day of. 318. Br J Nurs. Not eligible target population. Reasons for leaving among psychiatric nurses: a two-year prospective study. Comment. Tiburzi T. Aust Nurs J. Nurs Times. Comment. 331.30(1):65-80. Baker H. Nurses and medication. Staffing ICUs: the good news and the not-so-good news. 325. Folkard S. 330. Barta SK.m. Feb 1993. Appl Nurs Res. Not eligible target population. Oct 1997.7(7):11. Jun 1993. Comment. Mar 1998. 306. 335. JanMar 1998. Barash PG. Naphthine R. Work Stress.97(10):38-39. Not eligible target population.91(7):32-33. Not eligible target population. 312. Part 6. Kokoski P. May-Jun 2005. Ritual+workloads = medication error. Balling K.15(5):301-306. 309. J Pediatr Nurs. Folkard S. medication systems. Naphthine R. Int J Nurs Stud.15(3):58-73. Nurs Stand. Nolan MT.4(4):9-11. Not eligible target population. 310. Nurs Manage. Comment. Eur J Nucl Med. A tool for improving supplemental staffing.17(4):224230. Take the plunge: expanding the float pool to "closed" units. 305. Stanton P.

Berliner H. 355. Crit Care Nurs Clin North Am. Measuring patients' perceptions of nursing care. Intensive Crit Care Nurs. The influence of nurses' knowledge. 357. Everyday thoughts: harnessing the thought process toward a practical framework for increasing critical thinking and reducing error. 338.23(7):638-642. Health Serv J. Leadership through shared governance. A fable for health care safety. actual knowledge of pressure ulcer care in a hospital nursing staff. Bednar B. 'Great fleas have little fleas': Irish student midwives' views of the hierarchy in midwifery. Beltzhoover M. attitudes. Myers WA. Berggren E. Longabaugh R.14(4):xiii-xvi. Nirenberg TD. Jun 27 2002. Alcohol use among subcritically injured emergency department patients. 350. Blood loss estimation in epistaxis scenarios. Jr. Feb 1999.6(2):71-75. Not eligible target population. Ribak J.52(4):7. Oct 1998. 359. US healthcare.119(1):16-18. Jun 1995.336. Aug 1999. Jul 1999. 342. Berland A.33(24):30-31.112(5811):32.95(1):19-20.20(5):278-282. Comment. Svensson C. 364. Chvatal R. 346. Hospitals and nurses at odds over potential effect on staffing. McMullen N. J Adv Nurs. United straits.9(9):3940. 365.86(5):36-38. No association tested. Lyon J. Ratio daze in California. Beasley T. Munjas B. Mar-Apr 1988. 356. Mod Healthc. A retrospective analysis of employee turnover in the health care setting. Nurs Econ. 363.12(2):35-39. Nov-Dec 1990. Bergbom I. Sep 1995.29(4):4-5. Stoma care nurses: good value for money? World J Surg. Health care: mandatory nurse-to-patient staffing ratios in California.25(4):81-82. Databits. 353. Berden HJ. Becker B. Mar 1995. O'Brien D. Beardsley D. Dec 2002. Jun 12 1993.7(5):293-301. Workforce report 2003. Comment. Sep 1995. How frequently should basic cardiopulmonary resuscitation training be repeated to maintain adequate skills? Bmj.26(7):400-409. Apr 2001. Sep 2001. Kamsula M. Letter.43(4):370-376. Benjamin I. Board of Nursing decision puts patients at risk. Hey. Comment. Clifford PR. Melzer A. Belcher JV. Can Nurse. Medsurg Nurs. 354. Feb 1998. Calpin-Davies PJ. Self-scheduling: an innovative approach. Cancer Nurs. Stop floating--the next paradigm shift? J Nurs Adm. Not eligible exposure. Staff turnover in the dialysis unit. Comment. Jul 2000. Not eligible exposure.27(9):32B-D. Oct-Dec 2004. Willems FF. Sinitzky M. Behrman AJ.13(4):514-521.15(4):185191. Dec 2002. Hendrick JM. Not eligible target population. viii-ix. Schulten-Oberborsch G. 337.14(4):385-390. Review. Not eligible target population. Staff allocation and rostering in a Queensland public hospital. West J Nurs Res. Patients' and relatives' opinions and feelings about diaries kept by nurses in an intensive care unit: pilot study. Bechel DL. No association tested. Nephrol News Issues. 351. Becker A. 341. Dune L.4(2):7. Bennett DS. Controlling workload. No association tested. Comment. Not eligible target population. J Law Med Ethics. Comment. Fey J. Jan 2005. Nephrol News Issues. 344. Sep 1996. Acad Emerg Med. Workforce dilemmas: a comparison of staffing in a generalist and a specialist intensive care unit. Becker ER. Knape JT.38(3):310-317. Apr 1994. Begley CM. 348.78(1):35-38. Vestweber KH. Does patientcentered care pay off? Jt Comm J Qual Improv. Perceived need for education vs.2(9):784-790. 360. Psychiatric-mental health head nurse management concerns. Rehabil Nurs. May 2002. State staffing law may exacerbate nursing shortfall. Nev Rnformation. Green-McKenzie J. Thrall K. Shofer FS. Pijls NH. Beck KL.4(4):260-263. Ben-Ami S. Apr 1999. Larrabee JH. Benko LB. Not eligible outcomes. Not eligible exposure. Jan 1985. 340. 366. Seversen A. Kinzeler EE. Benko LB. Warner JA. Rn. discussion 642-633. Jun 16 2003. Nurs Manage. 349. Smith DG. Not eligible exposure. Diehl B. 339. and health beliefs on their safe behavior with cytotoxic drugs in Israel.30(2):312-313. Sep-Oct 1995. Berglin P. Berman S. Patient flow patterns in a recovery room and implications for staffing. 347.15(1):52-57. Nurs Manage. Intensive Crit Care Nurs. 367. Comment. J Laryngol Otol. Beck U. No association tested. 'Knowing your place': student midwives' views of relationships in midwifery in Ireland. News. Mod Healthc. Berger MC. Ethical issues in nursing.24(3):192-200. Not eligible year. Arch Psychiatr Nurs. Benson RM. 369. Jun 18 2001. that's my grandma! Ky Nurse. 362. Crit Care Nurs Clin North Am. Bednar B. Beach SM. 352. 361. Begley CM. J Nurs Adm. Not eligible outcomes. A non-specialist's guide to the CCU. 368. Beitz JM. Not eligible target population. Bell M. Webb CJ. The blind men and the elephant. Rabin S. 370. Not eligible target population.24(3):4. Beeman J. Duvvi S. Interview by Diane Boudreau.17(3):222-233. Foster RW. Mar 1994. Woolard R. Summer 2002. Aug 1991. Engelsher J. 358. J Occup Environ Med.9(6):10-11. No association tested. Comment. Midwifery. Jun 2001. Aug 1990. Staffing and critical care. J R Soc Med.31(25):52. Not eligible exposure. Oregon passes nurses bill. Not eligible target population. Beard EL. A credentialing program for nursing staff caring for pediatric patients with an ilizarov apparatus. Tandon S. Review. May 1990. Beattie J. Shaham J. Trends in bloodborne pathogen exposure and follow-up at an urban teaching hospital: 1987 to 1997.54(1):50-53. Not eligible year. Minugh A. Cameron AE. Gerbis P. 343. Jan 1991.306(6892):1576-1577. Beer HL. Qld Nurse. Organizational determinants of nurse staffing patterns. Not eligible exposure. Colo Nurse. B-10 . 345. Bennett DS. Wick G. No association tested.

Blanchfield KC.12(1):54-66. Sep 2004. Berrios CD. Not eligible target population.36(8):14-18.8(4):25-27. Berry D. Pepper G. Not eligible exposure. Continuous quality improvement: maintaining quality of care with changing staffing patterns.16(2-3):154-156. what we heard. 388.32(11 Pt 1):80. Beyers M. Ask AONE's experts . 393. Winter 1996. Jun 1996. Binnie A.. Full-time equivalent (FTE) numbers. Mar-Apr 2004. Bingham R. 390. Blackshaw G.7(37):30-33. Mar 2002. Sumner J. Not eligible exposure. Nurs Manage. Mar-Apr 2004. de Haan RJ. Brazzi L. 398. Nursing. Nurs Manage. Prendeville B. Vaughn T.. Not eligible exposure. Freedom to practise: patient-centred nursing. Nurse to Nurse Jan-Feb 1997. Developing a departmental culture for reporting adverse incidents. Astbury J. 380. Intensive Care Med. Aust Coll Midwives Inc J.19(2):67-74. R. Sexual abuse: giving support to nurses. Comment.. Armstrong G. Implementing nursing case management. Bertram DA. J Nurs Adm. Nurs Manage. Using elements of the nursing minimum data set for determining outcomes. Dec 1999.21(6):289299. Int J Health Care Qual Assur Inc Leadersh Health Serv. Comment. Bjork IT.. Commun Nurs Res. Ridder J. 406. Ask AONE's experts . The relationship between labour cost per patient and the size of intensive care units: a multicentre prospective study. Not eligible exposure. Patient satisfaction begins with satisfied professional and support teams. Bhatia R. Practical skill development in new nurses. Crit Care Nurse. Comment. 394. Bethel S. Not eligible target population. Mar 1999. Not eligible exposure. Infect Control Hosp Epidemiol. Nov 2002. Therapeutic holding: outcomes of a pilot study.12(4):356-370. Issues in nurses' practical skill development in the clinical setting. Staff gender and risk of assault on doctors and nurses. Mich Nurse. Arthur HM.29(8):88..24(2):48-53. Stratton K.96(4):39-40. 384.14(1):72-84. Beyea SC. Bilchik GS. Jun-Jul 2005. Exploring the critical care nurses' experiences regarding moonlighting. 377. Horowitz S. Comment.78(5):10. Nurs Manage. Comment. 46-48. 401. 395. 389. Giordano D. No association tested. 396. Beyers M. during.30(5):72. Beyers M. Ask AONE's experts . May-Jun 1992. Not eligible target population. May 2001. Curationis. Jt Comm J Qual Improv. 374. Jacobowitz WH.a synopsis of a 1996 survey.N. Too tired to work safely? Aorn J. The quality of Intensive Care nursing before. Evaluating nursing practice: satisfaction at what cost? Nurs Manage.20(3):42-9. 2003. Jan 1992. Patient and staff safety: voluntary reporting. 1994. Nurs Stand. Nov 2003.21(1):211-217. Comment. Not peer reviewed. 386. 387. Not relevant. Nurs Manage. Bland P. Patient and nurse-related implications of remote cardiac telemetry. Jones KR. J Rural Health. New grads face changing employment picture -. Attitudes to women undergoing TOP. Biddle J. Oct 1999. 383. 403. and after the introduction of nurses without ICUtraining. J Psychosoc Nurs Ment Health Serv.. An inpatient classification system for nursing service staffing decisions. Clin Nurs Res. Not eligible exposure. Bertolini G. Bissonnette T.34(8):22-23. Beyers M. Sep 1994. Health Aff (Millwood). What was said. Am J Med Qual. Nurs Times. 60. Binder RL. Quality with a human face? The Samuels Planetree model hospital unit. 373.8:90-100. Nursing administration quarterly Spring 1996. Sep 1998. Self-scheduling in critical care.11(3):14-18. Blain S. Simini B. Blegen MA.19(2):50-51.8(2):33-35. 385. 397. Leaving nursing.6(1):34-47. Bishop S. "A survey of antenatal clinic staff: some perceived barriers to the promotion of smoking cessation in pregnancy". Specialized teams complement nursing. Implementation of an inpatient case management program in rural hospitals. Boyd M. 391. Comment.22(4):545-550. Blair PD.32(3):190-196. Biordi DL. Not eligible target population. Grant A. Not eligible target population. Bhengu BR.. Not eligible outcomes. May-Jun 2003. Blank AE. about how to reduce overtime and use of per diem staff. J Nurs Care Qual. Not eligible year.. 9 tips for success. Mar 1977. McNiel DE. Dec 2003. 378. Rosenthal TC. Vojir C. Billinghurst F. 404. Bischof J. Nurs Inq.74(11):40-44. Jan-Feb 2002. Power in practice: a study of nursing authority and autonomy. Not eligible target population. Radrizzani D. 392.8(1):14-5. Bull Am Acad Psychiatry Law. Nov 2000. 405. No association tested. Bjork IT. May 1999. Binnekade JM. Jan 27-Feb 2 2000. Rossi G. Not eligible exposure. Rehabil Nurs. Blewitt DK. Comment. Comment. Nurs Stand. Bevan J. Comment. Rogers A. Comment. Norma Rae. Rossi C. about patientfocused care. Drury J. Aug 1998. about staffing options. Not eligible exposure.30(12):56.29(12):2307-2311. Arrighi E.12(1):50-55. Bell R. Aug 1998. Black K. B-11 . Aug 2003. 400. de Mol BA.26(6):48-56. 375.371. No association tested. Panjari M. Kulkarni R. Kirkevold M. Perla J. Not eligible target population. Birnbaum D. Continuous assessment and regular communication foster patient safety.80(3):559-562. Ranganathan P. Hosp Health Netw. 402. 381. 372. Jun 2-8 1993. Heart Lung. J Cannt. Thompson MC. Ask AONE's experts . Vroom MB. Healthc Exec.23(3):116117. Oct 13-19 1993. Not eligible target population. 376. Comment.17(3):144-146. Morgan B. about counting short-stay census. Spring 1998. Biller AM. Linton A.29(7):72. Matza D. Jun 1995. Not eligible exposure. Jul 1998. 382. Berry DM. 379. 399.25(9):41-43.

407. 410. Not eligible exposure 414. Bonner R. May 1995.8(5):467-477. The nursing shortage and its implications for case management. Jul-Sep 2003.3(2):36-38. Balantac DD. 433. Feb 2001. Smith B. Bond CA. Changing rosters--managing roster change. Boomer MJ. Borg MA. Bliss-Holtz J. Ann Emerg Med. Aug 28 1995. Aust Nurs J. Aust Nurs J. harms. Booker JM. The impact of continuity of nursing care personnel on patient satisfaction. Lazar N. Fiedler FE. Dec 1994. Not eligible target population. Feb 2002. 416. Blythe J. 411.24(1):19-25. 430. Franke T. Aust Nurs J. Bloice C. Wester JP. Part 4. Understanding rostering. Bohnen MV. 424. Not eligible outcomes. Sep 2000. 415. B-12 . Bosman RJ. Jul-Aug 1996. Revolution. Boehm C. J Nurs Adm. Not eligible target population.12(6):53-57. Understanding rostering. Bond CA. Boscarino JA. Lea A. Not eligible exposure. Understanding rostering. Nov-Dec 2001. May-Jun 2002.2(8):18-20. Bosek MS. Franke T.24(6):1144-1146.15(29):33-36. NovDec 1994.54(4):316-318. Full-time or part-time work in nursing: preferences. Beaumont R. PASNAP targets mandatory overtime. News. Bond GE. 434. Wormser GP. Jan 2003. Clinical pharmacy services. Smith B. Ministering to the patients. Gustafson D. Bond CA. Reluctance to care for patients with AIDS.14(4):241-244. Bonner R. 413. 425. Slash and burn redux. Discriminating types of medication calculation errors in nursing practice. Comment. J Hosp Infect. Sep 2001. Milazzo J. May-Jun 2005. Baumann A. Medication errors in United States hospitals. Not eligible outcomes. Pharmacotherapy. Not eligible outcomes. Nurs Stand. Franke T. hospital pharmacy staffing. Nurs Econ. Beaumont R. Raehl CL. Apr 4-10 2001. 409. Bloodworth C. 2005. J Wound Ostomy Continence Nurs. Products & consequences. Pharmacotherapy. 419.22(2):134-147. Bonadio WA. No association tested. Sep 1995.3(4):99-102. Not eligible target population. Nurs Econ. Nurs Econ. 435. Journal of continuing education in nursing Nov-Dec 1994. total cost of care. Nurs Res. Letter.24(10):6468. How a roster is developed. Gen Hosp Psychiatry. JanFeb 1993. Comment. 431.25(6):258-62. tradeoffs and choices.19(6):767-781. Nurs Adm Q. Boling J. Comment. Not eligible exposure. Bostrom J. Lane S. 54. Bonner R.29(1):83-90.32(3):580-586. Review. Borg E. JONAS Healthc Law Ethics Regul. Booth B. Zimmerman J. 412. Higgins A. Zandstra DF. Roseman C. Oct 1994. 429. Rissel C. Caritative leadership. A comparison of leadership vs. Pitterle ME. Part 1. Borromeo AR.43(6):373-375. Beaumont R. Challenging the myth of the 12-hour shift: a pilot evaluation. Smith B. Not eligible target population.90(15):30-31. Nov 1991. Who cares? Offering emotion work as a 'gift' in the nursing labour process.27(3):249-253. and medication errors in United States hospitals. and length of stay in United States hospitals: summary and recommendations for clinical pharmacy services and staffing. Not eligible exposure. Raehl CL. Professional liability during the shortage.8(3):69-77. 408. 432. drug costs. Comment. JanFeb 1999. Bolton SC.57(3):251-257. Raehl CL. Blumenfield M. Comment.21(2):129-141. Not eligible exposure. Interrelationships among mortality rates.11(1):35-41. Part 6. Conflict in decision making: do nurses have a role? Paediatr Nurs. 2002. Not eligible exposure. Restructuring nursing for a competitive health care environment. 427. Rood E. 436. 439. and justice. 422. renovation in changing staff values. A seasonal pattern of hospital medication errors in Alaska. The rights & wrongs of rostering. 418. 417. Pharmacotherapy. Bondas TE. Not eligible exposure. 428. 437. Tisnado J. Jun 1999. Boosfeld B. Hoffmann L. Not eligible target population. Beaumont R. Nurs Times. Aust Nurs J. Staffing and the cost of clinical and hospital pharmacy services in United States hospitals. Mar 1995. Ginn R. Understanding rostering. Management of drug errors. The professional salary model: meeting the bottom lines.6(3):11. Not eligible target population.. Smith B. Aug 2003. Not eligible outcomes. J Adv Nurs. Smith PJ. Denton M. Eagen MK. Hunter Group still bottom-line feeding. Dec 2001. Revolution. Mandatory overtime: professional duty. Case Manager. 426. Zeytinoglu I.7(7):21-23. Bed occupancy and overcrowding as determinant factors in the incidence of MRSA infections within general ward settings. Boettger JE. Intensive care information system reduces documentation time of the nurses after cardiothoracic surgery.13(6):410. 64. Carney M. Not eligible exposure.2(11):36-38. Efficacy of nurses suturing pediatric dermal lacerations in an emergency department. Pharmacotherapy. Intensive Care Med. Effects of a pressure-reduction mattress and staff education on the incidence of nosocomial pressure ulcers.97(8):34-35. Aust Health Rev. Part 3.2(10):40-42. Healthc Q. Bostrom J.17(1):37-43. 438.21(9):1023-1036. Apr 13-19 1994. Jan 1997. Aug 1995. Bonner R. Not eligible target population. 423. Psychiatry Res.3(3):6-7. 420. Basic academic preparation of foreign-educated nurses: a base for developing continuing education courses. Patients' perception of quality hospital care and hospital occupancy: are there biases associated with assessing quality care based on patients' perceptions? Int J Qual Health Care. Windle PE. Can Nurse. Jun 1995. Bond CA. 421. Not eligible exposure. Zimmerman J. Van der Spoel JI. Not eligible target population. Not eligible outcomes. Not relevant. Oudemans-van Straaten HM. Oct 1996. No association tested. An evaluation of a smoke free environment policy in two Sydney hospitals. Raehl CL.25(3):179-184. Sep 2001.

Apr 26-May 2 1995.9(2):8-14. Application of the Omaha System in acute care. Not eligible exposure. A study of nurses' views about the prevention of nosocomial urinary tract infections. Johnson-Hurzeler R. Boyd G. Not eligible outcomes. Lostocco L. 456. Nursing care and management of the elderly hip fractured patient. Pollett B. Nurses' use of palliative care practices in the acute care setting. Bowles C. MayJun 1995. Not eligible outcomes. Bowden FJ. 469. Not eligible exposure.440. and attitudinal factors. Wong ES. Western journal of nursing research Jun 1991.9(5):307-317. Martin Rabadan P. Apr 2000. Apr 1999.18(2):98-99. Radiol Manage. Aug 2003. Hamilton D. Drug errors. Not eligible outcomes.19(2):107-112. The development of multilevel critical care competency statements for selfassessment by ICU nurses.53(5):1229-1237. Br J Ind Med. Factors influencing nurses to work for agencies. Nurses' attire in a special hospital: perceptions of patients and staff. Braddy PK. Winter 2004. 1998. 457. Politics. Bradley G. Health Data Manag. 463. 441. Bratt MM. B-13 . Bradley CF. Not relevant. Policy. 446. Apr 1994. 449. Certified sick leave as a non-specific morbidity indicator: a case-referent study among nurses.6(5):379-87. Oct 1992. Identification of the perceived learning needs of balloon angioplasty patients. Aleman D. system. 462. Preventing central venous catheter-associated primary bloodstream infections: characteristics of practices among hospitals participating in the Evaluation of Processes and Indicators in Infection Control (EPIC) study. Job strain and evolution of mental health among nurses. Differentiated practice. 443. Support Care Cancer. Future intentions of registered nurses employed in the western New York labor market: relationships among demographic. Zayas LE. Sep 2000. A six-year prospective study.11(4):26-29. Interview by Daloni Carlisle. Gingras S. 468.4(2):95-107. Crit Care Nurse. Bremnes RM. patient-oriented care and quality of work in a hospital in the Netherlands. Cicchetti DV. & Nursing Practice Feb 2006. Apr 1998. Jul-Sep 2003. Impact of physician practice on nursing care. 455. 467. 445. St Jean J. Boudreaux ED.23(2):93-105.16(3):144-55. Bastida E. Can J Cardiovasc Nurs. Candela L. Bridgeman J. Bostrom JM. J Prof Nurs. Choosing the best system. Bradley S. Not relevant. Not relevant. Nauenberg E.26(1):54. Feb 2004.24(12):926-935.49(10):673-678. Steele L. Kozak C. 458. Bourgault AM. Washburn TA.87(14):3031. May 1991. Birrell F. J Nurs Adm.94(4):51.12(2):106-108. 2001. 454. 442. Nurs Stand. Boumans NP. Stolen bases. Am J Nurs. Smith N. Kritchevsky SB. Influence of stress and nursing leadership on job satisfaction of pediatric intensive care unit nurses. Nurs Adm Q. Not eligible exposure. Bradley D. Lopez-Rodriguez J. Broome M. Simmons BP.21(8):15-22. Comment. Cherlin E.54(4):279-287.15(4):15-18. Not eligible outcomes. Carroll LL. Nursing recruitment and retention in New York State: a qualitative workforce needs assessment. Experience with and attitudes to chemotherapy among newly employed nurses in oncological and surgical departments: a longitudinal study. Solomon SL. Dax EM. Dec 2003. Transforming practice using a caringbased nursing model.18(1):37-48.13(3):353-62. Brezynskie H. Bouza E. Aug 1995. Jun 21 1993. Pendon E. J Hosp Infect. Scully W. Not eligible target population. Suffer the little children. Rothman L. No association tested. McCorkle R. 460. J Occup Health Psychol. economic. Schoenhofer SO. Int Hist Nurs J. Not relevant. 464. 286. Nurs Times.158(12):810-812. Aug 2000. Horwitz SM. Comeau M. J Emerg Med. Bridger JC. Brewer CS. Jesus Perez M. Aorn J. 459. Bourbonnais R. Dynamics. No association tested. Scand J Caring Sci. Sanchez C. 450. Res Nurs Health. Tarbuck P. How do nurses learn about familycentred care? Paediatr Nurs. Am J Crit Care. Sep-Oct 1994. Richards CL. Review. Rincon C. Braun BI. 110. J Gerontol Nurs. Not eligible exposure. 453. Vinet A. 451. Lindsay P. 444. 465. Bradley EH. Operating room scheduling. Briggs B. Not eligible target population. Munoz P. Vezina M. Jan-Feb 2001. Nurs Econ. Ary R. Brewer CS. Brady J. Emergency department personnel accuracy at estimating patient satisfaction. Not eligible outcomes. Smith S. Kahn LS. Bowles KH. 461. Not eligible exposure. 466. 470.v. Jan 1999. Not eligible target population. 447. Mandry C. Interview. First job experiences of recent RN graduates: improving the work environment. Bourbonnais R.12(5):250-255. Nurs Econ. Not eligible exposure. Occupational exposure to the human immunodeficiency virus and other blood-borne pathogens. Jan-Feb 2004. Ask the experts. Just one slip. Apr 3-9 1991.7(1):11-16.6(2):44-51. Med J Aust. Infect Control Hosp Epidemiol. et al. Adam M.17(1):14-22. Kasl SV. Stage managing change: supporting new patient care models. 452. Journal of clinical nursing Sep 1997.13(3):166-173. Mar 2005. Young C. Visser M.7(1):54-63. May 1999.27(3):223-230. Boykin A.35(3):130-137. Not eligible exposure. The influence of nurses and parents in the evolution of open visiting in children's wards 1940-1970.9(31):35-38. Brennan W. Mar 2004. Not eligible target population. Terminated. Fried TR. A needleless closed system device (CLAVE) protects from intravascular catheter tip and hub colonization: a prospective randomized study. Not eligible exposure. Pumped up about i. Vezina M. Not eligible exposure. Comment. The nursing life. Breslawski S. Not eligible exposure. Applied Nursing Research Aug 2003. Boynton D. Landeweerd JA. 448. Not eligible exposure. Kelber S. Comment.

Vanderschueren S. J Nurs Adm. Brodell E. J Manag Med. No association tested. Matziou V. Brusco MJ. Porter M. 2001. Mar 1997. Muscatello DJ.24(11):855-862. 1997. Floating: a nurse's nightmare? Health Care Superv. Apr 2001. Pain intensity assessment by bedside nurses and palliative care consultants: a retrospective study. Shifting the patterns of nurses' work. Hitchings KS. Brown PW. Morlion B.5(1):18-21. Bartlett MJ. Brown B. 485. Prairie Rose. Nursing is critically ill: why? What can be done to help alleviate the nursing shortage. Franey BN. Nightmare on night shift. Rehabilitation Nursing May-Jun 1994. May 1993. Bryant C. Campbell-Lloyd S. Int J Nurs Stud. May 2002. 5-6. 498. Oncol Nurs Forum. Not eligible exposure. Continuing education evaluation of behavior change. Sklar DP. Not eligible exposure. Jun 16-22 1993. Maxillofacial surgery and the role of the extended day case. Comment. Comment. Feb 2004. Brown G. Not relevant. Am J Infect Control. Nov 2003. Buchan J. 478. Nurs Manage. Kaur G.70(1):25-28. Lessons from America? US magnet hospitals and their implications for UK nursing.31(3):144-150. social integration and flexible scheduling. Not eligible target population. Not eligible target population. Comment. May 2003. Bronder E. Feb 22 1997. Showalter MJ.65(3):4-6. Analysis of the roles and responsibilities of rehabilitation nursing staff. 488. Patients' knowledge of their caregivers' names. 494. Sage-Smith D.30(6):14. Nursing career satisfaction: the effects of autonomy.15(3):1015. Leading your leader. Jul-Aug 1993. How to develop a unit personnel budget. 477. Silberman S. No association tested. Brown H. Brotherton JM.28(9):21-27. Lane S. Skipper BJ. 501. Tracheal intubation via the laryngeal mask airway: a viable alternative to direct laryngoscopy for nursing staff during cardiopulmonary resuscitation. hospital teams. Rn. Nurse staff planning under conditions of a nursing shortage. Comment. Brown C. Dowd SB. family. Romond EH. Wong I. Crean SJ.471. 497.65(5):67-70. Part 1. Willey JS. Nurs Stand. 90. Eighteen-month followup and extension to critical care. 503.36(1):19-22. Kinneman MT. Apr 2005. Zyga S. Browne R. Brunt BA.20(6):352-357. Nurses' attitudes toward pain treatment with opioids: a survey in a Belgian university hospital. Shen L. Brown JS. Resuscitation. J Adv Nurs. Vaughan D. Brockopp DY.10(1):2. Winter 2003. Broekmans S. Futch J. 502. 495. Fay MS. Not eligible exposure.12(4):229-232. Aug 1996. 499. Nurs N Z. Gwinnutt CL. Nurs Manage. Fiscal and clinical evaluation of patient care.11(23):58-70.27(4):493500. 473. J Nurs Adm. Drug Saf. 472. Dec 1996. McAnulty JM. Parenteral drug administration errors by nursing staff on an acute medical admissions ward during day duty. Johnson JY. Am J Nurs. Bryant CJ. Off and running! Revolution. 489.19(2):373-384. Not eligible exposure. Brokalaki E.22(9):23-27. Hosp Top. Media frenzy follows diary publication. 480. Brown B. Brillhart B.2(7):7. J Healthc Qual. Tandberg D. and friends. Miller E. Hopper C. Mar-Apr 2000. Not eligible target population. Aspens Advis Nurse Exec. Ewert-Flannagan PA. Doezema D. Measuring and evaluating hospital restructuring efforts. Petersson O. Young MJ. Apr 1996. J Cancer Educ.16(2):49-54. Dec 2004. 483. Tsaras K. Sep 1992. Brown H. Do we practice what we preach? Health care worker screening and vaccination. Brogan G. Zhang T. 479.7(39):29. The orofacial cancer patient's support from the general practitioner. Oct 1997. No association tested. Sills F. Brillman JC. 474. Aorn J. Triage: limitations in predicting need for emergent care and hospital admission. Jan 1998.41(2):183-189. 476.23(7-8):58-64. 491. Omissions and errors during oxygen therapy of hospitalized patients in a large city of Greece. Kumar A. Winter 1997. Fisher SE. Arnetz B. Brokalaki H. Comment.15(4):18-20. 951-942. 475. A case management model for the future. The lights are bright? Debating the future of the permanent night shift. Kee CC. Kapella M.30(6):34-35. Nurs Stand.182(4):134-138. Not eligible outcomes. Minor Nurse Newsl. Sentinel event review. How to handle that staffing predicament. Bruner DW. 948. A teaching-hospital study.57(9):1539-1546. Bruera E. Part II: A new spirit of inquiry. Ann Emerg Med. 493. Nurs Manage. Bruce J. Shifting patterns of nurses' work. 505. Jul-Aug 1993. Not eligible exposure. 481. Preoperative patient teaching in ambulatory surgery settings. Not eligible target population.9(45):29. Not eligible target population. Sep-Nov 1996. Humphris GM. Not eligible target population. Brous E. 504. Intensive Crit Care Nurs. Comment. Role clarification: a quality improvement survey of hospital chaplain customers. Davis KD. Aug 2-8 1995. Downsizing within a hospital: cutting care or just costs? Soc Sci Med. Brownson K. Comment. A decision that defies logic. Not eligible exposure. 486. Jul 1996. Brockopp DY. Not eligible exposure.34(10):58-62. Not eligible exposure. Buchan J. Kinnaird S. Radiation oncology nurses: staffing patterns and role development. Oct 2003.101(4):57-58. Broomfield D. Sep 1998. 482. Fuss MA.20(4):651-655. Cline MK. J Nurs Adm. 500. J Nurses Staff Dev. Buchan J.13(1):1. Not eligible target population. Jan-Feb 2004. Bryden DC. 492.2(6):20. Review. News.19(3):145-50.13(4):228-231. Feb 1994. Cannon CC. 496. Bryan YE. 490. Support Care Cancer. Myrianthefs P. B-14 . Review. Not eligible target population. Not eligible exposure. 487. No association tested. Jun 1999. Stewart K. 484. Winter 1992. Formula for an effective acuity system. Fox MA. Palmer JL. Evers G.64(6):941-946. Brooks I. Nurs N Z. Comment. Simms S. Not eligible target population. Jun 1999. Brumfield VC. Br Dent J.

523. Dinger M. Greenglass ER. J Nurs Care Qual. 539. Not eligible exposure. Aug 2-8 2000. Not eligible exposure.Suppl:12.110(5719):24-27.22(3):241-248. Mixed-sex wards--the NT survey results. 531. Using 'weekenders' to staff the OR. Buerhaus PI. Jul 16 1998. Nurs Stand. J Health Organ Manag. 508. Dec 2002. Harjo L. Jan 1994. Your country needs you. Work status congruence. Capelouto N. Jan 1998. Privacy or help? The use of curtain positioning strategies within the maternity ward environment as a means of achieving and maintaining privacy. Not eligible exposure. 510. Burhansstipanov L.9(26):22-23. 540. Burgess L. The cost of understaffing. When bad things happen to good organizations: a focused approach to recovery using the essentials of magnetism. Buchan J. simulated. Buchan J.8(2):47-61.11(38):22-23. Burke RJ. 515. Is the shortage of hospital registered nurses getting better or worse? Findings from two recent national surveys of RNs. Jun 11 1997. 532. 513. Health Care Manag (Frederick).24(2):141-149. Burgess L. Not eligible outcomes.91(3 Pt 2):10591064. Not eligible target population. Aug 24 2000.29(3):228-240. Donelan K. work outcomes. Dittus R.6(3):191194. Not eligible target population. Mixed-sex wards. The impact of organizational and environmental factors on staffing in home health care. Not eligible exposure. Nov-Dec 2003. Wound DB. Buchan J. 520. May-Jun 1999. Nurs Times. Not eligible exposure. Health Care Manag (Frederick).196(6):977983. Jun 1996. Journal of clinical nursing Jan 2000. Jul-Sep 2003. Meet the travelers. Not relevant.90(31):35-38. June 14. Staiger DO. Not eligible target population. Not eligible outcomes. Wingate S. Auerbach DI. Workforce planning. White M. No association tested. Not eligible outcomes. Lawrence C. 535. Hatathlie L. Buchan J. Can J Nurs Leadersh. Not eligible outcomes. Correlates of nursing staff survivor responses to hospital restructuring and downsizing. 519. Cancer Pract. Not eligible target population. 511. Comment. Buchan J. Burke RJ. J Nurs Adm. J Adv Nurs. Patients' and professionals' perceptions of quality in discharge planning. Still attractive after all these years? Magnet hospitals in a changing health care environment. Staiger DO. Nurs Stand. 522. Staiger DO. Rich D. 536. Health Serv J. 528. Burke RJ. Buchan J. Implications of an Aging Registered Nurse Workforce. Burke RJ. No association tested. Jun 2003. The quality of mercy. Not eligible exposure. 634. and psychologic well-being. 534. Mixed responses. Buchan J. 518. The Native sisters. Implementation of hospital restructuring and nursing staff perceptions of hospital functioning. Review. Jul-Sep 2005. Mar 22-28 1995.12(2):21-29. Hodlin A. Inadequate date presentation. Janis Burge.27(1):15-23. 2000 2000. Goldfarb F. Burkle NL. Auerbach DI. Auerbach DI. 537. JAMA. Critical care nurses' decision-making activities in the natural clinical setting. 509. Buff DD. Burke RJ. Jan 12-18 1994. 55.10(4):233-240. Apr 2001. Review. Comment. 516. Not eligible target population. 521. Mar-Apr 2005. May 21 1997. Buchman TG. 514.40(8):903-909. 517. Rn.11(35):27. Nurs Times. The shape of time to come.30(1):100-108. Happy landings? Health Serv J. 525.S. Not eligible target population.9(1):25-36. suppl 1 p. Not eligible target population. nurse labor market? Health affairs Jul-Dec 2004.90(2):30-34. family concerns. Ulrich BT. Norman L.9(25):33.22(6):191-198. Hospital restructuring stressors: support and nursing staff perceptions of unit functioning. Psychol Rep.6(6):457-462. J Am Coll Surg. 512. Ray SE. Not eligible target population. Bull MJ. and actual accuracy.10(7):400-402. or as a form of signalling to peers and professionals in an attempt to seek information or support. Rethink the weighting game. Burman ME. Nov 1997. 530. 538. Burke RJ. Vigil G.96(9):20-3. Bupp JE. Culturally relevant "Navigator" patient support.283(22):2948-2954.23(2):120-127. Nurs Stand. Apr-Jun 2004. Sep 1990. 507. Nurs Stand. Cassell J. Buerhaus PI. Hosp Food Nutr Focus. Collins NA. Burke RL. Surviving hospital restructuring.23(2):61-71. Interview. Aorn J. 636. Public Health Nurs. Burke RJ. Not relevant. Families' perceptions of surgical intensive care. Not eligible exposure. Not eligible outcomes. Buerhaus PI. Canadian Nurse Oct 2000. Is the current shortage of hospital nurses ending? Health Aff (Millwood). Jan 2004. Recruitment.18(4-5):279-289. Not eligible exposure. New signs of a strengthening U.506.14(46):23. Burden B. B-15 . Work experiences and psychological wellbeing of former hospital-based nurses now employed elsewhere. Survivors and victims of hospital restructuring and downsizing: who are the real victims? Int J Nurs Stud. J Adv Nurs.12(10):4. Placement of cardiac electrodes: written. Juggling act: work concerns. Bucknall TK. Working on the bank: why do nurses do it? Nurs Stand. Dec 1993. The night float system of resident on call: what do the nurses think? J Gen Intern Med. Not eligible exposure.108(5613):22-25. Mar 15-21 1995.23(Supplement 2):W4-526-33. Health Care Manag (Frederick). Jul 1995. Review. Nov 2003.31(4):169-172. 533. Burke RJ. Burge J. Apr-Jun 2005. 527. Work-family congruence and work-family concerns among nursing staff. Burke RJ. 524. Jul 1999. Nurs Adm Q. Buchan J. An easy way to communicate pathways to patients. Nurs Econ. Comment. Greenglass ER. Not eligible outcomes. Niemczycki MA. Shabti R. Burek C. 526. 96. Next steps. 529. 2004. Wax ML. Buerhaus PI. May-Jun 1998. Am J Crit Care.52(3):632. Aug 3-9 1994.

J Contin Educ Nurs. Calliari D. J Vasc Nurs. Akehurst RL. More questions than answers. Butler D. Bushy A. 547. Prof Nurse. Not eligible exposure. Not eligible target population. ANA study links nurse staffing to quality.23(2):73-79.16(1):17. J Adv Nurs. Soviet nurses help alleviate Baltimore hospital's shortage. Sep 1994. Jan 2000.26(5):992-998. Hattar HS.91(26):35-37. B-16 . Callery P. Critical access hospitals: rural nursing issues. Giguere M. Nursing staff and patient perceptions of the ward atmosphere in a maximum security forensic hospital. Valuing research in clinical practice: a basis for developing a strategic plan for nursing research. A method to increase attendance at mandatory classes. J Nurs Adm. Richardson M. Cahill J. Not eligible target population. Sep 1996. CQI case study: reducing medication errors. Not eligible exposure. Not eligible outcomes. Hosp Community Psychiatry. Not eligible outcomes. Cavanaugh SK. Not eligible exposure. A study of role negotiation between nurses and the parents of hospitalized children. 545. Bokovoy J. Carey RG. 550. J Adv Nurs. Not eligible target population. 572. Education for inpatients: working with nurses through the clinical information system. Issues of recruitment and retention. Buttery J. Raviola CA. Halkins D. Capitulo KL.31(6):301-310.27(4):33-49. 566. Br J Perioper Nurs. Incidence of PTSD among staff victims of patient violence.9(1):83-92. Burns JP.17(3):339-346. Qld Nurse. Byrd ME. J Clin Nurs. 559. Family response to difficult hospitalizations: the phenomenon of 'working through'. Miller J.20(3):544-551. Aug 1992. J Adv Nurs. May 2004. Not eligible exposure. The role of the nurse in the medical ward round. Mar 1999. Not eligible target population. 543. Jun 2001. Role of nursing personnel in implementing clinical pathways and decreasing hospital costs for major vascular surgery. Wallace M. Jan-Feb 1995. 558. 560. May-Jun 1997.21(33):71. J Clin Nurs. 551. 564. 563.541. 569. Canavan K.20(6):30-34. Managing a multicultural nurse staff in a multicultural environment. 552. Not eligible target population. 548. Callery P. J Adv Nurs.8(22):20. Bokovoy J.7(6):288-293. Feb 23-Mar 1 1994. Eades M. Calpin-Davies PJ. Not eligible exposure.7(4):351-359.30(3):229236. The case of users and observers. Jul-Aug 1996. 555. J Nurs Adm. Callister LC. Not eligible exposure.21(5):232-237. Not eligible exposure. May 1995. Use of a validated model to evaluate the impact of the work environment on outcomes at a magnet hospital. Oswald SL. The effects of demographics on determinants of perceived healthcare service quality. Not eligible target population. Burner OY. Aug 19 1991.11(4):170-171.29(3):1. Arch Psychiatr Nurs. O'Connor S. Can J Nurs Res. 317. Burnard P. 574. Truog RD. 557. Nurs N Z. 542. Gilchrist B. Annualised hours.7(2):71-79. The relationship between a calculation test given in nursing orientation and medication errors. Cadigan S. Not eligible exposure. Mar 1992. Jul 1998. 556. Not eligible target population. Dec 1998. Summer 2004. Nov 1993. 573. Nov 1993. Jul-Sep 2005. Looking for positive changes in nursing. Nurs Stand. Not eligible exposure. Busby A.16(7):772-781. Caldwell MF. 561. Not eligible target population.29(3):658-664. Oct 1997. Comment. Calligaro KD. Let the team decide? Evaluation of self-rostering on an acute general medical ward. Brunsdon J. Jul 1999. Griffith JL. Pugh J.8(7):28. Calabretta N. J Nurs Adm. Implications of client-centred counselling for nursing practice. Jun 2001. Frisch S. Campbell C. Cunningham P. Aust Crit Care.31(6):290-292. J Nurs Staff Dev. Patel A.12(4):213-215. Not eligible target population. Turner DE. News. Jt Comm J Qual Improv.8(4):459-466. Campolo M.34(5):246-256. Mar 2001. Smith L.7(1):23-29. Jan-Feb 1997. Not eligible outcomes. Am Nurse. Jul 1991. 570. Caraher M. Capuano T. Patient satisfaction with emergency nurse practitioners in A & E. Mountjoy A. Caring for parents of hospitalized children: a hidden area of nursing work. Apr 2001. Pioneering the 12-hour shift in Australia-implementation and limitations. 73. Winter 1995.9(2):86-90. Not eligible exposure. Not eligible target population. Comment. Miller P. 544. Not eligible outcomes. Nov 1997. Houser J. Professional responsibility versus mandatory overtime. Teeters JL. Thompson L. Clin Nurse Spec. Health Care Manage Rev. Ankner ML. Not eligible target population.43(8):838-839. 565. 553. Jun 28-Jul 4 1995. 568 Canning S. Not eligible exposure. Comment.26(1):11-14. Capuano T. Hitchings K. Dougherty MJ. 554. J Clin Nurs. Mitchell C. The role of the nurse in childbirth: perceptions of the childbearing woman. Caplan CA. DeLaurentis DA. Not eligible target population. Butler L.11(4):112-115. 562. End-oflife care in the pediatric intensive care unit: attitudes and practices of pediatric critical care physicians and nurses. Jun 1990. 546. Aug 2002. Patient's perceptions of bedside handovers. Calliari D. 3. Burns J. Nurs Times. Not eligible outcomes. Crit Care Med. Feb 1993. Burrows Z.14(5):313-322. Comment. Med Ref Serv Q. Mod Healthc.14(3):57-61. Doctor-nurse substitution: the workforce equation. A sociological approach to health promotion for nurses in an institutional setting. Hitchings K. 571. J Nurs Adm. Child-focused single home visiting.10(5):8-20. The Beverly Allitt case. Byrne G. J Manag Med. J Nurs Manag. 1996. 567. Work flow analysis: eliminating non-value-added work. 549. Public Health Nurs. Cain M. Not eligible exposure.

Jan 23-Feb 12 2003. Everett J. MacInnes P. May-Jun 2001. AACN Clin Issues. 609. Pract Midwife. Comment. May 2000. Not eligible target population. Jul 24-30 1991. Sep 25-Oct 1 1996. 596. Nurs Times. Not eligible outcomes. Gordon DL.87(50):39. Feb 2001. Comment. Carlowe J. Cassard SD. Chamberlain G. Nurs Manage. West J Nurs Res. Chu RW. J Nurs Manag. Serious concerns about a nurse's basic competencies.12(2):79. Oct 24-Nov 13 2002.sharpening the vision and facilitating the process. Chan FS. Mar 9-22 2000. Jan-Mar 2002. Feb 1995.92(39):26-27. Not eligible target population. Nursing attitudes to the care of elderly patients at risk of continuing hospital care. Carlisle D. J Nurs Adm. Wraight A. Dec 1992. Jul 23-29 2002.13(21):1288. Dec 11-17 1991. Carveth JA. Not eligible target population. Weisman CS.22(2):221225. Castledine G.26(5):7-13. Yes. J Nurs Adm. Paint and perseverance. Lombardi M. Case Reports. Nurs Times. 589. Castledine G. Carter M. Jenkins-Clarke S. 584.2(7):35-39. J Adv Nurs. May 1225 2005. Kerr D. Not eligible target population. 38. Br J Nurs. 604. Kaiss N. May-Jun 1998. Sep 2003.3(3):128-130. The good news and the bad news. Morou G. Not eligible target population. Implementing patient-centered care in Lebanon.25(5):519-532.9(5):259. Cating G. Eur J Epidemiol. Not eligible target population. Biggeri A. Chiu T. Chow CC. 591. Chan DS. Celia B. Zignego AL. Sep-Oct 2000. Carlisle D. Don't bank on it. Castledine G. Br J Nurs. 587. 607. Not eligible target population. Editorial.19(1):73-77. Comment. Not eligible target population. Validation of the Clinical Learning Environment Inventory. A nurse in any language. News. J Adv Nurs. Larocque S. Caty S. Catalani C. Not eligible exposure. Reducing hospital inpatient length of stay for patients with diabetes. 48. Universal precautions and dedicated machines as cheap and effective measures to control HCV spread. A stately pleasure dome. Carzoli RP. Cecchini C. Mandatory OT is the last straw. 593.26(3):64-65. 586. Comment. Yeung SH.6(1):153-156. Birth at home. Carlowe J. Cavan DA. 588. Chaaya M.18(2):162-164. 582. Nurse in charge who walked out on an understaffed ward. Carlisle D.92(38):3839. Dec 1994. Chow PK. Betrayal of trust.29(4):415-433. 600. 608. Murphy S. Nurs Times. Chan C. The impact of unit-based self-management by nurses on patient outcomes. 594. Sep 1996. Leung PM. 605. Crowley P. Nursing absenteeism and its effects on the quality of patient care. 603. Not eligible target population. Apr-Jun 1998. Trial by error. Senior nurse whose incompetence resulted in the death of a patient. Diabet Med. Carr A. Edtna Erca J. Mar 18-24 1998. Not eligible target population. Br J Nurs. Cuevas LL. 2004.1(5):4.87(30):18. 606. Hamilton P. primary nursing can survive 12-hour shifts.98(30):22-24. Nurs Diagn.14(2):10-18. 576. GRASPing the nettle. Arts in action. Pang WC. Not eligible target population. 595. Mar 8-21 2001. Aug 2003. Mar 1995. Jul-Aug 1999.10(3):166-171. 597. Ceria CD. Redefining nursing according to patients' and families' needs: an evolving concept. Nurs Times. Gottard A. 610. Aug 11-17 1999. 578. Nurses need to sort out their system of care.13(1):3-4. Not eligible target population. May-Jun 1995. Rahal B. Determining case manager workload: are there secrets to success? Nurs Case Manag. Not eligible target population. Aug 1995. 590. Sep 18-23 1996. J Gerontol Nurs. Hong Kong Med J. Ierpi C. Nurs Times. Nurse who covered up for a sister who was having problems. 580. Health Serv Res. Case 22: The incompetent practitioner. Comment. 599. Castledine G. Nurs Times. Frati E. Comparison of neonatal nurse practitioners. Nov 25-Dec 8 2004. Castledine G. Toti G. quiz 52-13. Carr-Hill RA. Arch Pediatr Adolesc Med. Nurs Stand. Comment. Apr 17-23 1991. Use of an electronic barcode system for patient identification during blood transfusion: 3-year experience in a regional hospital.22(12):11. Hempel S. Young BW. Not eligible target population. 577.13(3):249-256. physician assistants.44(3):173-178. Br J Nurs. Can J Nurs Leadersh. Staff nurse who had an alcohol problem and made nursing errors.24(3):448-455. Chan JC. Fraser L.148(12):1271-1276.11(19):1231.87(16):28-29.95(32):34-35. 592. AACN Certification Corporation. 602. Castleforte MR.33(9):437-440. Martinez-Cruz M. 598. Carroll-Johnson RM. Revolution. and residents in the neonatal intensive care unit. Not eligible target population. Editorial. Jan 1994.14(9):516. Not eligible outcomes. Prevalence of HCV infection among health care workers in a hospital in central Italy. Family-centered care in Ontario general hospitals: the views of pediatric nurses. 601. Not eligible target population. Oct 1994. Comment. 581. Not eligible exposure. Michelassi S. Castledine G. Case Reports. 585. Perceived patient deviance and avoidance by nurses. Koren I. Age and gender differences in pain management following coronary artery bypass surgery. Accid Emerg Nurs. No association tested. Conduct unbecoming? Nurs Times. May 2005. Carrick JA. An evaluation of the role of the night nurse practitioner. Carlisle D.12(26):15.2(1):21-26. Measurement systems in principle and in practice: the example of nursing workload. Benvenuti M. Nurs Res. the introduction of a workload measurement tool into an accident and emergency department.24(2):4345. Jun 2004. Letter. 579. Carter H. Not eligible exposure. Carr SM. Chan F. Refocusing health visiting -. Caterinicchio MJ.575. Br J Nurs. Not eligible exposure.10(5):350. B-17 . Wong R. Br J Nurs. Cerrai T. Lau J. 583.

640. Chokbunyasit N. Hodges S. Not eligible target population. Mar 2002. A medical crisis: who'll care for your patients? Med Econ. Christensen P. Nephrol News Issues.Suppl:30. Jun 1998. Franklin GA.78 Suppl 1:S19-25. Miller FB. Jul 1997. 625. Chenoweth L. B-18 . Not eligible target population. Meet the travelers. Christmas D. Richardson JD. Kim JS. Not eligible exposure. Jul 2004. French P. Chou KR. Not eligible exposure. Mandatory overtime: conflicts of conscience? JONAS Healthc Law Ethics Regul. McCallum RW. Choi-Kwon S. Leroy J. Staff ratios: California law may spread to other states. J Clin Nurs. Evaluating the efficacy of the infection control liaison nurse in the hospital. Suski MC.78(9):67-68.24(11):1029-1043. Am J Gastroenterol. Broadening the focus. and practice related to HIV transmission in northeastern China. Feb 2002. The impact of work-related risk on nurses during the SARS outbreak in Hong Kong. Solutions for inadequate staffing.9(3):191-201. J Trauma.27(6):553-560.6(3):253-274. Lam TH. Ahn JS. Chang E. 636.39(2):157163. Girault C. Willis WK. 632. 635. Chong S. J Adv Nurs. Spring 2005. Physician extenders impact trauma systems. Toward efficient medication error reduction: error-reducing information management systems. Apr 2004. Nurses' knowledge of and compliance with universal precautions in an acute care hospital. Menard JF. Choi E. Hancock K. Rn. Holzemer WL. Chartier K. Mar 2001. Chan SS. Review.18(5):22. Clin Nurs Res. Nurs Spectr (Wash D C). Nurs Res.49(2):78-85. Charles J.53(6):370-378. RNs--hands-on care and more. Reiner DK.58(5):917-920. Cheek J. 639. Not eligible target population. 616. Not eligible target population. Chen WT. Aug 1997. Chan S. 628. Aug 2002. Review. Chang SO. Chevron V.28(3):274-287. 629. Review. Sirisanthana T. Jan 2004. Chan V. Chong J. Comment. J Adv Nurs. Mundahl H. 637. Chartier K. Int J Nurs Pract. Salili F. The efficiency of fluid balance charting: an evidence-based management project. Graham E. Nov 2003. Comment. Chartier K. 627. 615. Effects on nurse retention. 74. Not eligible target population. Comment. Chang AM. Importing nurses: combating the nursing shortage in America. 618. JulSep 2005. Fallis WM.83(2):33-37. Stone PW. Chewitt MD. Du Y. Hosp Top. Med Care. Shit F. Not eligible target population. Brekke ML. 612.26(6):10491053. Patient Educ Couns. Not eligible target population. Not eligible exposure. Nov 1986. 634. attitudes. Christmas AB. Lam P. Crit Care Med. Potacharoen O.7(1):3. Hoffman SR. Jun 2003. Perceived nursing work environment of critical care nurses. Molassiotis A. Semin Oncol Nurs. J Nurs Adm. Lai CY. Oct 2003. Unplanned extubation: risk factors of development and predictive criteria for reintubation. 626. Bonmarchand G. 614. 623.19(4):284-290. Chandler C. Not eligible exposure. An experiment with scheduling. 79. Cho SH. Chan R. Interview. 613.18(7):417-422. Moon S. 620. Yiu I. Not eligible target population. Fam Community Health. Han M. Jul 2004. Song M. J Nurs Manag. Using multilevel analysis in patient and organizational outcomes research.4(1):10-12. O'Phelan C. Prevalence of HBV infection in nurses and manual workers in Maharaj Nakorn Chiang Mai Hospital. 617. Dec 1997. Wong DC. May 2005. Leung SS. Larson E. Not eligible target population. J Nurs Manag. 72. Gradidge K.52(1):61-65. Not eligible target population. Dec 2003. Evaluation of a health care assistant pilot programme. Bakken S. Tiwari AF. Jan 13 1997. J Med Assoc Thai.611. Comment. 631. 641. News.18(8):28. Sep 2003. Lai AS.103(10):14. Wong AS. Am J Nurs. Oct 1990. 622. Not eligible target population. Jeon YH. 621. Chandra A. 619. Choi YB. Not eligible target population. 638. Glasson J.18(8):23. Review. Nurses' knowledge. 630. J Med Syst. Nurs Outlook.5(4):229-236.33(6):820-827. Marshall BJ.12(5):651-659. Ho B. National nurse-to-patient ratio proposed. Reynolds J.16(4):187-195.10(2):103-113. Jul 2004. Occupational exposure to Helicobacter pylori for the endoscopy professional: a sera epidemiological study. Chung LH. Podratz RO. Mar-Apr 2001. Chesanow N.27(12):42-49. 642. 633. Physical restraint use in a Korean ICU. Chung K.89(11):1987-1992. Nephrol News Issues. Lam LW. Not eligible target population. Not eligible year. Preventing exposure to secondhand smoke. Fighting the shortage with strong retention strategies--University of Michigan Health System model. Nurs Res. Review. Nephrol News Issues. Nov-Dec 2004. Lee SK. Leung GM. Jameson H.56(1):85-92. Park HA. 624. Arch Psychiatr Nurs. Jan 2005. Lu RB. Ching TY. What stroke patients want to know and what medical professionals think they should know about stroke: Korean perspectives. Not eligible target population. Lam TH. Kwon SU. Seto WH. Diane Christmas. Bridging the gap between hospital and home. Richard JC. Nurses and the administration of medications. Mao WC. Factors relevant to patient assaultive behavior and assault in acute inpatient psychiatric units in Taiwan. Choi J. Not eligible target population. May 7 2001. The influence of demographic variables and ward type on elderly patients' perceptions of needs and satisfaction during acute hospitalization. Cho SH. Chan E. The conceptual structure of physical touch in caring. The surgical hotline. AIDS Patient Care STDS. Rodriguez JL. Nov 1994. Jul 1995.15(10):1128-1131. Barkin JS. Choi T. Mar 2002. Editorial. Int J Nurs Stud. Nurse staffing and adverse patient outcomes: a systems approach. Jan-Feb 2003.

92(7):1115-1119. Harmuth Y. Hosp Q. Cobb MD. Shapiro S. An experience with "research by committee". Comment. Interdisciplinary education program for nurses and pharmacists. Jan 1992. 670. Not eligible target population. McFarlane L. Davis NM.103(1):42-47. Jun 2003.35(1):1719. J Nurses Staff Dev. Clarke A. Cohen-Katz J. Jarrett M. Nurs Stand. Oct 20-26 1993. Oct 2003. Hayes J.14(4):369374. Coates M. Clarke SP. Emergence of resistant staphylococci on the hands of new graduate nurses. 644. May 1993. Special care units need all pharmacy services. 'Something always comes up': nurse-patient interaction in an acute psychiatric setting. Mar-Apr 1996. May 2004. What's behind RN turnover? Nurs Manage. Baroletti S.10(3):177-185.61(21):2294-2296.8(5):45. Mar 1997. Cohen MR. Clin Nurse Spec. "Change is inevitable and desirable": an interview with Ontario's Minister of Health and LongTerm Care. Interview by Peggy Leatt. Dec 2002. Messinger C.28(2):105-115. part III. Clifton B. Acutt B. Baker DM. The effects of mindfulnessbased stress reduction on nurse stress and burnout: a qualitative and quantitative study. Am J Public Health. Wiley S. Dec 1999. Jan 7 2003. Not eligible exposure. Dec 2001. 662. Larson E. Smith P. B-19 . Hadfield-Law L. Sep-Oct 1998. Cohen LM. Jul 2002. Cleary M. Mar 1990.5(1):56-59. The impact of unwaged domestic work on the duration and timing of sleep of female nurses working full-time on rotating 3-shift rosters. 656. Aust Crit Care. Green GM. Nesin M. Case Reports. 664. 650. No association tested. 149. Cimino MA.20(9):12. Normile LB. Not eligible exposure. Jan 13-19 1993.20(3):42-43. Comment. Heart Lung. Bush S. Absconding: nurses views and reactions. Apr-Jun 2004.643. Dealing fairly with medication errors. Not eligible target population. Clarke SP. 676. Churchill W. Taking orders by phone? Nursing. Not eligible exposure. I've been told I have to move to another part of the unit. Not eligible exposure. 657. Interview. Hausner J. Nurs Adm Q. 655. 647. Knaub G. 648.153(21):2481-2485.34(10):50-53. Am J Hosp Pharm. 671. Reilly C. Clarke T. Cline D. Larsen PD. 652.22(1):18. Am J Health Syst Pharm. Not eligible outcomes. Abbenbroek B. Aspens Advis Nurse Exec. Clement J.25(2):161-164. Not eligible exposure. 645. Mogan-McCarthy P. Pediatr Crit Care Med.34(6):44-48. The end is night. Speaking up.52(3):7. Capuano T. Not eligible exposure. Aug 1998. Shaha SH. Not eligible exposure. Traveling nurses. Neal K. Nursing. Pa Nurse.5(2):124-132. Pierce P. One solution to supplementing your OR staff. What doI do? Nurs Times.12(1):4-6. Affirming reflection.6(6):469-477. Cody WK. Knowledge and presence: accountability as described by nurses and surgical patients. Comment. Comment. Aorn J.30(1-2):345349. J Psychiatr Ment Health Nurs. Clark BA. Comment.19(2):78-86. Mar-Apr 2005. increasing use of practical nurses. Effect of intravascular surveillance and education program on rates of nosocomial bloodstream infections. Failure to rescue. Dec 2002. Infect Control Hosp Epidemiol. Nurs Times. Sloane DM. Cohen MZ. A hospitalization from hell: a patient's perspective on quality.9(4):138-147. Not eligible target population. Cohen H. Not eligible target population. Larson E. May 1992.138(1):33-39. Nov 1 2004. 653.55(5):1249-1253. Blane C. Assessing medication prescribing errors in pediatric intensive care units. Cina J.89(2):42-44. Not eligible exposure. Am J Nurs. Clark N. Clark K.28(8):56-57. Kiyimba F. Clark JS. McCue JD. 668. Review. 651. An aging population with chronic disease compels new delivery systems focused on new structures and practices. Jan 2005. Cleary PD. but I don't want to go. J Prof Nurs. Rutledge C. 666. 649. J Hum Ergol (Tokyo). Self-scheduling: a practical application of shared governance. Clay ML. Comment. Roach H. Nov 8 1993.28(6):489-495. Mar 2004. Cimiotti JP. Clark AP. Dec 1996. Nurse staffing levels and prevention of adverse events. Sep 2002. Hardy L. 673. Not eligible exposure. Kirschbaum MS. Not eligible outcomes. Clissold G. Ann Intern Med. Comment.50(5):913. J Psychiatr Ment Health Nurs. Nurs Sci Q. Brodsky L. Fall 2001. An opinion: staff nurses at risk. Cirone N. Nurs Manage. Delays in implementing admission orders for critical care patients associated with length of stay in emergency departments in six mid-Atlantic states.14(5):244-249. 674. 672. Clarke SP. Holist Nurs Pract. 658. Case Reports. J Emerg Nurs. Wu F. 646. Review. Jan 2003. Don't let doctors intimidate you. Moore JF. Nursing. Clark MF.96(18):30. 665. The policy implications of staffingoutcomes research. May 4-10 2000. 660.25(5):431-435. Not eligible exposure. Effects of hospital staffing and organizational climate on needlestick injuries to nurses. Aiken LH. Sep 1990. Cohen MR. Comment. Jan 1999. Comment. Application of the 80/20 rule in safeguarding the use of high-alert medications. 661. Review. Review. Bowers L. Della-Latta P. Nursing. Cohen MR. Aug 1993. Comment. Do clinical and formal assessments of the capacity of patients in the intensive care unit to make decisions agree? Arch Intern Med. Clarke M. 667. Crit Care Nurs Clin North Am.6(3):219-224. Cohran J. Clarke SP. Heilmann S. Comment. Aiken LH. Balancing staffing and safety. Beeken JE. 675.16(5):237238. Johnson M. The impact of a high dependency unit continuing education program on nursing practice and patient outcomes. Deitrick L. Jun 1999. Mandrack MM. 654.8(11):6-7. Comments on ASHP guidelines for preventing medication errors. May-Jun 1994. 677. 663. J Nurs Adm. Edwards C. 669. 659.

Yassi A. Planning change in scheduling practices: a theoretical perspective. Work hardening in an early return to work program for nurses with back injury. No association tested.8(9):14-16. Visiting children in hospital: a vision from the past. Colen HB. Pharm World Sci. Paediatr Nurs. Cooper MC. Nurs Times. Hunt M. Legal Cases. Connor D. Thomsen F. Mar-Apr 1991. WORK: A Journal of Prevention. One-to-one midwifery: Part 6. Jan 1998. Jan 1994.94(5):68-69. Tate R. B-20 . Not eligible target population. Nurs Crit Care. Not eligible target population. Guttmannova K. Sep 1997. No association tested. 710. Not eligible target population. 67. Cooper PG. Spencer D. Condliffe B. Cooke P. Costello A. Thomas S.273(9):703-708.11(5-6):279-293. Nurs Times. Considine J.25(3):118125. Cook DJ.7(2):82-87. Change from the bottom up. 705. Spinal cord injury nurses in action: partners in practice. An error by any other name.2(1):7-20. Can J Nurs Adm. Determinants in Canadian health care workers of the decision to withdraw life support from the critically ill. King D. Spanier A. 702. Comment. Griffin T. Am J Nurs. Assessment & Rehabilitation Mar 1997. Jama. Banerjee SN. Relationship between staffing ratios and effectiveness of inpatient psychiatric units. 694. Dec 1998. 708. Not eligible target population. Connor T. Apr 2000. Feb 1996. Coile RC. AARN News Lett. J Nurs Staff Dev. 681. 691. Cook R. Bradley S. Colodny A. Sayles L. Not eligible target population.92(10):20-21. Phase 1 of the systematic process redesign of drug distribution.21(3):487-491. Cooper J. O'Mara EM. Corby S. Not relevant. quiz 44. Not eligible target population.678. May 15-21 1991. Comparing methods of cardiopulmonary resuscitation instruction on learning and retention. News. 701. Sep 2001. Nov 2001.12(3):32-35. Feb-Mar 1996. Short L. Comparison of outcome predictions made by physicians. Oct 2001. Nurs Manage. 686. Oct 1992. Am J Crit Care. Feb 4-10 1998. Moser DK. Jaeschke R. Fraser J. Comment. Wise LC. Neef C. Buckley M. Shifting shifts. Accid Emerg Nurs. Chenger P. Conklin D. Not eligible target population. Not eligible target population.44(3):13. Not eligible target population.14(1):1. 699.4(2):81-84. Reeve J. Nurs Stand. Oct 9-22 1997.52(10):1374-1379. 682. Not eligible exposure.4(1):17-21.4(4):18-19. Jenkins T. Nurse-patient ratios revisited. No association tested. MacFarland V. Comment. Streiner DL. 704.19(1):2327. Not eligible target population. Infect Control Hosp Epidemiol. Nurs N Z. Nov 1996. 65. Comment. Hartstein AI. Not eligible target population.8(4):201-209. May 1998. Cook AF. Turner D. Identification and verification of critical performance dimensions. Rn. Molloy DW. Dracup K. by nurses. 696. No association tested. Easing winter pressure: commissioning and evaluating a medical day case unit. Increased bloodstream infection rates in surgical patients associated with variation from recommended use and care following implementation of a needleless device. Comment. Feb 28-Mar 5 1996. Cole A. Not eligible outcomes. Russ Coiles Health Trends. Connell J.6(9):23-25. Ung L. Huff S. Not eligible target population. Corona GG. Volk H. 1997. 685. Medication errors by nurses: contributing factors.4(3):211-215. 695. Jun 1995. Nurs Times. Gillow K. No association tested.14(3):79-82. 4-7. Jr. Mod Midwife. Aug 12-18 1992. 697. Agency nursing: one hospital's experience. Mar 6-12 1996. Conners AM. Comment. 693. 24. 687. Smith SD. Nurs Times. Fla Nurse. 684.87(20):21.8(2):149-56. 698. Paul GL. The challenge facing critical care nurses in the UK: a personal perspective. 711. The mysteries of the Milton Tank! Nurs Prax N Z. Schuring RW. Br J Nurs. Triage nurses' decisions using the National Triage Scale for Australian emergency departments.10(5):313-319. Conway R. Accid Emerg Nurs. J Manag Med. Nurs Times. Willan A. Coombs M. Satisfied customers. Nursing workforce shortages: "code blue" for RN staffing across America.92(9):30-32. Nurs Stand. Corley MC.6(18):1071-1075. Can a zero defects philosophy be applied to drug errors? J Adv Nurs. Jun 2003. 703.11(3):27-31. Cormack K. Collier V. Hoas H. SCI Nurs. Cooper JE. 692. 690. 683. Not eligible exposure. Mar 1995. Not eligible exposure. Bowman A. Copeland-Fields L. 680. Not eligible target population. Medsurg Nurs.104(6):32-43.46(1):8-9. Snell L. 707. Br J Theatre Nurs. Family-centred care in practice. The challenges and benefits of job sharing in palliative care education.97(29):26-27. Tsushima ST. Not eligible exposure. Patient classification system in a rural emergency department. Evans C. Editorial. Jun 2004. Denny M. Coleman JC.55(10):21-22. 679. Comack M. We turned med/surg staff into telemetry experts. Joyner JC. 688. 712. Part-time working. Jul 19-25 2001. Collins SE. 689. Mar 1 1995. Cole A. Mar-Apr 1991. Apr-Jun 2004. Oct 2000. Mar-Apr 1999. Witness for the prosecution. Kinnie-Steeves A.13(41):32-34. Coleman S. Corder L. 709. Not eligible exposure.6(47):45. and by using the Mortality Prediction Model. Level the playing field.39(2):3-4. Cookson ST. Nurse attorney notes. 706. Not eligible outcomes. Jun 30-Jul 6 1999. Patient and nurse criteria for heart transplant candidacy.27(2):63. Sep 1996. Opportunity 2000 in the National Health Service: a missed opportunity for women. Guyatt GH. Psychiatr Serv. Ihrig M. 700. Audit of consent forms. Day in the life: Back to school nurses. Jarvis WR. Jan 1990. Canadian Critical Care Trials Group. Nurs Forum. Cooper C.

Not eligible target population. Diers D. 723. 721. Anaesthesia. Should we be getting danger money? Nurs Times. The other foot: who is an agency nurse? Tenn Nurse. 727.35(3):249-255. Francione DA. 20. 736. Notes from the field. Not eligible outcomes. Appraisal of the clinical competence of registered nurses in relation to their designated levels in the Western Australian nursing career structure.11(4):131133. Williams AM. 734. 718. Med Pediatr Oncol. Dec 1998. J Nurs Adm. Donlevy S. The effects of nurses' job satisfaction on retention: an Australian perspective. McGilvray S. Not eligible exposure. Nov 2001.31(3):217-230. Care centered organizations. Jun 1994. Crownover AJ. Sep 1993. May 1997. 728. J Nurs Adm. 64D. An inner-city hospital experience. Coughlin C. Not eligible exposure. 717. Why do registered nurses work when ill? J Nurs Adm. Spring 1993. mean and stupid! Nurs Manage. J Nurs Scholarsh. Jun 1996. Crimlisk JT. Cherlin E. Feb 1995. JohnsonHurzeler R. Tachibana C.97(29):23. Not eligible target population. Rotunna S.27(1):70-80. Crout LA. Excellence in evidence-based practice: organizational and unit exemplars. Daghistani D. JanMar 2005. Cullen L. 716. 738. Not eligible exposure. Rn. AprMay 2000.26(6):405-408. Staffing solutions: an in-house agency. Aust Crit Care. Cowin L.5(1):38-43. J Gerontol Nurs.31(3):113-120. 2003. Ryan C. 745.26(7):45-51. Contemp Nurse. 742. Coston B. Not eligible exposure. Cumbie SA. 714. 741. Online J Issues Nurs. Part 2. Poor agreement in application of the Australasian Triage Scale to paediatric emergency department presentations. Fighting through an appeals process. Nov 25-Dec 1 2003.35(1):23-28.27(2):63. D'Addario V.56(1):15. Dec 2000. Jul 19-25 2001. 'I'm delighted the new role is making a difference'. Swanson B.30(2):84-87. Agency nursing: one hospital's experience. Jan 2005. Not eligible target population. Jul 2000.6(4):339-345. Inadequate data presentation. Costello K. ANS Adv Nurs Sci. Evolution of BCMA within the Department of Veterans Affairs. Review. Not eligible target population. Nursing management Feb 1996. 64F. D'Agata EM.21(9 Suppl):S386387. Greiner J. Cox C. Mar-Apr 1999. Gattuso M. McNulty MJ. Mar 2001. The changing role of the nurse executives. Bombei C. Burman ME. Wise S. Crit Care Med. J Nurs Adm. 746. May 2002. Curry L. Daffurn K. Sheldon JA. Valuing people as individuals: development of an instrument through a survey of person-centredness in secondary care.58(2):57-59. AWHONN Lifelines.15(1-2):48-60. 744. 733. Int J Nurs Stud. Aug 1993.713 Costello A. Curtin L. News.90(6):6. quiz 5243. Curtin LL. Comried L. Not eligible exposure. Letter. Jan 2001. Prevention of indwelling central venous catheter sepsis. How case management can improve the quality of patient care. Dec 1994. Aug 2003. Med Care. Nurs Times. Dean-Baar S. Bradley EH. Hanna IT. Not eligible target population. Stewart A. 743. New graduate RNs in a float pool. No association tested.4(2):21. Jun 2005. 729. McDaniel C. 739. Craig EA. Healthtexas. Rodriguez Z. Dec 1998.99(47):26-27. Jun 1994. Feb 2001. Curley A. Michalski M. Williams B. J Adv Nurs. Cioffi J. McConachie I. Individualized care: perceptions of certified nurse's aides. Lean. Comment. Not eligible exposure. McCorkle R. Cramer LD. Nurs Adm Q. Comment. 715. Infect Control Hosp Epidemiol. Cronin-Stubbs D. Docherty P.26(6):539. Czaplinski C. who should measure? Health Bull (Edinb). Crellin DJ. Not eligible target population. Jr. Stark B. Letter.56(2):183. J Contin Educ Nurs. B-21 .32(5):283-291. 722. Appl Nurs Res. 2003. Nosocomial transmission of Mycobacterium tuberculosis from an extrapulmonary site.28(5):7-8.29(1):32-38. Matsuno K.8(3):5. Vinayagam S. Toledano S. Editorial. 735. single payer: what's best for patients and RNs? Calif Nurse. Not eligible target population.36(12):1626-1638. Caring for parents of critically ill children. An integrated analysis of nurse staffing and related variables: effects on patient outcomes. Crouch D. 726. Crome P. Coyle J. Crow D. Coyle GA. 731. 725. 720. Chang E. Cruickshank JF. Schoenike S. 5. Advanced practice nursing model for comprehensive care with chronic illness: model for promoting process engagement. Crit Care Nurs Clin North Am. Johnston L. 724. 7. Apr 2002. Not eligible target population. Not eligible exposure. Curley MA. Nurses' attitudes and practice related to hospice care.22(1):10-12. Nurs Manage. Addressing concerns in legislation. Jan-Mar 2004. Crandall M. Not eligible target population. Policies hinder nursing staff. No association tested. 740. Duchene P. Tsushima ST. Czurylo K. Heinen M. MacKay RC.32(4):211-217. Gruman C. Int J Qual Health Care. Conley VM. J Emerg Nurs. Epsom R. Not eligible exposure. Crispin C. Mar 1995.47(2):10-11. Aug 1991. Radiation exposure of nurses on an intensive care unit. Nurse or doctor: biometry for intraocular lens power calculation. Nurse-to-patient ratios. The effect of staff nursing on length of stay and mortality.17(2):127-142. Continuing education outcomes related to pain management practice. The effects of a training program on nurses' functional performance assessments.24(8):64A-64B. Nurses' responses to acute severe illness. Curtin LL. Not eligible outcomes. Comment. 719. Comment. Porter M. Foreign nurse recruitment. Cupitt JM. 737. Horn M. 730. Feb 1992. Not eligible exposure.36(3):450-459. Comment. 732. Comment.53(2):105-109. Lefkowitz LB. Managed competition vs.

The effect of a VIPS implementation programme on nurses' knowledge and attitudes towards documentation.21(78):31-38. Comment. Comment. Aust Crit Care. Hawkins LG.27(5):507-510. Nurs Prax N Z. 753. Davis NM. Williams S.94(3):14.21(3):132-138.91(4):56. Pierson C. 748. Dotson T. Semin Nurse Manag.94(5):17. Am J Crit Care. Patients' evaluation of pain and nurses' management of analgesics after surgery. Dale C. Davidson J. Trop Gastroenterol. Dann D. cross-sectional survey of accident and emergency department senior house officers. Autonomy at work: woman-centered birth and midwifery. Davidhizar R. Giger JN. May-Jun 1996. Nov 1993. Comment. 780.18(3):325-332.23(3):120-121. Training and supervision needs and experience: a longitudinal. No easy option. Comment. Baranowski SL. Feb 1999.75(880):86-89. Power nap rejuvenates body.10(2):74-75. 771. May 2002. Person CD. Feb 2000.3(6):22-24. Always read medication labels. Davidson SB. 754. Tanger JL. Dhadphale S. B-22 . Darby M. Mar 1995. Not eligible target population. Patrawalla V.51(3):67. The making of a supermodel. Crawford S. 766. Ankersen L. Not eligible exposure.5(5):331-338. Comment. Successful interviewing and selection strategies for patient-centered care delivery. The effects of health care reforms on job satisfaction and voluntary turnover among hospitalbased nurses. mind. 760.78 Suppl 1:S1-6. Mar 1994. Not eligible exposure. Davis NM.31(10):33-36. Davies H. Thomas D. 752. Minarik P. Phelps C. Davidhizar R. Gentzsch P. Dalayon AP. A look at travel nursing: two sides to the coin. Apr 1991. Mar 1995. Clifford JC. Sawant P.15(2):77-82.. Davidson H. Br J Perioper Nurs. Davol LH. Not eligible target population. Oct 1 2002. Not eligible target population. Elander G. Davis E. A phenomenological study of patient expectations concerning nursing care. Not eligible target population. Folcarelli PH. Dandrinos-Smith S. Am J Nurs. Am J Nurs. Comment. Jul-Aug 1991. Jun 1999. Shirhatti RG.15(4):51-53. 772. Combating confirmation bias. 763.94(7):17. Davis D.35(6):634-645. Jul 1994. Optimal staffing for hospitals: in search of solutions. 750. 759. Darmer MR. Not eligible exposure. Procedures used in withdrawal of mechanical ventilation. Garman DA. Postgrad Med J. Blueprint for healthcare. Comment. Thinking critically about delegation. Dykes AK. Daubener J. Effects of education on the prevention of pressure sores. Desai N. D'Avirro J. Components of preoperative patient teaching in Kuwait. 777. An interdisciplinary clinical advancement program within a patient-centered care model. Daniel K. Dyer MA. LaPierre B. J Nurs Manag. Jun 2001. Suthisanon L. Davis R. Davis NM. Mar 1994. Comment. 779. 767. Client-centred midwifery.118(10):796-798. 749.30(4):866874. Glucksman E. Nursing resources in accident and emergency departments. Daly BJ. Mar 1996. Rudy EB.99(6):61-62. Mishler MB. Rehabil Nurs. a personal journey of self discovery through further nursing education. J Emerg Nurs. Comment.11(6):210. The effect of a study day on the subject of pain for nurses working at the thorax surgery department. Holist Nurs Pract. Duprat LJ.10(1):12-21. Jun 1999. 761.7(5):271-280.23(4):88. Nurs Manage. J Nurs Manag. Oct 1996. Scand J Caring Sci. Comment.19(3):537542. Todays OR Nurse. J Adv Nurs. 765. 756. Not eligible target population. Nielsen BG. Nurs Manage.747. Comment. Oct 2000. Tantiwatanapaibool Y. Daugherty J. 778. Factors that influence nurses' customer orientation. May-Jun 2005.19(3):126-133. Sep 2004. Das HS. Not eligible target population. What makes a good intensive care unit: a nursing perspective. Oct 2004. Satisfying a hunger . Daly BJ. Hobbs M. Am J Nurs. 773. Comment. Comment. Is a doctor needed in the adult ENT pre-admission clinic? J Laryngol Otol. J Adv Nurs. 770. Golden slumbers. J Med Assoc Thai. Comment. Not eligible target population. Not eligible target population. Partnering with nurses to handle personnel shortages.3(1):27-35. Midwifery Today Childbirth Educ. Danchaivijitr S. 757. Jul 1995.4(6):26-28. Am J Nurs. Not eligible exposure. Banerjee AR. A nurse-managed special care unit. 755.59(19):1824-1826. Wellesley A. J Nurs Adm. Oct 2001. Qual Lett Healthc Lead. 751. Nurs Manag (Harrow). Egerod I. Jul-Sep 2002. Not eligible target population. Darby DN. Poole V. Not eligible target population. Not eligible target population. The quick fix? Am J Nurs. Marshall W. Pract Midwife. Darvas JA. Davis JE. May 1994. 774. Med Care. Vyas K. Vispute S. Davis LA. 762. Efficacy of low dose intradermal hepatitis B vaccine: results of a randomized trial among health care workers. "Premium shifts": a solution to an expensive option. Jul-Aug 1993. 776. Lynch J. Pa Nurse. Review. Sep 1999. Sep 1996. Comment. Comment. Jun 1997. Scott R. Dahlman GB. Preparing a nursing department for downshifting. 769. Apr 1992. Oct 1999. Summer 1997(42):23-25.93(11):14.. Dale J. Am J Health Syst Pharm. Not eligible Exposure. Miller B. Daniel M. 775. Davis NM. Landberger G. Jitreecheue L. Concentrating on interruptions. Lippert E. Teaching patients to prevent errors. 764. Jan 1995.3(1):11-18. Not eligible target population. 758. Am J Nurs. 768. Darling H.

Nurse/physician collaboration: action research and the lessons learned. Oct 1997.20(3):2933. Decter MB. Interview.5(1):27-29. Russell C. de Rond ME.12(1):62-68. 787. Opportunity afforded by junior doctors' hours being reduced. Wells SE. Daynard D. 805. Burke LJ. Short-changed? Nurs Times. et al.27(4):825-828. Nurs Manage. Pediatr Nurs. Not eligible target population. J Nurs Manag. Mandin H. Agency nurses: the right solution to staffing problems? Journal of Long-Term Care Administration Fall 1992. Convergence of health ratings across nephrologists. McGrail M.17(1):15-23. Health and performance factors in health care shift workers. Sque M. Dean KA. Dechant GM. and patients with end-stage renal disease.35(4):590-598.51(3):15. B-23 . Pain.32(3):199214. Jul 10-16 1991. Development of an assessment tool to measure the influence of clinical software on the delivery of high quality consultations. Denyes MJ. Ross J.5(42):43. J Adv Nurs. Intensive Care Med. Development of a new eye care guideline for critically ill patients. 803. Not eligible target population. Jordan-Marsh M. A study comparing two computerized medical record systems in a nurse run heart clinic in a general practice setting. Variant Creutzfeldt-Jakob disease: need for mental health and palliative care team collaboration. May 2001. Not eligible exposure. Russell C. Jan-Feb 2004. 793. Oct 1998. Crain AL. Barrett V. Involvement and fragmentation: a study of parental care of hospitalized children in Brazil. Aug 2001. De Groot HA. Bryan K. Health Manpow Manage. Neuman BM. Children's nurse and service manager in acute paediatrics. Asche SE. Interview by Loretta Loach.12(2):85-90. Not eligible target population. 798. Not eligible target population. Norman R. Not eligible outcomes. Jr. Not eligible outcomes.27(4):267-280. A case of a financial approach to manpower planning in the NHS. Fla Nurse. Intensive Crit Care Nurs. Callery P. Wainwright SP.24(10):1062-1069. An evaluation of a teaching intervention to improve the practice of endotracheal suctioning in intensive care units. Wessell J. Abu-Saad H. Not eligible target population. Apr 2003. Not eligible target population. Wilson-Barnett J. de Lusignan S. Dec 15 2000. 807. Barre PE. Devanney JJ. van Dam FS.31(2):11-2. Is there a relationship between 12-hour shifts and job satisfaction in nurses? Alabama Nurse Jun-Aug 2004. 791. 786. Dewsall J. Feathers CA. Self-scheduling can work. A model for patient-centred nurse consulting in primary care. Testing the limits: shift rotation and the ADA. Sep 13-19 2001. De La Cour J. The implementation of a Pain Monitoring Programme for nurses in daily clinical practice: results of a follow-up study in five hospitals. 802. Dawson D. Not eligible outcomes. J Clin Nurs. Day GR. Dechairo-Marino AE. Nov-Dec 2001. 800. Med Care. J Adv Nurs. Med Inform Internet Med. Biomechanical analysis of peak and cumulative spinal loads during simulated patienthandling activities: a substudy of a randomized controlled trial to prevent lift and transfer injury of health care workers. Revolution. Nov 26-Dec 2 1997. Day T. Wells S. Not eligible target population 801. de Keizer NF. Comment. 809.27(6):559-564. Not eligible target population. Sep 2003. Market value & real values: industry's choice in implementing ratios. Implementing the differentiated pay structure model. May 1998. May 1990. Process and outcomes. 804. Jan 2004. Devadas D. Al MJ. 580. 785. de Vries K. Jan-Mar 1991. Not eligible target population.21(2):119-122. J Nurs Adm.35(10 Suppl):OS70-75.28(5):28-38. de Wit R.30(3):35-37. Negligent patient abandonment. Devins GM. 795. No association tested.56(4):326331. Dennis S. George VM. Dearholt SL. de Rond M. The relation between TISS and real paediatric ICU costs: a case study with generalizable methodology. Not eligible target population. Cooper JE. van Dam F. de Lusignan S. Villarruel AM. Self-scheduling for nursing staff. Mar 1999. 792. Scochi CG. Dec 2003. 784. The Tredgold model of nursing. Not eligible target population. Nurs Times. Canadian hospitals in transformation. Bonsel GJ. Not eligible target population. J Clin Epidemiol. Yassi A. Paul LC. Appl Ergon. Dec 2004. Aug 1997. Nurs Times. Apr 1998. Legal Cases. 790. Rocha SM. Dawson C. Not eligible exposure. Bevington WP. Apr 2005. Not peer reviewed.97(37):27.28(8):47-48.14(1):31-48. Nursing home. J Occup Environ Med. Not eligible target population. Wells R. 799. Issues Compr Pediatr Nurs. AARN News Lett. 1991. Dec 2002.93(48):4041. Int J Palliat Nurs.96(40):39-40.46(5):4-8. Deitzer D.10(5):682-696. No association tested. Oct 5-11 2000. King K.781. Tate R. A Pain Monitoring Program for nurses: effect on the administration of analgesics. Nursing actions to prevent and alleviate pain in hospitalized children. Devine J. 788. DeMoro D. Jun 2001. J Nurs Adm. Nurs Manage. Binik YM. DeMoss C. 806. Haus E. de Wit R.46(12):1278-1281. Not eligible target population. 794.89(1):25-38. Jan 23-Feb 12 2003. de Ruyter A. Taub K.9(12):512-520. de Lima RA. Nurs Stand.. Sep 2001. Arrowsmith P. Saulo M. 789. Muller MJ. 797. 808. Legal Cases. Br J Nurs. Comment. Not eligible exposure. Myles K. Gemke RJ. Suicide in the ward setting. 810. Not eligible target population 783. 782. 796. Casual work in nursing and other clinical professions: evidence from Australia.31(5):223-232. nurses. Traiger G.

832.9(2):77-83. J R Soc Med.8(19):1322-1323. Disomma C. Dixon L. DiIorio C. 837. Alamance Regional Medical Center improves patient safety with CPOE.18(1):18-23. 831. Dogan S.14(1):61-67. 9: The law relating to whistle blowing.811. Marcon E. J Nurs Adm. Vedio A. Nurs Stand. Mar-Apr 2005. Linda was a nurse working on night duty and concerned about staffing levels. Dinsdale P. Diehl-Oplinger L. J Child Health Care. J Adv Nurs. Kaminski MF. Ducharme M. Mar 2000. May 1996. Mar 23-29 1994.14(1):107-113. Occupational allergic contact dermatitis in hospital workers caused by methyldibromo glutaronitrile in a work soap. Sleep quality in hospitalized patients. 816. Tartaglia A.6(3):172-174. 825. Korber S. J Healthc Inf Manag. Pietruch BL. Need critical care nurses? Inquire within.11(23):28. Feb 26 1997. Not eligible target population. Diba VC. Pierce L. J Clin Epidemiol.20(2):92-102. Leach RM. 820. Nurs Manage. Dingman SK.27(5):34. Apr 2005. Not eligible exposure. Dickens GL. Intensive Care Med.18(1):64-6. and persons with epilepsy. length of stay. Not eligible target population. Tartaglia A. Working year. Lucas S. Dickenson-Hazard N. J Neurosci Nurs. Smoking and mental health nurses: a survey of clinical staff in a psychiatric hospital. de Matta R. DiMeglio K. Jul 1993. PCS: one system for both staffing and costing.30(11):8. Nurs N Z. Not eligible exposure. 819.19(2):74-77. Dinsdale P. 833. Dickson J. 817. Fosbinder D. Jan 2005.31(3):44. 839.105(5461):28-29. Not eligible target population 818. Strategies to reduce delays in admission into a postanesthesia care unit from operating rooms.23(6):1247-1253. Confidentiality.27(1):29-34. 46. Dodd-McCue D. Not eligible target population. Nurs Stand. Rittenmeyer H. Heart failure disease management: impact on hospital care. The more. Dingley J. Implementing a caring model to improve patient satisfaction. Dogan O. 826. 823. Corry K. Kuthy S. Levine TB. Not eligible exposure. Group cohesion and nurse satisfaction: examination of a team-building approach. Dickson M. Mar 11-17 1998. A computer-aided comparative study of progressive alertness changes in nurses working two different night-shift rotas. Pre-admission clinic in an ENT unit. Wilkerson S. Jul 2003. Feb 1995. 824. DiFrancesco M. Not eligible exposure. J Nurs Adm. Powell P. King MC. Not eligible exposure. Faulkner K. Not eligible exposure. Dijkers M. Chowdhury MM. Manteuffel B. J Clin Nurs. Jul 7-13 2004.11(4):445-451.94(10):14. Lane JA. Nurs Outlook. Joyal E. Nurs Manage. Mar 2005. Aust Crit Care. Pediatric nursing Jan-Feb 1992.56(7):605609. Not eligible target population. Review. 827. Adisesh A. Exploring nurses' experiences of providing high dependency care in children's wards. Mar-Apr 1997. Dimond B. 2005. 812. Streetman PS. Levine AB. Not eligible year. Piatek C. 842. Quantification of phase I postanesthesia nursing activities in the phase II postanesthesia care unit. Comment. Padula C. Dimond B. 838. Mitten-Lewis S. Mar-Apr 2003. Prog Transplant. Contact Dermatitis. Nurs Manage. Donoghue J. The impact of protocol on nurses' role stress: a longitudinal perspective. Paradise T. Peters TJ. 821. 828. Neal DE. Not eligible target population.8(26):23-26. 822. Accid Emerg Nurs. Oct 28-Nov 10 1999. Not eligible target population. Williams M. and reimbursement. Not eligible target population. Not eligible target population. Jun 1996. Gillatt D. Discher CL. Improving healthcare delivery with the transformational whole person care model. Donovan JL. Jul 13 1995. Klein D. Unintended consequences: the impact of protocol change on critical care nurses' perceptions of stress. 841. 836. Sep 2004. Not eligible target population. Stubbs JH. Editorial. 36. Hamdy FC. 813. Dodd-McCue D. Comment. Feb 2003.18(43):12-13. Nov 2000.45(2):86-88. Andrews T. Relationship between TISS and ICU cost. Patient-centred cystic fibrosis services. Not eligible target population. Statham BN. Aug 2004. Prowse M. Not eligible target population. Not eligible target population.1(4):12-14. 829. Congest Heart Fail. Not relevant. Who can best recruit to randomized trials? Randomized trial comparing surgeons and nurses recruiting patients to a trial of treatments for localized prostate cancer (the ProtecT study). No association tested. Not eligible exposure. Dundas R. Doman M. Dexter F. J Nurs Adm. Veazey KW. May 2001. Dilemma. Noble S.24(10):1009-1017. Mar 2004. Ertekin S. 814. Apr 2005. physicians. The connection delivery model: care across the continuum. Not eligible target population. Dodge JA. Donlevy JA. Nurs Stand. 834. Dexter F. Casualisation crisis. Nursing. Not eligible exposure. Preferences concerning epilepsy education: opinions of nurses. Oliver SE.98 Suppl 45:2-6. Jul 1998. Nurs Times. Decker V. Warnick M. B-24 . 815.48(2):118119. Br J Nurs. Haw CM. the better.14(2):56-63. Every nurse is a leader. Didovich K. J Psychiatr Ment Health Nurs. Treacher DF. Not eligible outcomes. Webb C. Barrett A. Jan 1986. 840.35(3):110-120.35(4):205-216. Health Serv J. Critical care dependency tool: monitoring the changes. 835.17(1):25-34. Oct 1998. The effect of child care proximity on maternal reports of separation anxiety in employed nurses. Donadio G. Not eligible target population.29(12):30-37. Piermont N. 830. J Perianesth Nurs. Epstein RH. Winter 2004. DeNicola V. Myer K. Dickie H. Dec 1999. All of the people most of the time. Staff roles. Not eligible target population. Holist Nurs Pract. Post haste. Blay N.8(3):180-197.

Mar 2001. 859. Mar 2001. 1998. 857. Not eligible target population. Steele L. Thirst for knowledge.25(7):4045. Oct 1999. International Journal of Occupational and Environmental Health Jul-Sep 1997. Nurs Stand. Not eligible target population. Dumais MM. Nov 2003. Night nurses: why are they undervalued? Nurs Stand. 873.. van Merode F. Nurs Stand. No association tested.45(7):2. Oct 1992. Use error: a nurse's perspective. Olde J. Paediatr Nurs. J Adv Nurs. Effects of performance feedback on patient pain outcomes.33(7):10. Comment. Bangsberg DR. 858.14(35):18-19. 860. Not eligible target population. GHA Today. Canadian Journal of Nursing Research Mar 2001. Sep 2005. Hosp Health Serv Adm. The more things change.9 Pt 1:64-69. Comment. Nurs Times.21(7):465-469. Maslin-Prothero S. Doucette JN. Whitman D. A heterogeneous outbreak of Enterobacter cloacae and Serratia marcescens infections in a surgical intensive care unit. 869. 877. 856. Doyle KA. Jan 10-16 2001. 861. Not eligible outcomes.7(3):4. Duncan SM. Howland K. Duxbury J. Not relevant. Nurs Times.94(30):58-60. Eagle DJ. Job sharing--the way forward? Nurs Stand. 874. Duxbury M. Nov 5 2004.36(4):5. Duchene P. Nurs Manage. Dougan M.97(39):25.11(8):23-25. Interview by Joanne Disch. Nov 2002.27(2):32-33. 871. Nurs Manage. Not eligible outcomes. Editorial. Not eligible outcomes. Lambert A. Jul 2002. Estabrooks CA. Perdreau-Remington F. Waiting in vain. Dykes F. Clin Nurs Res. Nurs Times. Not eligible exposure. Wells J.9(11):33-36. Szalapski J. Nurs Stand. 844. Mayewski J. Nov 2000. Not eligible outcomes. Dowding D. Jul 1999. 872. Not eligible exposure. Midwifery. Comparison of three instruments in predicting accidental falls in selected inpatients in a general teaching hospital. Driedger L. Hyndman K. Doreen F. Duchene P. Nurs Manage. Duckett R. 853. Feb 1996. 855. Jul-Aug 2004. US survey finds link between patient recovery and nurse numbers. Am J Crit Care. Jun 2000. June 1995. Duffin C.10(2):7173. Jul 2000. XIIth International Symposium on Night and Shiftwork. Duncan K. Nurs Manage. Robinson C. Not eligible outcomes. Fall 2002. Surgical gloves. Meeting supplemental staffing needs: an in-house approach. Bryan-Brown CW. Borneo HT. J Adv Nurs. Comment. Introducing products to prevent needlesticks.9(4):379-397. Case Reports.4(50):32-36. News. Montplaisir J. Dumont M. Nurs BC. Staff ratios: just about numbers? Nurs Manage. 868. 876. If you don't know where you're going. 846. Winter 1990.89(35):29-31. Dunton N. Jul 2001.843. Night nursing. A critical ethnographic study of encounters between midwives and breast-feeding women in postnatal wards in England. Not eligible target population. 875. 866. Serving up uncommon service. Nurs Econ. 36. Sleep quality of former night-shift workers. Eastaugh SR. Not eligible target population. Hospital nurse productivity. Not eligible target population.96(2):49-50. Interview. Dzendrowskyj P. Evans LA.9(10):31-34.15(17):12. The phone call that changed my life. 852. Promoting children's rights: the role of the children's nurse. 850. Jul 29-Aug 4 1998. Feb 2000. B-25 . J Gerontol Nurs. Dracup K. Pozehl B. Nurses' experience of violence in Alberta and British Columbia hospitals. Medinfo.38(4):313315.117(1205):U1150. Duffin C. Duffy D.21(3):241-252. Effects of nursing industrial action on relatives of Intensive Care Unit patients: a 16-month follow-up. 863. 845. Avoiding disturbed sleep in hospitals. Letter. Eastaugh SR. "Magnet" status as markers of healthy work environments.33(6):836-846. Dumont R. Nov 30-Dec 6 1994. Duxbury J. Sep 1-7 1993. Lanigan C. et al. Infect Control Hosp Epidemiol. Comment.33(11):11.34(11):26-30. May 1723 2000. Jan 2003. Sep 27-Oct 3 2001. Comment. Durham S. anywhere you end up is OK. Salama S. Nurs Manag (Harrow). Can Nurse. Taunton RL. J Health Care Finance. Deliver empowered care. 849. 851.23(10):62-66. Ho E. Dorsey G. Examining the effects that manipulating information given in the change of shift report has on nurses' care planning ability. Sun SJ. Foxwoods symposium series. 848. Dec 7-13 1994. InfanteRivard C.35(4):561-573. Shaw G. 132. Not eligible outcomes. Out of the shadows: a study of the special observation of suicidal psychiatric in-patients. Eastman M. Oct 2004. 2002.21(5):944-950. Avoiding drug administration errors: the way forward. The other side of the bed. Not eligible target population. Brown C. Not eligible exposure.13(1):17-20. Drew JA. Tange H. 865. Sep 5-11 1990. Gajewski B. Johnston L. Comment. 854.29(1):14-22. Hospital nursing technical efficiency: nurse extenders and enhanced productivity. Dugger B. Census variation staffing. discussion 398-401. et al. Creat Nurs.9(2):128-130.. Biomed Instrum Technol. Not eligible target population. User needs and demands of a computer-based patient record. Interview by Mary Hampshire. How do you change yours? Br J Perioper Nurs. Interview. 870. Not eligible exposure. 864.8(2):4-6. 862. Dunn L. Mar-Apr 1991. Not eligible target population. N Z Med J.52(1):53-9.3(3): Suppl):S10-4. Nursing outlook Jan-Feb 2004. Douglas DA. Conference abstract. Nurse staffing and patient falls on acute care hospital units. Drennan V. 878. van der Loo R. One solution to poor staffing ratios. Review. Not relevant 867. 847.32(4):57-78. Dummett S. May 1995. Staff mix and public safety.

Not eligible exposure. Sereika SM. 912.6(2):6. Am J Crit Care. Nov 2004. Not eligible target population.36(2):114-131. 910. Enmon P. New act may limit recruitment of foreign nurses. Davis BA. May-Jun 1998. 888. Cusson RM. Two hospice quality of life surveys: a comparison. 885. J Hum Ergol (Tokyo). Evans M. Edwards SD. 893. Improving the ward environment through observation of care. 892. 887. Comment. Sep 11-17 1996. Ellis J. Jun 2004. 901. according to national data. 909. Crit Care Nurse. 882.92(43):34-35. Eschiti VS. Engler AJ. Wong J. Aug 2002. Elder R. Meanings of giving touch in the care of older patients: becoming a valuable person and professional. Sep 1991. Edwards N. Erickson ST. Evans M. Nurs Stand.10(37):39-42. 896. Comment. Jones DE. Shamian J. Not eligible target population. 908. Ditomassi M. Efraimsson E. Can J Nurs Res. 895. Valimaki M.33(2):96-104. Not eligible target population. Ellis J. Interview by Dina Leifer. Edel EM. Piha J. Comment. Apr 2005. Ellila H. Endacott R. Feb 5 1990. Ermer GR. Mar 11-24 1999.92(37):32-34. Nurs BC. Endacott R. Not eligible exposure.22(1):3-6. Nurses' attitudes towards shiftwork and quality of life. Clinical decisions made by nurses in intensive care--results of a telephone survey. Oct 23-29 1996. Not eligible target population. News. 906. Etheridge G. J Adv Nurs.64(3):67. Estryn-Behar M. J Clin Nurs. Not eligible target population.22(9):45-46. 911. Hamilton GA. Nov 1997. Hospitals. Eubanks P.100(46):36-38. 891.35(2):16. Evans J. Patient satisfaction with triage nursing in a rural hospital emergency department. Crit Care Nurs Q. Hyden LC. Vinck L. Sandman PO.880. 889. Nurs Crit Care. Sandman PO. Chellel A. Putting a price on care. Ellis S. Jul-Sep 2004. 894. Feb 2001. Scand J Soc Med. Will work for visa. Res Nurs Health. Whitledge L. Elliott TE. To stay or not to stay. Blizzard forces nursing home evacuation. Gastroenterol Nurs. 897.26(5):953-961. Not eligible outcomes. Aug 8 2005. Not eligible target population. Eischens MJ. Dec 2001. B-26 . Comment.35(32):14. Bringing talk to the table. Cross currents. A perioperative patient acuity system: planning and design. 97-89. Estabrooks CA. Mod Healthc. CannonHeinrich C. Neonatal staff and advanced practice nurses' perceptions of bereavement/end-of-life care of families of critically ill and/or dying infants. Humphrey CK. Br J Nurs. Not eligible exposure. Barriers to effective screening for domestic violence by registered nurses in the emergency department. Measuring the hospital practice environment: a Canadian context. Buckley J. 900. Work schedules in health care in France: very few changes between 1991 and 1998. Doswell N. Overtime and fatigue. The Synergy Model: linking patient needs to nurse competencies. Jun 5 1996. Nurs Manage. Are nursing's 'extraordinary' moral standards realistic? Nurs Times. No association tested. Rasmussen BH. Jun 2001. Not eligible target population. Not eligible exposure. Caillard JF. Mil Med. Discharge planning: "fooling ourselves?"-patient participation in conferences. Low nurse-topatient ratios save lives but are costly: study. 883. Ellefsen B. West IJ. Demetropoulos S. Jan 16 1996.12(4):601-609. 904. Not eligible target population. Ellis S. Planting seeds at Esalen: collaborative relationships in holistic healthcare. Lou Q.27(1):9-10. Escriba-Aguir V. Not eligible exposure. 898. Nurs Stand. Erickson JI. Not eligible target population. Comment. Acorn S. J Clin Nurs. Tourangeau AE. Ellis JM. Case Reports. Hesketh KL. Littlepage N. Not eligible target population.2(4):191-196. Feb 1999. Goldberg MA. 890. Nurses' construction of clinical situations: a study conducted in an acute-care setting in Norway. 48P. Not eligible exposure. Interview. Nurs Manage. News. The patient-centred care model: holistic/multiprofessional/reflective. McEleney BJ. Not eligible target population. Letter. Jan 10 2005. J Nurs Adm. Not eligible exposure. J Psychiatr Ment Health Nurs.13(6):489-498. 899. Jul 2003. Nurs Manage.33(3):32-33. Jul 2004. May 1995.20(2):115-118. Feb 2003.19(3):263-268. 48. The value of collaborative governance/staff empowerment. Critical care nurses. West MG. Neal C. Nov 16-22 2004.35(3):50-52. 902. Giovannetti P.22(1):27-41. Rasmussen BH. Jun 1992. Sourander A. Bill would boost visas for skilled workers. Erlen JA.19(1):88-90.15(3):143-148. Nurs Times. ethical decision-making and stress. Brockett RT. Am J Hosp Palliat Care. Not eligible target population. 886. Summer 2005.25(4):256-268. Nursing dependency scoring: measuring the total workload.8(5):296-301.15(48):16. Chong SK. Characteristics and staff resources of child and adolescent psychiatric hospital wards in Finland. 903. 907. Beginnings. May 1999. Prevalence of immunoglobulin G to Helicobacter pylori among endoscopy nurses/technicians. Esposito L. Elliott BA. Edwards DF. 905. Feb 2000. Thomson D. Nurs Times.30(1-2):327-332. 881. Not eligible target population.12(2):209214. Ellett ML. Edvardsson JD. Mar 2004.13(5):562-570. The implications of day surgery for inpatient hospital wards.25(3):3. Petow W. Mother's Hours: "extra" RNs balance the workload. 17. Mod Healthc. Kim HS. J Nurs Care Qual. Almes E. More on mandatory overtime and wearing blue ribbons. Dawson D. Clarke H. Aug 15-21 2001. Not eligible outcomes. Nurs Spectr (Wash D C). J Emerg Nurs. Jan-Feb 1999.26(5):48N. Jul-Aug 1997.165(2):131-134. An oral history of the "joint" nursing experience at Landstuhl Regional Medical Center. 884.

Maguire P. Farrell C. Survey provides a snapshot of staffing challenges in the OR.4(1-2):5154. Nurs Manage. and outcome issues. Gemma PB.24(1):1-16. Am Heart Hosp J. Mar-Jun 2002.21(2):2223. Not eligible outcomes. Aug 2000. Nurs Health Sci. Apr 1992. Cancer Nurs. Comment. 921.25(6):34-35. Med Care. Concepts of health: implications for public health work.6(3):26-31.21(8):54-55.6(6):369-377. Not eligible outcomes. Comment. Richards T. Not eligible target population. Fetzer SJ.18(6):377-379. Delbos V. Not eligible year. 918.10(7):34-42.90(2):42-44. Eve M.16(9):1062-1070. Teaching and support: nursing input in the postpartum period. J Adv Nurs. 914. Identifying the concerns of women undergoing chemotherapy. Richman PB. J Hosp Infect. Not eligible exposure. 52. Jr. Chotard-Frampas V. 935. 933. Cleary PD. Feutz SA. Not eligible target population. Heaven C. 926. Kirchhoff K. McLeay J. Kec R. Mar-Apr 1994. Turner B. 937. Farwell B. Jan 12-18 1994. Comment.913. Not eligible target population. Nursing.5(8):404-408. Fagerstrom L. Aug 1991. Low staffing levels leave little time for care. Not peer reviewed.37(1):39-43. Patient Educ Couns. 932. Fahs MC.21(4):20. Oct 2000. Farrington M. Richards J. Conway K. Fiesseler F. 940. Filipovich CC. Jul 1980. Fall 2003. 945. Jun 2001. Health care in America: an intimate glimpse. Am J Public Health. Intensive Crit Care Nurs. Sep 1991. Not eligible exposure. Ferguson TB. No association tested. Jousset N. 942. Jan 1991. Diabetes Educ. Farrell GA. Evans ML. Martin ML. How to cope with under staffing. 927. Chisholm L.23(3):49-50. Evans SK. 923. The nature and causes of violent incidents in intensive-care settings. The nursing shortage: whose liability problem? Part II. Nurs Times. Facchinetti NJ. Editorial. The nursing shortage crisis in Quebec's McGill University affiliated teaching hospitals: strategies that can work. 10-13. Not eligible outcomes. J Perianesth Nurs. Jan 2005. Anderson L.28(4):337-347. 1991. Understaffing: a risk factor for infection in the era of downsizing? Infect Control Hosp Epidemiol. Comment. The inpatient AIDS unit: a preliminary empirical investigation of access. Renfrew M. 916. Beaver K. Feng JY. Comment. J Nurs Manag. Nurses' intention to report child abuse in Taiwan: a test of the theory of planned behavior. Not eligible exposure. 915. Field PA. Findlay J. Jones DP. 925. Sep-Oct 1993. Roquelaure Y. 939. Teach nurses effective ways to deal with inadequate staffing. Fairburn K. et al. 938.70(11):4-5. Staffing implications: a legal update. on-call hours. Ewens A. Not eligible target population. 917. Fulop G. Comment. Not eligible target population. Strain J.28(2):131-144.17(3):147-149. Dec 1999. Br J Community Nurs. Legal Cases. May 2004. 929. Not eligible exposure. Not eligible target population. Dec 2003.98(12):57-59. Dec 2002. How accurately do nurses perceive patients' needs? A comparison of general and psychiatric settings. 920. Winslow EH. 941. 931. 924. Ferns T. Feldberg C. economic. Not eligible exposure. Muller C. Am J Nurs.22(3):145-148. 943. Nurs Manage. Eriksson K. 934. Can nurses appropriately interpret the Ottawa Ankle Rule? Am J Emerg Med. Seeing with new eyes. Stat Bulletin Nov 2001. Farnham JA. Beyea S. Not eligible outcomes. Mar 1996. Feldstein MA. Campbell GM. FallWinter 2001. Nurs Manage.22(1):64A-64C. J Law Med Ethics.1(4):264-272.17(6):1. Fermin P. Laundon T. Aug 2001. Int J Nurs Stud. Wu YW. Comment. Evaluation of a training program for the prevention of lower back pain among hospital employees.56(1):72-77. Redpath C. Continuous quality improvement in medicine: validation of a potential role for medical specialty societies. ANS Adv Nurs Sci.82(4):576-578. Not eligible exposure. Nurses' attitudes to visiting in coronary care units. Can J Nurs Adm. Fargen J. Comment. Fernsebner B.29(3-4):413-414. Yamamoto WG.18(3):228-236. Mandatory overtime: a survey of registered nurses. Aug 2005. Nurs Manage. Not eligible exposure. Jun 1994. Jun 1995.10(3):224-233. Ferrante A. A comparison between patients' experiences of how their caring needs have been met and the nurses' patient classification--an explorative study. Labor law: no minimum wage for nurses' off-premises. Jan 1999. Balancing assignments: a PCS for a step-down unit. Res Nurs Health. No association tested.20(2):125-128. Empowerment as a process of evolving consciousness: a model of empowered caring. Sacks HS.46(2):118-122.18(4):207-210. 922. Nursing care and patient satisfaction. Evaluating dispensing error detection rates in a hospital pharmacy. 930. Projecting staffing requirements for intensive care units. Crit Care Nurse. Ann Intern Med. An innovative approach to maintaining critical skills. Mar 1992. Falk-Rafael AR.125(12):1005-1006.30(12):38. Trundle C. Shifting time. 928. Dec 15 1996. No association tested. Mjolsness E. Effects on nursing workload of different methicillinresistant Staphylococcus aureus (MRSA) control strategies. Oncology nurses and chronic compounded grief. 936. Dec 1998. Sep 1994. Szucs P. Nurs Manage. Nov 1998. Fiesta J. An inpatient diabetes educator's impact on length of hospital stay. Feddersen E. Engberg IB. Schmeidler J. 919. Fanello S. Prof Nurse. Not eligible outcomes. Lockwood DH. 944. Farr BM. Fiesta J. OR Manager. Sep 2001. Not eligible target population. Feb 1990. B-27 . 946. J Nurs Adm. Maez-Rauzi V.

Nursing in Saudi Arabia. Arcona S. Bates DW. Feb 2002. Fitzpatrick MA. Jul 13 1995. O'Connor LJ.34(1):67-73. J Adv Nurs. J Gen Intern Med. Vickers RM. An Afghan hospital in wartime. Not eligible exposure. Aug 22-28 2001. J Hosp Infect. Apr 2002. Expressed emotion on long-stay wards. Louwerens JW.17(7):443-447. Not eligible exposure. Kapoor WN. Jan 1990. Yu VL. 960. Not relevant. J Nurs Care Qual. The numbers game. Fitzpatrick JJ.12(1):19-26. Calame A. Dec 1997.947. Apr 6-12 1994.105(5461):30. Fitzpatrick JJ. Zeier H. Kettles A. Issues in Mental Health Nursing Sep 2001. Not eligible target population. 2002. Apr 8 2002. King J. Not eligible target population. Glass CA. J Adv Nurs. Nurs Manage. Not eligible target population. 990.17(2):26-27. Fink R. Kominos S. Overcoming barriers and promoting the use of research in practice. 956. McKee EP. Comparison of methods for detecting medication errors in 36 hospitals and skilled-nursing facilities. again? Nurs Manage. Fitzpatrick JM.97(10):20. Not relevant. 949. Flynn L. Can Nurse. Not eligible exposure. Insubordination--patient load. Deets C. The efficiency of management of emergency surgery in a district general hospital--a prospective study. Mar 2005. Arena VC. Mar 1 2002. Fitch JA. please. JanFeb 2000. Oral care in the adult intensive care unit. 948. Finnema EJ. J Nurs Staff Dev. Am J Nurs. 951. Flannelly LT. May-Jun 1991.8(1):52-56. Tympanic membrane vs. Thorburn J. Firn S. Interview by Margaret Atkin. 987. Sep 1996. A purpose built MRSA cohort unit. Flynn L. No association tested. Eur J Anaesthesiol. 959. Orloff JJ.6(3):189-198. Murphy OM. Does international nurse recruitment influence practice values in U. Flynn ER. Finn T. J Nurs Adm. Flannelly KJ. Jul 2000. J Nurs Adm. Jan-Mar 2004. Outcomes Manag. Not eligible target population. Wolf ZR. Flucker CJ. Fine MJ. Nurs Times. Galusha D.29(1):18-27. Comment. Griffiths R. Not eligible target population.90(14):57.33(4):6.31(6):324331. Rihs JD. Dec 2003. Jun 2000. Not eligible exposure. Comment. Comment. Fletcher CE. Editorial. 958. Not eligible exposure. Pepper GA. Barker KN. 995. Fletcher E. Fletcher M. Stewart L. Launching the Tidal Model in an adult mental health programme. Thompson CJ. Brady A. 961. Munro CL. Not eligible target population. The 50-millilitre syringe as an inexpensive training aid in the application of cricoid pressure. Flexible working. Not eligible target population. Eichorn A. Arch Intern Med. Objectifying psychomental stress in the workplace-an example. Interview. Meehan TP. Weisz M. pulmonary artery thermometry. van den Bosch RJ. Smith T.9(2):132-9. Dean LM. Patient and hospital characteristics associated with recommended processes of care for elderly patients hospitalized with pneumonia: results from the medicare quality indicator system pneumonia module. FitzGerald EL. 952. Nov 1994. Revolution. Hospitalized elders: changes in functional and mental status. The possible dream. Hart E. Dettling AC. 993. B-28 . Hinson N. Selected predictors of registered nurses' intent to stay. Roberts JD. Ruth M. Aiken LH. Comment. Sep 1999. 957. Not eligible target population. 955. The educational needs of part time clinical facilitators.59(5):436-446. Fine MJ.8(5):314-318. Stier L. NLN Publ.21(12):812-817. 950. Nurses. Health Serv J. Evaluation of housestaff physicians' preparation and interpretation of sputum Gram stains for community-acquired pneumonia. Shift work and its impact upon nurse performance: current knowledge and research issues. Callahan B.102(2):42-45. Not eligible exposure. Dlugacz YD. J Christ Nurs. White MT. Jun 1990(20-2294):318-326. Am J Health Syst Pharm. Nov 2001. Crumplin MK. Not eligible outcomes. Not eligible exposure. 994. Jan 1999. and wounded fighters--a photo essay. Flynn EA. Not eligible exposure. physicians. Fitzpatrick F. Not eligible exposure.27(12):1926. Prout S. Home Healthc Nurse. Good timing. Agency characteristics most valued by home care nurses: findings of a nationwide study. hospitals? J Nurs Scholarsh. McGoldrick TB. Findlay J. Ann R Coll Surg Engl. Stier L.73 Suppl:S46-52. Slooff CJ. O'Connor LJ.72(1):27-31. Salinas TK. 989. Stevenson C. 971. Fisher ML. 953. Jun 2001. Not eligible target population.15(49):33-36. J Nurs Adm. Nurs Stand. Flood D. Qld Nurse. J Adv Nurs. 954. Jul-Aug 1990. 984. Fine JM. Not eligible outcomes. Fischer JE. Hospital RNs' job satisfactions and dissatisfactions. Am J Crit Care. Cox.46(4):271-279. Spring 2000. 988. Flynn K. Fletcher CE. While AE.24(3):473-478. Jablonski RA. Fisk J. Evaluating improvements in nursing staff at a state psychiatric hospital. Smith T. Failure mode and effects analysis. 985. 991. Flaherty MJ. Int Arch Occup Environ Health. Mikeal RL. White MT.162(7):827-833. Flook DJ.S.20(5):950-957.1(1):22-27. An interdisciplinary way to analyze and reduce medication errors. Jun 2001.22(6):621-32. 996.35(3):121-129. Effect of three teaching methods on a nursing staff's knowledge of medication error risk reduction strategies. 986. Not eligible exposure. No sex.9(4):10. 982. Petrillo M. Emma & the med error.32(6):42. Not eligible target population. 983. 29. Fenelon LE. Not eligible exposure. 992. Apr-Jun 2004. JanFeb 1996. Fanconi S. Inquest produces change. Dec 2000. Nursing care quality initiative for care of hospitalized elders and their families. 45-48. Pellegrini JM.19(2):156161. Bonnes D. Salinas TK. Fink JL. 981. Contemporary Nurse Jun 2000.

Patel N. Jan 2003. Nurs Case Manag. The nursing shortage: dynamics and solutions. Sjogren K. Not eligible exposure. Nurs Times.95(1):33-37. Minick P. Jul 2005. Forbes MA. Comment. Not eligible target population. Primary nursing in long-term geriatric units. 999. Trapped in Iraq. Freeman BA.39(6):350-354. 1009. Midwest jobfocus. Jt Comm J Qual Saf.101(1):88. An investigation of the effects of time and involvement in the relationship between stressors and work-family conflict. Westwell J.86(46):16-17. Pediatric and neonatal nurses get "one more hand". Infection. J Nurses Staff Dev. Not eligible target population. Rositani R. Frid I. Francke AL. ED crowding and diversion: strategies and concerns from across the United States.31(1):120-125. Brain death in ICUs and associated nursing care challenges concerning patients and families. Best H.13(4):338-344. quality. Deatrick JA. Not eligible exposure. Oct 1992. Uehlinger DE. Staffing: the ANA's primary concern. Jan-Mar 1998. Kee CC. Factors influencing movement of chronic psychiatric patients from the orientation to the working phase of the nurse-client relationship on an inpatient unit. Luiken JB. Flynn L. Turner D. Am J Crit Care. 1017.20(5):253257. Not eligible target population. 1013. Zuercher Zenklusen RM. Review. 1011.4(2):164-174. Hosp J. Frick S. Fondiller SH. Dwyer DJ. Fryklund B. Jul 1996. Sep 1990. Not eligible target population. Importance of the environment and the faecal flora of infants. 1001. Not eligible target population.4(1):28-33. physical and relaxation interventions. 1006. Abu-Saad HH. Not eligible exposure. Nurs Res. Forrester DA. Lagerstrom M. Garssen B.11(9):635642. Foley M.33(3):288-295. Multiple sclerosis: the Treetops model of residential care. Josephson M. 1026. Can Nurse. Foley DR. Not eligible exposure. Nov-Dec 1999. Walsh N. 75-76. discussion 258-259. Crit Care Nurse. 1003. Azzapardi WB. Not eligible target population. Not eligible target population.6(4):302-310.35(4):385-390.10(4):294. Baltimore hospital bucks RN staff reduction trend. 1016. J Emerg Nurs. France DJ. Nov 1992. Not eligible exposure. A comparison of frequency and sources of nursing job stress perceived by intensive care. J Adv Nurs. B-29 . Comment. Grypdonck M. J Adv Nurs. Murphy PA. A chemotherapy incident reporting and improvement system. hospice and medical-surgical nurses. Not eligible outcomes. Friend B. Edens C. 78 passim. 1022.34(1):36-44. Physical restraint management of hospitalized adults and follow-up study.27(6):559-565. Fall risk assessment of hospitalized adults and follow-up study. Burman LG. Harvey SS. Intensive Crit Care Nurs. Dec 2001. Nurs Clin North Am. Fochsen G. 1025. Not eligible exposure. J Adv Nurs. Grypdonck M. 1020. and satisfaction with hospice after-hours care. Luiken JB. Perspect Psychiatr Care. Medical futility: predicting outcome of intensive care unit patients by nurses and doctors--a prospective comparative study.31(2):456-461. 2003. Not eligible exposure. Quality benefits of an intensive care clinical information system. Garssen B. 1004. Effects of a nursing pain programme on patient outcomes. Apr 1999. Cartwright J. 1012.91(3):73. 1023. Am J Nurs. BellBowe J.7(1):51-53. The practice of professional nurse case management. Psychooncology. Feb 2001. 1007. Bene B. Comment. Not eligible target population. Crit Care Med. Revolution. Comment.15(5):577-584. Fox ML. Jan 1999. Forrester DA.17(10):1260-1266. 1024. Br J Nurs. May 2002. Francke AL. Bergbom-Engberg I. 1019. One solution to poor staffing ratios.15(6):251258. McCabe-Bender J. Daley P. Flynn S. May 9-22 2002. J Occup Health Psychol. Whitlock JA. 1014. 1000. Comment.19(5):96. Dec 1997. Miles P. Gibson D.997. Not eligible exposure. Foxall MJ. Stories seldom told: paediatric nurses' experiences of caring for hospitalized children with special needs and their families. Jan-Feb 1999. Cowie M. Tullus K. 1018. Effects of a pain programme on nurses' psychosocial. J Nurs Scholarsh. Mar 1991. Nurses' attitudes toward patients with AIDS and AIDS-related risk factors.25(3):551560. 1021. Spring 1997. Standley R. Coronado JR. 1002. Forrester DA. Not eligible target population. Apr 2003. Nov-Dec 2000. Nov-Dec 1990. J Nurses Staff Dev. Feb 2003. Nov 14-20 1990. Haljamae H. Can Nurse. Transplant care: giving patients a new lease on life. J Nurs Adm. Cost. Characteristics of nurses and hospital work environments that foster satisfaction and clinical expertise. Not eligible exposure.28(2):221-230. AIDS-related risk factors. No association tested. French E. Crit Care Med. Frank IC. Berglund B.16(6):267-276. 1015. 2000.29(4):171-180. Kosterewa-Tolman D. 998. News. do-not-resuscitate orders and aggressiveness of nursing care. nursing staff and parents as sources of gramnegative bacteria colonizing newborns in three neonatal wards. Fraenkel DJ. Fogle M. Martin ML. Factors contributing to the decision to leave nursing care: a study among Swedish nursing personnel. Forchuk C.88(10):29. Tiedeken K.14(1):21-29. Comment.32(5):273-282. 32. Feb 1998. De Schepper AM. 1005. Jan 2001. Ford C. 1008. Am J Nurs. Jennings BM. 1027. Sep-Oct 1992. A supportive clinical practice model. Fontaine K. Fox M. May 1990. Forchuk C. Hux M. News. Not eligible exposure.15(1):113. Foley BJ. Forrester DA. Zimmerman L. Strike contingency planning. Not eligible target population. Oct 1999. Abu-Saad HH. medical diagnosis. McCabe-Bender J. Home care nurses' descriptions of important agency attributes. J Nurs Manag. Patient Educ Couns. Ford K. Jul 2001. 1010.

Not eligible target population. An assessment of the staffing level required for a high-dependency unit.26(4):176-177. Garrett DK.20(3):150-151. 1049. 1043. Fujino M. News. Not relevant. J Occup Med.32(4):175-177.1(5):25-27.5(2):36-7. 1056. Coleman M. Not relevant. Not eligible target population. Gamble DA. Ganz DA. Part-time working: speaking out. Help.14(4):210-222. May-Jun 1992. May 10 2005. Not eligible target population. Schnelle JF. Schroeder M. Pass CM.26(5):264-71. Training programme in techniques of self-control and communication skills to improve nurses' relationships with relatives of seriously ill patients: a randomized controlled study. Gallagher RM. 1041.17(46):12. FothergillBourbonnais F. Nurs Stand. MCN: The American Journal of Maternal/Child Nursing Sep-Oct 2001. Should nurse-to-patient staffing ratios be mandated by legislation? MCN Am J Matern Child Nurs. Not eligible exposure. Sep-Oct 2000. Garvey A.174(4):233-234. Fall 2004.7(1):37-44. Gary R. J Nurses Staff Dev. Counting the costs. 1054. Career commitment in nursing. Coping with a crowded ED: an expanded unique role for midlevel providers. 1048. Blankenship J. 1060. Not eligible target population. J Obstet Gynecol Neonatal Nurs. B-30 . Fudge L. Fuchs BC. Garcia Lopez FJ. Hospitals may find Congress will attach some controls to funding for new nurses. Dec 15-2005 Jan 4 2004. Effects of family structure information on nurses' impression formation and verbal responses. Not eligible target population. 1037. Effects of ward rotation on subsequent transition processes of Japanese clinical nurses. Not eligible exposure. 1050. Garbett R. Furillo J. Apr 2002. J Nurs Adm.31(2):91-96. Nurse to patient ratios in American health care.21(2):125-128. 1029. 1040.5(1):35. Apr 2001. Fortier M. 1039. Review. Nojima Y.29(5):221-227. Dec 2001. Comment. Documenting JCAHO standards in assigning nursing staff. Behind (and between) the lines. Comment. Implementing a hospital-based animal therapy program for children with cancer: a descriptive study. McDaniel AM. 1051. Marin Lopez MT. Belles-Isles M. Aug 6 2001. Zhang M. Orton ML. Anaesthesia. Zwemer FL. Jul 2005. Gabrielson A. Boyles C. Furlong S. Not eligible exposure. Indicators nurses employ in deciding to test for hyperbilirubinemia. Comment. Not eligible exposure. J Hum Ergol (Tokyo). Gardner J.32(2):425431.19(14-16):33-37. Nurs Times. Eriksson LE. 1058. Mo Nurse. 1055. Not eligible Exposure. Am J Emerg Med. 1038. No association tested. Gardner DL. Chamberlain M. Jul 2001. ANA's nurse staffing principles. Zwerling C. A longitudinal cost analysis of primary and team nursing. News. Jeffrey R. Aug 2000. Not eligible target population. Can Oncol Nurs J. Team-based self-rostering. 1035. Nurs Stand. Not eligible target population. Review. Feb 2001. Schootman M. Waghorn K. Not eligible target population. 1046. Gajewska K. Jones MA. Mar-Apr 1997. Jun 2004. Patient-centered care in the OR: is this possible? Can Oper Room Nurs J. Kercher L. Arnetz B.99(4):50.8(3):155-160. 1045. J Prof Nurs. J Adv Nurs. Nursing Economics Mar-Apr 1991. Gale J. Epidemiology of back injury in university hospital nurses from review of workers' compensation records and a case-control survey. Mar 2003. May-Jun 2004. 1047. Jul 30Aug 5 2003. Res Nurs Health. Garfield M. Assessing patient dependency and staff skill mix. Gardiner WC. 1044. 1059. Comment. Gadbois C. Nurs Health Sci.11(7):310-316. 1042. Vincent JL. Revolution. Jr. Ward M. 1057. Not eligible exposure. South Carolina Nurse Summer 1990. Nurs Stand. 1036.14(4):50-53. J Healthc Qual. 1030. Sep 4-10 1996. Garcia de Lucio L. De Marre F.64(2):14-15. J Nurs Adm. 1034.11(25):33-38. Ganapathy S. Different job demands of nightshifts in hospitals. Costeffectiveness of recommended nurse staffing levels for short-stay skilled nursing facility patients. Apr 1999. with strings.30(6):1224-1227. Gagnon J. author reply 151. Feb 2000. Peterson C. Not eligible target population. Fuortes LJ. 1031. Nordstrom G. 1033. Not eligible target population. Mar 2005. 1032. Gates D. Fillion L. Gardulf A. Am J Nurs. Yang H. Soderstrom IL. Apr 1997.30(6):626-633. Why do nurses at a university hospital want to quit their jobs? J Nurs Manag. Mar 12 1997. Shi Y. Kany KA.1028. Mas Hesse B.31(32):24. Bouchard F. Rowell PA. Mod Healthc. Simmons SF.13(4):329-337. Filipino nurse recruitment as a staffing strategy. Ensuring safe nurse-to-patient ratios: Safe Staffing Bill mandates ratios based on patients' needs rather than budgets. Marrone S. Caamano Vaz MD. Jul-Aug 1992. Ganong LH. Br J Perioper Nurs. Not relevant. Comment. Not eligible target population. Sep 1994. A new look at nurse burnout: the effects of environmental uncertainty and social climate. Gardner KG. Analysis of terminal events in 109 successive deaths in a Belgian intensive care unit. Tilbury M. Not eligible outcomes. Jul-Aug 2001.20(2):139-151. Intensive Care Med. Furillo J.36(9):1022-1026.30(12):295-300. 52-53. J Contin Educ Nurs. Sep-Oct 1998.9(2):97-104. Garretson S. Furillo J. 1052. Smoking practices of hospital employed nurses. Mar-Apr 1995.15(1):8-10. "Patient-focused care" and other incantations. Gaston TA. BMC Health Serv Res.92(36):52-53. 1053. Ridley S. Landry M. Not eligible exposure. West J Med.55(2):137-143. Review. Nov-Dec 2001. The shortage of full-time nurses working at the bedside is becoming a national concern. Measuring nursing support during childbirth. The use of gaming strategies in a transcultural setting. Gagnon AJ.

1088. Aug 18-24 1999. Not eligible outcomes. Norton PG. Caron M. J Nurs Adm. Monsallier JF. Not eligible target population. Comment.24(9):29-34. Gerardo C. 1071. Comment. Legrand P. Role expansion in intensive care: survey of nurses' views. Mar 39 1999. Jul-Aug 2001. Gobbi M. Anticoagulation therapy a success with patient-focused model. 1070. Giraud T. McGovern PM. 1078.16(1-2):20-29. and accidents related to sleepiness in hospital nurses. Oncology outcomes among supplemental staff.95(33):36-38. The little things: perceptions of breastfeeding support. 1063. Not eligible target population. Breaux DK.20(5):33-40. 1065. Gladstone J. Workforce. Journal of Emergency Nursing Jun 1994. Hughes TL. Nurse requirement planning: a computer-based model. No association tested.21(1):40-51.27(4):541546.104(11):81. Dhainaut JF. 3rd. A new generation patient classification system. Cizeau F. J Hosp Mark. Mar 2004. Not eligible exposure. Geraci EB. An epidemiological study of the magnitude and consequences of work related violence: the Minnesota Nurses' Study. Geyer S. Comment. Bradbury M. Diabetes Educ. Ducellier D. 1087. Marketing alternatives for hospitals to the nursing crisis. Gerberich SG. Casebeer A. Okla Nurse. Sep-Nov 2002. Geisser MS.9(5):286-294. et al. Gillan J. Not eligible exposure. 1076. Not eligible exposure. Review. Jun 2003. May 1994. Not relevant. B-31 . 1092. Nov 1995. Jan 1993. Comment. 1074. Watt GD. Misuse of gloves: the foundation for poor compliance with hand hygiene and potential for microbial transmission? J Hosp Infect. Golder DJ. A quality improvement project for better glycemic control in hospitalized patients with diabetes.95(9):31. Gold DR. J Natl Black Nurses Assoc. Dec 2003. Not eligible exposure.22(4):628-637. Drug administration errors: a study into the factors underlying the occurrence and reporting of drug errors in a district general hospital.47(3):24-25. Nurs Times. Recruitment. Gerrish K. Gill KP.15(6):313-323. 1089. Oct 1995.40(4):997-1020. Chevret S. Gibbs G. Aug 2005. 1091. 1090. Rotating shift work. Goldman RL. Brun-Buisson C. A patient classification system for the hemodialysis setting.14(2):16-24.4(1):71-95. J Adv Nurs. Sep 2001. Am J Public Health.25(4):181-185. 1073. Bennett C. Gobis L.101(9):78. Dec-2004 Feb 2003. Gillis AJ. J Adv Nurs. 1990. Jun 2004. Jul-Aug 1994. Starved of attention. Jul-Aug 2001. Spunt J. Nov-Dec 1997. Gaudine AP. Ghosh B. 1069. Health Serv Res. Nurs Manage. Godin M. Ursic P. Jan 17-23 1990. Jul 1992. Vaxelaire JF. Kermode S. Semones C. 1077.61(6):495-503. Baum TM. 1083. Nurs Inq. Hansen LL. Jul 2005. Journois D. 1082.30(4):401-409. Iatrogenic complications in adult intensive care units: a prospective two-center study. Occup Environ Med. Geraci TA. 1080. Ginsburg L. Nurs Times. Giovannetti P. Dare to be different. Speizer FE. Ryan AD. Goldman BD. 1064. What do nurses mean by workload and work overload? Can J Nurs Leadersh. Night nursing. Gilman JA. 1066. J Contin Educ Nurs. Nurses' knowledge of growth and development principles in meeting psychosocial needs of hospitalized children.94(5):88. Apr 1990. Johnson JM. Lewis S. Not eligible target population. Comment. Not eligible exposure. Improving nurses' responses toward substance-misusing patients: a clinical evaluation project. Not eligible target population. Gilliland M. Gill SL. Nursing arithmetic. The impact of continuing education on patient outcomes in the elderly hip fracture population. Nurse Pract. Bock N. Oct 1995. Comment. May-Jun 2000.57(2):162-169. Georges CA. The perils of floating.56(6):31-32. Copoulos S. Comment. Joseph T. Case Reports. 1093. Not eligible target population. Jun 2004. reduced quality care. Am J Nurs. No association tested. Bolton LB. Sep 1998. Long night's journey into day. Dec 1999. Griffith V. Mongin SJ.12(2):117-125.45(6):579-587. Gestes JL. Tosteson TD. Glover D. 1094.13(2):22-27.13(4):363-371. 1081. Not eligible target population. Not eligible exposure. Rogacz S.5(2):78-87.86(3):20. No association tested. Arch Psychiatr Nurs. J Pediatr Nurs. Quality of care in African-American communities and the nursing shortage. Intensive Crit Care Nurs. Nurs Econ. Sollet JP. Chai SH. Geschwinder RF. Workforce reductions: low morale. Not eligible exposure.82(7):10111014. Am J Nurs. Bates DP.89(35):26-28. Sep 1-7 1993. Girou E. 1067. Nov 2004. Nursing practice as bricoleur activity: a concept explored. Gerace LM. Not eligible target population. May 1990. Glassford B. Legal Cases. Cruz G. Oppein F. Look before you leap. Crit Care Med. Nontraditional staffing models in longterm care. Goldman HG. Not eligible target population.26(11):66-67. Putting patient safety first.1061. Not eligible outcomes. Jun 2005. Reflex action. Hansen HE. J Gerontol Nurs. sleep. 1072. Aug 2004.20(3):189-94. Trustee. Czeisler CA. Nachreiner NM.29(8):46-47. J Obstet Gynecol Neonatal Nurs. 1084. Harrison C. Am J Nurs. Not eligible target population. An observational study of the emergency triage nursing role in a managed care facility. 1085. Nurs Times. 1079. Bleichner G. Gillespie BM. 1075. Oien SM. 1086. J Nurs Manag. How do perioperative nurses cope with stress? Contemp Nurse. 1062. Not eligible target population. Integration of overseas Registered Nurses: evaluation of an adaptation programme. Gaze H. Church TR. 1068. An educational intervention to enhance nurse leaders' perceptions of patient safety culture. Nurs Times.15(6):320-322. Review.

Reflective practice and its role in mental health nurses' practice development: a year-long study. Not peer reviewed.Gordon S. Not eligible outcomes. Smith K. Nurs Adm Q.49(5):412-420. An attempt to shorten inhospital therapeutic delays.18(47):39-44. The impact of change on violent patients. Engberg IB. Formula for emergency physician staffing. Not eligible exposure. Survival skills in the acute care workplace: a "float" pool perspective. Nurs Manage. 1125. Not eligible target population. New Jersey nurse Jun-Jul 1998. 1117.6(1):55-67. Gosztyla J. Gordon S.16(5):322-324. Griffith CA. Gonzalez-Torre PL. 1105. Houlihan KP. 1098. Reflective narrative and dementia care. Fowler S. Grady G. J Am Med Womens Assoc. Sep-Oct 2004. A modified simulation program addressing a staff nurse educational need identified by a student clinical nurse specialist across three shifts in a cardiac step-down unit. Goode CJ. Not eligible target population. Goodare L. 1106.99(42):38-39. All right on the nights. 361. J Clin Ethics. Not eligible target population.29(3):177181. Clinical Nurse Specialist Mar-Apr 2006. 1104. A hard day's night. Golightly C. Ferreira RM.26(3):48I. A day-to-day decision support tool. Not eligible exposure. J Accid Emerg Med. Gould D. Sep 1999. Not relevant. Not eligible target population.8(6):675-683. 1115. Armstrong FD. J Hum Ergol (Tokyo). Not eligible target population. Gould D. Comment. Not eligible target population. Banet GA. 1109. Nov 1999. Staff nurse column.15(1):19-33. Not eligible exposure. Differential medication of child versus adult postoperative patients: the effect of nurses' assumptions. J Psychiatr Ment Health Nurs. Not eligible exposure.1095.7(2):109-117. Hardy MA. Feb 2000. A 360 degrees evaluation of a night-float system for general surgery: a response to mandated work-hours reduction. Child Health Care. Grady C. Nurs Stand. Confidentiality: a survey in a research hospital. Jacob J. Graham MV. Goldstein MJ. Jun 2001. Sep-Oct 2004. Stroke. Mulder J. Nov-Dec 1995. Widmann WD. Fowler S. Comment. Lombardi Junior M.11(5):23-26. Nurs Stand. Temporary assignments can open many doors. Not eligible exposure. Charlton S. Not eligible target population. 1123. May 1990. 1108. 1122. Graham IW. Feuth T. 1121. What variables should I consider when making staffing decisions? Nurs Manage. Gottvall K. B-32 . Comment. 1118. Malkoff MD. The impact of managed care on female caregivers in the hospital and home. Spring 1991. Fall 1994. Pogue L. Apr 2000. 1114. Not eligible target population. Sep 1990. Consistency of retrospective triage decisions as a standardised instrument for audit. Goodacre SW. 1096. 1116. Aug 4-10 2004. Gillett M. Curr Surg.20(2):90.4(3):47-49. Pregnancy outcomes of adolescents enrolled in a CenteringPregnancy program. Bloom KC. Acute confusion and unreal experiences in intensive care patients in relation to the ICU syndrome. Nurs Econ. Chamberlain A.32(6):13-14. 1126. and autonomy. J Clin Nurs. Gosztyla J.31(3):536-547. Van den Heuvel WJ. Sounding the alarm. Grady MA. 1119. Granberg A. Burch CM. Crit Care Nurse. Mar 1995.2(1):25-30. Not eligible target population. collaboration. Does birth center care during a woman's first pregnancy have any impact on her future reproduction? Birth. Graff LG. 1110. 1124. Comment. Nurs Econ. Wright LK. Part II. 1100. Impact of a CareMap and case management on patient satisfaction and staff satisfaction. 1113. Not eligible exposure.22(1):47-59.96(6):21-22.61(5):445-451. Lundberg D. Survival skills in the acute care workplace: a "float" pool perspective. Not eligible exposure. Graf E. Feb 1999. Development of the Nursing Minimum Data Set for the Netherlands (NMDSN): identification of categories and items. Oct 21-27 2003. Pulling from Peter to save Paul: is "floating" administratively or professionally sound? Revolution. Diaz J. Am J Emerg Med.13(6):337-348. Nurs Times. 48L. The use of a ward-based educational teaching package to enhance nurses' compliance with infection control procedures. Radford MJ. Epping PJ. Intensive Crit Care Nurs. Jun 1996. 1120. 1101. Not eligible target population. Goode CJ. Jan-Feb 2002.8(3):194-199. Jul-Sep 2005. Edmonds S.20(1):28-36.25(10):1920-1923. J Nurs Adm. Feb 2-8 1994. 1099. Sep 2004. Buresh B. 1103. No association tested. Work activities of practical nurses and risk factors for the development of musculoskeletal disorders. Capacity planning in hospital nursing: a model for minimum staff calculation. Goossen WT. Adenso-Diaz B. Waldenstrom U. A model to facilitate interactive planning. Systematic observation of hand decontamination. JunJul 1998.30(12):369-374. Fall-Winter 1998. Fischer FM. Oct 1994. J Midwifery Womens Health. Grady C. Am J Nurs.52(2):75-77. Mar 2000. Review. Jan 1997. Code stroke. Goode CJ. Sanchez-Molero O. Harris RD. Winter 1993. Nurs Manag (Harrow). Gooding L. 80.8(3-4):80-83. discussion 30-24. 1102. Dec 2001. Gonzalez JC. J Adv Nurs. Tulyapronchote R. Comment. Goncalves MB. Not eligible exposure. Not eligible exposure. N J Nurse. Not eligible exposure. Comment. Routh DK. 1097. Gould J. Gomez CR. 1107. Spring 1997.28(6):14. Sauer CM. Romano C.20(9):16-19. Comment. 1112. Pulling from Peter to save Paul: is "floating" administratively or professionally sound? Revolution. Kim E. 1111. Graf E. Hasman A. The pull of magnetism: a look at the standards and the experience of a western academic medical center hospital in achieving and sustaining Magnet status. Graham IW.28(6):14.Suppl:18. Frederiks CM.29(3):202213. J Clin Nurs. Sep 2002.8(19):38-40. Krugman ME.

No association tested. patients and relatives to witnessed resuscitation in adult intensive care units. Jan 1998.22(2):40-42. Comment. Hosp Q. Arch Intern Med. Flynn E. 1155. Not eligible target population. Not eligible target population. Mar 1999. Aug 1991.9(2):31.1127. Greene J. Medici G. Stress and the effects of hospital restructuring in nurses. Picton P. 1139. Greene J. Zaccagnini L. Adult-health/medical-surgical nurses' perceptions of students' contributions to clinical agencies. Aspens Advis Nurse Exec. The Practice Environment Project. Granum V.20(4):669-676. Aug 5-20 1998. The impact of dedicated medication nurses on the medication administration error rate: a randomized controlled trial. Gregoire MB. Puukka P. Medication calculation skills of nurses in Finland. J Wound Care.12(2):117-123. Greenberg M.24(1):9-16. Jul 1995. Davis RB. Jan 2004. Sep 1990. Gibson KM. Griesmer H. 1153. Johnson N.73(4):50-52. Grandell-Niemi H. 1134. No association tested. 1147. Comment. 1129. Nurs Manage. Shane R. Gupta AM. Pursley D. Sep 2001. Oct 1998. Nurs Manage. Turner SA. Gray JE. Grant LA. Not eligible target population. J Clin Nurs. A health care challenge for nurses. Riddington L. Midwifery. Comment. Kane RA. 1146. Not eligible target population. Feb 28-Mar 5 1996. A process for outcome evaluation. Jul 2003. Rehabil Nurs. Hardeman JL.92(9):40-43.78(1):16. Not eligible target population. Mazurek GH. Can J Nurs Res. Developing a consumer-focused unit culture.14(12):32-35. Study examining attitudes of staff. Griffiths P. Nurse shortage. Babington LM.33(2):93-108. Stereotypes of childbearing women: a look at some evidence. 1152. Grindel CG. Turner TL. Dec 2003. Not eligible target population. Pressure sore prevention in hospital patients: a clinical audit. Wallace RJ. 1132. Apr 1994. Stewart JE. Singh S. Not eligible exposure. Coupland VA. May 1993. O'Hara PA. Apr 1999. May 1996. Nurses' use of computer databases to identify evidence for practice--a crosssectional questionnaire survey in a UK hospital. Not eligible exposure. Wilkinson SL. Apr 2003. 1150. 1133. Oct 27 2003. 1149. 1128.30(4):673-682. Feb 1991. 1137. Beeney J. No association tested. Patsdaughter CA.18(1):2-9. Jul 2004. Nov-Dec 1995. Ferrell BR. Nurs Stand. Am J Respir Crit Care Med. The revision of a workload measurement tool to reflect the nursing needs of patients with traumatic brain injury. Deaney CN. 1141. Medical staff. Schneider P. News. Grewal PS. Safran C. Grant M. Hoying CL. Hupli M. Geriatr Nurs. Am J Hosp Pharm. J Nurs Educ. Griffiths P. Comment. Green JM. Summer 2000. Kitzinger JV.152(2):808-811.6(3):125-132.36(5):8-11. and assignment in Alzheimer's special care units. Oncol Nurs Forum. Medsurg Nurs. Unscheduled readmissions for uncontrolled symptoms. Mar 2001. Not eligible target population.29(10):41-42. Not eligible target population. Leino-Kilpi H. Greaves C.48(8):1704-1708. S C Nurse.12(4):519-528. Wood SP. 1151. Hosp Health Netw. No association tested. 1158. 1138. Ryden M. Comment. Harper DW. Mar-Apr 1996. 80. Grinspun D. Sharma A. Development of inpatient oncology educational and support programs.17(2):81-85.11(11):6-7. Comment. Self-scheduling turned us into a winning team.43(7):297-304.106(6):1318-1324. 1144. Grant AM. Grindel CG. Baby CareLink: using the internet and telemedicine to improve care for high-risk infants. J Gerontol Nurs. Health Info Libr J. 1154. Dec 2000. Pompilio-Weitzner G. Not eligible exposure. 1140.8(3):129-131. Elashoff J. Not eligible exposure. Twelve-hour shifts on a new telemetry unit. Hernandez CA. Staff ratios.9(7):14. Greenglass ER. 1130. 1157. J Am Diet Assoc. Panditaratne HG. 1135. Not eligible target population. Gregoire MB. B-33 . Grice AS. 1131.3(4):22-24. Oct 1994. Responding to Esther's voice: improving the care of acutely ill older adults.163(19):2359-2367. Lee J. Greene J. Grassman D. 313. Dec 2004. Rivera LM. Powell CW. 1156. Aug 1995. J Nurs Adm. Hailing one of health care's priceless resources--nurses commentary. Patients' perceptions of bedside handover. Putting patients first: the role of nursing caring. 1142. Dec 1995. Who should serve patient meals? Hosp Food Nutr Focus. Not eligible exposure. Deakin CD. Gray J. Comment. Rn.72(15-16):78.26(5):43-51. Griffiths H. No association tested. Clinical outcomes for nurse-led in-patient care. 1136. Cass J. Expansion of clinical pharmacy services through staff development. Peterson K. Review. 1148. Apr-Jun 2002. Griffith DE. Greengold NL. Grinspun D. training. Nurs Times. Nurs Clin North Am.91(6):820-824. Not eligible exposure. Potthoff SJ. 1145. Haverty PF. Tuberculosis outbreak among healthcare workers in a community hospital. Barker K. quiz 59. Zhang Y. Sawant NH. Hitting the visa limit. Br J Anaesth. Samarasinghe SR. Dec 1993. Action STAT! The crisis nurse. Nursing students' perceptions of nursing as a subject and a function. Nurs BC.56(12):21-23. From whodunit to what happened. Case Reports. 54. Not eligible target population. Dec 8-14 1999. Greeneich D. Burke RJ. Quality of patient meal service in hospitals: delivery of meals by dietary employees vs delivery by nursing employees. Bolton LB. 1143. Where have all the RNs gone? Hosp Health Netw.94(10):1129-1134. Not eligible outcomes. A controlled evaluation of a lifts and transfer educational program for nurses. Hosp Health Netw. Greene SA. Carlson B. Kinneman M. Glickman S. Nordhaus-Bike AM.20(6):306-309. Pediatrics. Green A. Gresk KD.

Not eligible exposure. Mete S. Oct 2004. 1161. Della-Latta P. Not eligible target population.11(10):27-30. 1169. Harvey D. 1162. Bonell C. 1182. Bishop R. Todd B. Wittner M. May-Jun 2002. Nov 1999. Nursing and midwifery malpractice in Turkey based on the Higher Health Council records. Mar 9-15 2004. Not eligible exposure. Wheeler K. Jul 1996.100(10):36-39. 1174. Balance of power--do patients use researchers to survive hospital? Nurse Res.171(3):614-624. Grossman RJ. How nurses perceive medication errors. J Emerg Nurs. Grypdonck MH. Schork MA. Dec 1994. Emerg Med (Fremantle). Nurs Manage. Guidez C. Not eligible target population. No association tested.4(4):12-16.30(11):64-68. Guy J. Duncan F.25(3):210-215. Houghton A. Shepherd M.45(3):10-15. 1175. Spetz J. 1186. Rubin HR. Cushion NB. Not eligible target population. Hackenschmidt A.12(4):71-81. Nurs Pract. Infect Control Hosp Epidemiol. 1176. Nurs Manage. A float nurse from the newborn nursery who has scant critical care experience. 1164. Paediatr Nurs. Comment. Boily CA. Sep 2004. Hackel R.31(6):39-43. Apr 2000. Measuring shortages of hospital nurses: how do you know a hospital with a nursing shortage when you see one? Med Care Res Rev. Dec-2000 Jan 1999. Banister G. Saiman L. Davies E. Not eligible target population. Nurse educator Jul-Aug 1995. Not eligible exposure. Not relevant. 1172. Ethics in action. 1170. 1181.27(3):203-207.20(1):6-14. Peyser PA. Work-related stress of registered nurses in a hospital setting. Why not person-centered care? The challenges of implementation. 1160. 1171. 1187. Brophy K. Jul 1995. Johnson CC. Mar 2001.23(2):121-131. J Nurses Staff Dev. Weis C. 1178. 24. 1166. 1189. Tanowitz HB. Jul-Sep 2003. Siegel JD. Bannerman TL. Gropper EI. Krumm S. 1185. Breathing life into customer satisfaction. Sep 1996. Case reports.58(4):387-403. Ownby DR.66(9):27-30. Sep 1990(540):53. Hale PC. Spring 1998. Ross J. Crossover trial of partial shift working and a one in six rota system for house surgeons in two teaching hospitals. Gupta S. 33-34. Ronald T. Looking to the future: health professions education in Texas. Nurs Adm Q. Tex Nurs. Hale C. Nov 2-8 2004.30(4):377-379. Not eligible exposure. Flexible scheduling and part-time work. Butt L. The staffing crisis. Sep 2003. Rn.21(7):1179-1187. Nurs Manage. Gunning CS. Patients' and healthcare providers' opinions regarding advance directives. Blastocystis hominis in hospital employees. Haas J. Hafsteinsdottir TB. Redesigning faculty roles to enhance program outcomes: a case study. Gullick J. Comment. Oncol Nurs Forum. Non-medical technicians reduce emergency department waiting times. Gundogmus UN. 1177. NDT competence of nurses caring for patients with stroke. Dryer D. Jun 2000.98(3):535-544. Zabora J. Not eligible exposure. Haddad A. Mason RC. 1163. Not eligible target population.40(1):55-58. Pati AK. Jun 1992. Sanchez PJ. 1184. Grossman I. Desynchronization of circadian rhythms in a group of shift working nurses: effects of pattern of shift rotation.36(5):289-294. Dec 2001. Hageseth KL.58(7):21-22.1159. Spotlight on. Ozkara E. B-34 . 1167. J Nurs Adm. Not eligible exposure. Nurs Times. Coffman J. Health Forum J. Hainsworth DS. Claudio T. 1190. Seven methods to effectively manage patient care labor resources. 1180. J Infect Dis. Gullick J. Hagenow NR. Review. Tenover FC. 1991. Not eligible exposure. flutamide trial]. Focus Crit Care. 1179. Strike a balance with decentralized housekeeping. Evaluating a change to primary nursing: some methodological issues.7(4):277-290. Grossman S.74(4):11-12. Haley RW. Haisfield ME. 1168. Not eligible exposure. Living with nurse staffing ratios: early experiences. Gupta A.87(6):729732. J R Coll Surg Edinb. Nurs Ethics. The effect of an organisational model on the standard of care. Shore AD. Not eligible target population. No association tested. A study into safe and efficient use of defibrillators by nurses. Weiss LM.18(4):273. Wu F. Lippman D. [How can a nursing team participate in a clinical trial? Zoladex.32(2):66-68. 'A child's eye view': the development and evaluation of a teaching video. Am J Gastroenterol. Drug errors: what role do nurses and pharmacists have in minimizing the risk? J Child Health Care. Rushforth H. quiz 15-16. "Fess up" to patients? Rn. No association tested. Ash M. Review. Ethics in action. Grumbach K. 1173. Jan 1996. Jan-Feb 2004. Nurs Times.100(44):42-44. Eradication of endemic methicillin-resistant Staphylococcus aureus infections from a neonatal intensive care unit. Nursingconnections.11(5):489-499. 1191. Seago JA. Not eligible target population. Haigh C. Not eligible exposure. Aug 2004. San Gabriel P.11(1):41-49. The prevalence of anti-latex IgE antibodies among registered nurses. No association tested. Aug 1994. 1188. J Neurosci Nurs. Haggart R. 1165. 1183. Owen WJ. Haddad A. Feb 1995. McGuire DB. Oncol Nurs Forum. Gropper RG. 2005. Hader R. Grzybowski M.13(1):66-69.27(1):31. Not eligible target population. J Hum Ergol (Tokyo). Hagenstad R. Aug 1991.23(6):963-967. Persaud J. Not eligible target population. The effect of death education on attitudes of hospital nurses toward care of the dying. Outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit linked to artificial nails. Not eligible exposure. Soins. McColl L. Taylor PR. Feb 2002. Review. Rubenstein D. Hall DS. J Allergy Clin Immunol. Dec 2003. Grouse A.20(4):5-7. Neild A. Mar 2004. Role-modeling experience improves nursing students' attitudes toward people living with AIDS. Not eligible target population. Not eligible exposure. Mar 1995. Comment. Simon D.

5(39):44. Not eligible target population. Aug 2003. Jun 1998. Greenway MN. Combining utilization management and discharge planning. Not eligible association presentation. The radiation dose to accompanying nurses. Halpern JS. Apr 1999. Paediatr Nurs. 17.7(17):1010-1017. Halloran EJ. Pena L. 1221. Doran D.8(8):1-2. A patient rates nurses: the good. J Adv Nurs. Not eligible target population. 1217. Caring for sick buildings. Hancock MR. Hamilton J. 1216.7(1):17-22. Thomson WH. Trauma nurse practitioner: the perfect job? J Emerg Nurs. Hardy LK. Harding R. Harrington SS.77(920):657-661. Jan-Mar 2004. Barrett C. Nurs Manage. Not eligible target population. Norberg A. Harber P. Dec 5-11 1990.5(11):20.18(4):138-141. 1197. Hansen HE. J Clin Psychiatry. RN staffing: more care--less cost. Nurs Stand.9(9):19-21. Outcomes Manag. Planning Australia's hospital workforce. 1207. Hosp Community Psychiatry. Not eligible exposure. Research utilization and interdisciplinary collaboration in emergency care.11(4):202-213. Am J Nurs. AACN Synergy model for patient care.17(4):7-10. Sep 1983. A pointless system? Am J Nurs. Aug 1992. Jan 1990. 44. Nurs Stand. May-Jun 2003. Review. 2002. Hamilton J. Not eligible target population. J Pain Symptom Manage. Mills A. Summer 1990.13(9):9-11. Greer D. Nurs Stand. Not eligible target population. Hardin S. Hallberg IR. No association tested. Comment. Park W. Am J Nurs. Mallette C. Intensive Crit Care Nurs. Aspens Advis Nurse Exec. Billet E. relatives and other patients in a nuclear medicine department waiting room. Not eligible exposure. Hussey L. 1210. Balk JA. My sham trial. training.7(3):2831. Nursing staff mix models and outcomes. Journal of Advanced Nursing October. Hall EO. Hansten R. Nucl Med Commun. Jun 19-25 1991. Jul-Aug 1995. Professional practice: facts & impact. 2003. Feb 2003. Interpretation of trauma radiographs by radiographers and nurses in the UK: a comparative study. Not eligible year. quiz 17.98(3):42-45.35(8):470-474. Bond M. Mar 1998. O'Connor S. Delaney NM. Haller E.103(11):120.25(4):519-526. Hamilton M. 1222 Hardy ML. Interview. Harmond K. 1202. 1209. Sep 24-Oct 7 1998. May 30-Jun 5 1990. Oct 2003. 1194. Harding NJ. Is computer-based instruction an effective way to present fire safety training to long-term care staff? J Nurses Staff Dev. Hall M. 1204. 1200. Ahn YC. Nurse staffing. Washburn MJ. Oct 15-21 1997. Not eligible exposure. Laschinger HS.19(3):147-154. Not eligible exposure. Hardy M. Hamer G. Fowle T.43(8):836-837. Comment. 1195. Hansten R. Nov 2003. 1226. McNiel DE. Jul-Aug 1995.23(1):73-76. Streamline change-of-shift report. Accid Emerg Nurs. May 1993.14(9):18-22. Doran D.44(2):217-226.11(1):17-22. O'Brien-Pallas LL. 1201. B-35 . Not eligible target population. Jpn J Clin Oncol. Harloe LJ. Jul-Sep 2000. and patient care quality. Crit Care Nurse. 1220. Aug 2004.25(5):6177. Hall LMPRN. Generating ideas for research: an Australian research experience. A balanced scorecard approach for nursing report card development. Int J Trauma Nurs. Hand D. Impact of an electronic chart on the staff workload in a radiation oncology department. Hall LM. 1215. Requesting and interpreting trauma radiographs: a role extension for accident & emergency nurses. Curtin discusses the nursing shortage. Handelman E. 1228.57(8):329-332. Harding LK. J Healthc Qual. Nursing work and the implications of "the second shift". 1224. Aug 1996. Case Reports. Harrahill M. 1206. Hayes K.92(8):18. 1196. Walker BL.4(36):47. 1212. NHS cuts: shifting attitudes. 1225. 1223. Comment. Time out. Personal history. Not eligible outcomes. 1214. Schug VL. the bad and the loving. Gavel P. Barrett C.6(3):85-87. Strawn N. Pendall D. Lee JE. Edgar L. Eastes L. Lim do H. Strain among nurses and their emotional reactions during 1 year of systematic clinical supervision combined with the implementation of individualized care in dementia nursing. Impact of a smoking ban on a locked psychiatric unit. Dec 1993. Case study of a CHF patient. Comment. Comment. White K. J Christ Nurs. Hsu P. Leah L. Br J Radiol. A double concern: Danish grandfathers' experiences when a small grandchild is critically ill. 1219. A replication study of staff injuries in a state hospital. 1213. Feb 2004. Ju SG.1193. Comment.20(1):14-21. Not eligible target population. Han Y. Warren H. Stewart C. Acad Emerg Med. News. Can J Nurs Adm.18(12):1860-1875.12(4):18-19. Aug 2005. 1198. Not eligible exposure. Comment. Ten tips for telling people what they don't want to hear. Nov-Dec 1990. care delivery model. Reflections on family-centred care. Gastroenterol Nurs. Harmond K. Aust Health Rev. Conn W. Squires L. Not eligible target population. Not eligible exposure.6(4):271-279. Not eligible target population. 1203. Huh SJ. 1227. Pedersen C. J Nurs Care Qual. Aspens Advis Nurse Exec. Hanson RH. Keeping your eye on the ball: an open letter to nurse executives. Hampton S. Hamilton D. Nurs Manage. Not eligible target population. 1208. Not eligible outcomes. Aug 1999.7(1):18-26. Jan 1992. Hall LM. 1211. 1199. Comment. Can electric beds aid pressure sore prevention in hospitals? Br J Nurs. Biros MH. Nov 1997. 1205. Not eligible outcomes. A survey examining nurses' knowledge of pain control.3(4):23-26. Nurs Stand. Not eligible target population.34(8):58-59.25(4):337-338. Kim K. Not eligible target population.19(1):27-33. Apr 1994. Short-staffed but safe. Aug 1992. Harris M. Binder RL. and worksite as predictors of back pain of nurses. Am J Ind Med. Jan-Mar 2003. 1218.

74(2):4-5. Dec 2001. Feb 23-Mar 1 2005. Not eligible outcomes. Int Nurs Rev.7(6):3. Ratcliffe CJ. Not eligible exposure. Djaldetti M. J Adv Nurs. Provider. Nov 1991. Hart A. Comment. Meeting the nursing shortage head on. Lau DC. Reducing insulin medication errors: evaluation of a quality improvement initiative. Mar 2003.37(2):173-177. Hospitals. 1250. Wolloch Y. Woolford P.34(10):437-439.13(2):137-146. Not eligible exposure. Fish M. Nurs Times. parttime. May-Jun 2004. Harty-Golder B. Apr 2004. Thurman S. J Nurs Adm. 1257. Not eligible exposure. How should a lab design a fail-safe system for point-of-care testing? MLO Med Lab Obs. 1253. 64D. Aug 10-16 1994. Adolescent and nurse perceptions. 1255. 1234. Am J Emerg Med. 1236. Not eligible target population. 1246. Waltz C. Self-scheduling in a CVICU (cardiovascular intensive care unit). Aust N Z J Public Health. Nurs Manage. Jun 2003. Pinfield LT. Hartley J. Jul 5-11 2005. Br J Nurs. Landstrom G. Review. Nurs Times. Not eligible target population. Hedstrom M.165(4):272-274. Fottler MD. Healy AN. A comparative evaluation of two educational strategies to promote publication by nurses. Hendler I. Distressing and positive experiences and important aspects of care for adolescents treated for cancer. A round table discussion. Hatcher I. 1235. Mar-Apr 1998. Jul 27-Aug 2 2004. Nov 26-Dec 9 1992. 1242. Not eligible exposure. 64F passim. Health Care Manage Rev. Not eligible exposure. Henneman EA. Comment. The effect of full protective gear on intubation performance by hospital medical personnel. Comment. Jan-Feb 2004. Nisbet MM. Hendel T. Perel A. 2005. Potter S. Not eligible target population. Mar 2004. Assessing the outcomes of professional practice redesign. J Prof Nurs. J Nurs Scholarsh. Chaimoff C. Neiman V. Hart J. Not eligible target population. 1230. von Essen L. The Effect of Case Management on U. Heinz D. Repercussions of work schedule congruence among full-time. Patient satisfaction in two departments of surgery in a community hospital. Feb 2001.19(2):113117.33(12):22-23. Mar 2001.47(4):224-231. Heatlie JM.100(30):20-23. Mich Nurse. Not eligible exposure. Shift systems: staying power. Heller A. Galon V.1229. O'Connor L. Hawkins CA. Isr J Med Sci. Dimens Crit Care Nurs. 1232.25(3):34-42. 1244. Hospital ethical climates and registered nurses' turnover intentions. 1254. Fall 2002. Nowak M. Mar-Apr 2003. Not eligible target population. J Nurs Adm. Havens DS. Nurses rightfully are tired. Sullivan M.19(24):78. Harrison S. Tyler JL. Not eligible exposure. Impact on staff nurse perceptions. Not eligible target population. Mil Med.29(2):79-84. Aug 1993. Nolin J. Aboudi S. Hasan-Stein L. Teaming up for more with less. 1247. News. Aust Nurs J. Gawlinski A. Health Serv Manage Res. Reduced doctors' hours. Hawkins T.101(27):10-11. Auditing PICC line management. Contemp Nurse. Healthc Financ Manage. Apr 2000. Bekerman L. 1238. and contingent nurses. An intravenous medication safety system: preventing high-risk medication errors at the point of care.20(3):196201. Aug 2003.1(14):722-725. Comment.S. Not eligible exposure.22(11):64A. Mar 2002. 1231. Inequalities in health care provision: the relationship between contemporary policy and contemporary practice in maternity services in England. 1245. J Nurses Staff Dev. Hayes J.37(5):485-493.30(4):41-42. Dec-2000 Jan 1999. Haynes G. Not eligible target population. 1251. Hutton L. Hart SE. Swartz BW. Hemmings P. 1248. Rosenberg G. Oct 2004. Segal E.26(2):108-115. Quality assurance of nurse triage: consistency of results over three years. Peled R. 1233. Sutton K. Dec 2000. Skolin I. Hayes J. 1237. Not eligible target population. Measuring staff nurse decisional involvement: the Decisional Involvement Scale. 'The ones that got away': implementing an exit policy for nurses in a public hospital. March-April 2004 2004. Not eligible target population. Dec 1996. Not eligible exposure. Not eligible outcomes. Not eligible target population.8(46):42. B-36 . Nurs Stand. J Contin Educ Nurs. Night nurse practitioners are not 'mini-doctors'.32(12):1338-1343. Hecht WA. An investigation of professional advice advocating therapeutic sun exposure. Harrison JP. Sep 20-26 2001. Mar 2005.23(1):44-50. Nurs N Z. Mar 1995. 1258. Hospital nurse staffing and patient outcomes: a review of current literature. Not eligible target population. Not eligible outcomes. 1239. Hendy R. The impact of the changing healthcare environment on the attitudes of nursing staff: a longitudinal case study. Strategies used by hospital nurses to cope with a national crisis: a manager's perspective.6(3):191202.8(1):6-17. Comment. Mercer AA. A "near-miss" model for describing the nurse's role in the recovery of medical errors.4(2):1415. 1261. Nurs Stand. 1240. 1259. Fish M. Hendel T. Henninger DE.57(3):52-58. Hutchinson J. Heckert DA. Hay E. Gaffney FA. Lewer H. Nahtomi O. Hastings C. discussion 18-19. Hartley J. Meyerovitch J.22(2):64-70.97(38):32-33. J Nurs Adm. Non-nursing duties are eroding our status. 1256. Comment. Suero E. Time to change.27(4):30-41. Comment. Wiener M. Not eligible target population. 1249. Leadership style and choice of strategy in conflict management among Israeli nurse managers in general hospitals. Lockey R. Vasey J.19(2):92-98. Havlovic SJ. Two hospitals report: the pros and cons of 12-hour shifts. Nursing Economics. 1252. Nurs Times. 60. 1243.33(6):331-336. Nurses face a lottery over choice of shifts. J Nurs Manag. Nolan MT. Mar 1998.15(12):29-36. Apr 2002. Eur J Oncol Nurs. 1260. 1241.

Hinds PS. Nurs Staff Dev Insid. Lombardo BA. J Vasc Nurs. neurosurgery. ANA sounds alarm about unsafe staffing levels: PR campaing sheds light on RN replacement trends. Wistow G. J Adv Nurs. Burleson C. May-Jun 1992. 1283.27(5):19. Schaffner A. 1277. 1268. The challenge of providing family-centred care during air transport: an example of reflection on action in nursing practice. fatigue. Larsson US. Job sharing: a viable option.96(18):38-39. Comment. Communicating nursing research Spring 2001. J Am Acad Nurse Pract. 1292. Jan 1999. Bottomley S. Nurs Econ. Herrmann J. Speroff T. Heyman EN.Himali U. Not eligible year.26(2):4360. Mar 1995. 1270. Higgins J. Herrmann LL. No association tested. Communication problems of hearingimpaired patients. Not peer reviewed. No association tested. Hodby D. Sr Nurse. Mar-Apr 1995. Not eligible target population. Empowering nurses to manage care. Mar 2002. 1293. Himali U. Hertting A. Nurs Times. Nurs Spectr (Wash D C). Comparing patient.17(6):213-218. Hess RG. Not relevant. Conference abstract. Jan 2004. 1271. May 4-10 2000. Jun 1999. An unsafe equation: fewer RNs = more workplace injuries. Hines J. Hewitt BE. 8. Gilger E. and sickness absence among employed women. Thorax. 29. 1263. Nurs Diagn. Not eligible outcomes. Dulberg C. Higuchi KA. A care pathway for home parenteral nutrition. Changes in employment status: the experiences of Ontario registered nurses.92(16):44-45. Nurs Times. 118. Canadian Journal of Nursing Research Summer 1994. Self-scheduling: two success stories. 7. Apr 17-23 1996. Theorell T. Vigilance: a concept and a reality. Stewart TO. agitated. Harkins D. No association tested. 1279. and cost outcomes of all-registered nurse staffing. Not eligible target population. Jun 2005. quiz 288-279. or suicidal patient.22(4):277-288.5(3):20-22. Hensing G. challenges and ambiguity for registered nurses. J Nurs Adm.27(4):15163. Hitchings KS. Comment. Bruce T. Not eligible target population. No more short staffing. 1286. Scofield R. J Adv Nurs. No association tested. Nursing acute psychiatric patients: a quantitative and qualitative study. May 5 1997. Not eligible exposure.27(2):1. Not eligible exposure.14(19):33-37. Hurst K.11(11-12):30-36. Not eligible exposure. The association between sex segregation. Hesterly SC. Milestone Action Plans. 1285.6(2):96-98. 1278. Feb 2004. 1291. Dollars and sense: the economics and outcomes of patients undergoing carotid endarterectomy at Royal Adelaide Hospital.10(4):137-147. Editorial. Skinner C. Hiscott RD.34:296.13(2):107-111.20(1):6-11. Nov-Dec 1981.22(11):53-56. 1281.29(6):1434-1443. Nurs Pract. Hewlett PO. Sociology and Social Research Oct 1990. 1289. Not eligible target population. Review.Hilton P. 1264. 1276. "Health Care Challenges Beyond 2001: Mapping the Journey for Research and Practice. Kline N. B-37 . Higgins LW. Job turnover among nursing professionals: impact of shift length and kinship responsibilities. 1992. and staff descriptions of fatigue in pediatric oncology patients.42(11):1154-1159. Research examines nurse mobility.15(1-2):118-124.7(9):3.Hill A. Factors associated with nursing diagnosis utilization in Canada. Am Nurse. May-Jun 1992. Not eligible exposure. Washington. J Am Geriatr Soc. Sharratt MT. Aug 2003. Sep-Oct 1992. parent. Goddard M. Jan 26-Feb 1 2000. May 1995. Nov 1994. 1287.75(1):32-7. Contemp Nurse. et al. Mar 1993. 1274. Not relevant. Nov 1992. Oct 1999. Hiscott RD.1(3):3.5(5):38-40. Occup Environ Med. Not eligible exposure.93(3):66-69. Herman CJ. J Nurs Adm. Not eligible exposure. Changes in the school-to-work transition for Canadian nursing program graduates. Nilsson K. 1272. Nurs Stand. Burge A. Conceptualizing nursing work-force redevelopment. Skill mix in hospital. Wiles R. The effect of 12 hour shifts on cognition. 1282. Jr. Staff. 1267. Am Nurse. News. Comment. Hirter J.25(3):33-35. Canadian Journal of Nursing Research Winter 1995.52(11):994-997. Zabramski JM. 1284. J Nurs Adm. Improving compliance with immunization in the older adult: results of a randomized cohort study.1262. Crna. Hensinger B. Nurses' perceptions of collaborative nurse-physician transfer decision making as a predictor of patient outcomes in a medical intensive care unit. 1265. Tandem practice model: a model for physician-nurse practitioner collaboration in a specialty practice. 34th Annual Communicating Nursing Research Conference/15th Annual WIN Assembly. Connop PJ.12(5):14-17.29(1):52-63.61(2):e7. Private patients' perceptions of nursing practice in the National Health Service. Hodge MB. 1290. Quargnenti A. Registered Nurse Oct-Nov 1993. Atwood JR. Alexanderson K. 1288. Not eligible target population. Canadian nurses head South. Not relevant. Hibbs PJ. 1275. Oct-Dec 1999.45(2):145-154." held April 19-21. Not eligible target population. Van Nest RL. working conditions. Aug 1999. 1280. Not eligible target population. Jul-Aug 1995. quiz 12-13. Am J Nurs. J Adv Nurs.Hilton J. Wrinkles in time. 1266. Hockenberry-Eaton M. Cancer Nurs. Health Syst Rev. patient. Taken to task. 1269. Managing costs: the confused. Duff V.. Higgins R.29(10):8-10. Cebul RD. Hinshaw AS.. 1992-5. Tuberculosis in National Health Service hospital staff in the west Midlands region of England. Hiscott RD. Hiscott RD. Nov 1997. Not eligible exposure. 1273. and mood in acute care nurses. Lounsbery K. 2001 in Seattle. Comment. Downsizing and reorganization: demands.

1295. Jun 1999. Part 5. Piper RK.11(6):493-503. Jan 2001. J Nurs Adm.32(6):352-358. Effectiveness of nurses as providers of birth labor support in North American hospitals: a randomized controlled trial. Not eligible exposure. 1300. Not eligible target population. The utilization of the healthcare assistant role in intensive care. 1306. Sep 1998. Sussman G. Nurs Manage. Sep 1995. quiz 131-122. Not eligible target population. Nurs Times. Donahoe MP. 1317. Paediatr Nurs. Not eligible exposure. Neonatal nurse knowledge of penicillin therapy. 1307. Feb 2005. A review of a supervised practice programme for overseas nurses.3(1):34-36. Taking a closer look at employee turnover in the dialysis unit. Harsh J. Hannah ME. Mich Health Hosp. Not eligible exposure. 1296. Holness DL.11(39):35-38.29(3):263-267. Warren J. 1315. MarApr 2000. Bersten AD. Horner M. 1325. Scott LD. Apr 1995. Not eligible outcomes. Not eligible target population.36(2):24-26. Not eligible target population. Jun 1995. Who's the boss? Children's perception of hospital hierarchy. Vedig AE. Recruiting nurses from the Philippines to combat the nursing shortage in central Ohio. O'Neill BS.17(7):52-55. Am J Crit Care. Prospective evaluation of residents and nurses as severity score data collectors. Role stress and career satisfaction among registered nurses by work shift patterns. Job embeddedness: a theoretical foundation for developing a comprehensive nurse retention plan.33(6):337-342. Nurs Adm Q. Sep 18 2002. Muir HA. Taft SH. Nurs Manage. 1320. Outcomes of care managed by an acute care nurse practitioner/attending physician team in a subacute medical intensive care unit. Holle ML. Tomlinson PS. Not eligible outcomes. Oct 1998.9(13):817. Not eligible outcomes. Willan AR.34(5):216-227. Crit Care Med.51(1):1. 14. Jan 2005. Hollingdale R. Myhr TL. 1323. J Clin Nurs.14(2):121-130. quiz 426. Scharfenberg C. Holmas TH. J Nurs Adm.9(12):794-801. Understanding rostering. Apr 3-9 1996. Not eligible outcomes. Junior doctors' hours and the expanding role of the nurse. 1311. Hostetter A. 1305. Hoffman AJ. Nephrol News Issues. Bersten AD. Strike DG. 1327. 1309. Nursing must look after its young. Holt AW. Nethercott JR. Fuller S. Review. discussion 253-164. Hostutler JJ. Asch SM. It's all in the mix. Bolstad B. Neonatal Netw.100(27):38-41. Intensive care costing methodology: cost benefit analysis of mask continuous positive airway pressure for severe cardiogenic pulmonary oedema. Fla Nurse. Time in hospital. the findings of a qualitative study. Hoffart N. Holmes L. Warin J. Ohio Nurses Rev. Hodgson J. Oct 1994. Sep 2002. Houchins G. Homsted L. 1312.32(1):22-25. 1304. Comment. Holtom BC. 1301. May 2004. Horns KM. J Clin Nurs. Nurs Stand. Comment. 1310. Lowe NK. Shiftwork and the hierarchy. Willdermood S. Not eligible exposure. 1326. The power of collaboration: Arizona's best kept secret. Broccard AF. Nurs Times. Jun 18 1997. Houser BP. 1321. Hodnett ED. Hogan J. Jan 1995. A prescription for success: integrating 12 inpatient and 17 outpatient programs. Mar 2003. 1316. Holness A. Worthley LI. Bury LK. Not eligible exposure. B-38 . Aust Nurs J. Theatre nursing (2). No association tested.77(2):4. Williams J. Apr 1997. Child in hospital: family experiences and expectations of how nurses can promote family health. Jul 6-12 2004. Tasota FJ. Heart-smart service. McCrary P. 1297. Hogan J. Sauve MJ. Stevens B. 1314. Not eligible exposure. Health Econ.4(7):27-28.32(2):162-172. Crooke PS. 1313. Stremler R. Comment. Comment. Snyder C. Not eligible exposure. Hollar-Ruegg T. J Nurs Adm. 1324. Jul 13-26 2000.18(3):21-30. Exposure characteristics and cutaneous problems in operating room staff.20(12):1688-1691. Tarlo SM. Gafni A. Crit Care Med. 1302.22(2):170-174. Comment. Bushardt SC. Holyoake DD. 1303. Not eligible target population. Health care management review Summer 1993. Developing indicators of nursing quality to evaluate nurse staffing ratios. Dec 1992. Paavilainen E. Int J Nurs Stud.14(2):212-222. Hodge MB. Hotchkiss JR.23(10):81-82. Comment. Ohlsson A.10(4):47. Apr 1994.288(11):1373-1381. Jun 2003. Jun 2002. Not eligible target population.11(5):33-36. J Nurs Adm.92(14):35-36. A comparison. Keeping nurses at work: a duration analysis.28(4):42-45. Self-scheduling in five med/surg units. Case Reports.7(5):460-466. Feb 2002. Hogston R. Letter. 1319. Holdnak BJ. Skowronski GA. Safe staffing: a serious concern. Olson VA. Comment. Staff ratios in intensive care: are they adequate? Br J Nurs. Hoffman LA. Not eligible target population. 1298. Nurs Manage. Hogan M. Roda PI. Not eligible exposure. 1299.1294. Weston JA. Shift coordinators dispel myths. Smith P. Houser E.29(1):43-50. Contact Dermatitis. Nilsson M. Phillips CY. Not eligible exposure. Patient needs in the emergency department: nurses' and patients' perceptions. Simonson DA. Aspens Advis Nurse Exec. Vedig AE. An agent-based and spatially explicit model of pathogen dissemination in the intensive care unit. Gills MB. Scott E.33(1):168-176. 1308. Oct 1992. Back pain in nursing and associated factors: a study. Holt AW. Jul-Sep 2005. 1318. Not relevant. Hopkins S. Hopia H.9(9):37-38. Jama. Zullo TG. An examination of leadership style and its relevance to shift work in an organizational setting. Holloway IM. Anaesth Intensive Care. 1322. Oct 18-24 1995. Nurs Stand. Br J Nurs. Not eligible target population. Jan 1999.10(4):1-3. Evaluating quality nursing care through peer review and reflection. Astedt-Kurki P. Comment. Br J Theatre Nurs. Mar 2005. Jul 1995. Kravitz RL.32(6):338-345. Jun 22-Jul 12 2000. Playle JF.

Int J Nurs Stud. Hudson J. Feb 1979. Health Manpow Manage. Aust Crit Care. Nurse educator May-Jun 1992.11(4):163-173. Review. Not eligible outcomes. May-Jun 1999.78(9):24. Humm C. Not eligible exposure. Satisfaction and continuity of care: staff views of care in a midwife-managed delivery unit. Sep 2004. A model for evaluating the context of nursing care delivery. 1331. purpose and implications. Iapichino G. Comment. Hung R. Hwang JL.9(5):26-29. A shift in time. Tilem-Kessler D. Nurse to patient ratios and patient outcomes. Comment. Ferla L. J Nurs Adm. Not eligible target population. Hydes-Greenwood J. Houser J.15(3):39-57. Sep 2004. 1360. Night duty: all night long. 1997. Huch MH. and compensation of agency and hospital nurses. Hudon PS. Nov 1992. Daily classification of the level of care. 1343. Resistance to documentation--a nursing research issue. Not eligible target population. Good G. Fraser CA. 1356. Rubenstein LV. Idelson C. Mar-Apr 1999. A method to describe clinical course of illness. Decision making: stability of clinical decisions. Yahav J. Penrod J. J Perinat Neonatal Nurs. Hill PD. 1336. Glazener CM. Factors associated with critical thinking among nurses. Jan 2003. Hagen S. An analysis of catering options within NHS acute hospitals. Not eligible target population. Not eligible target population.29(4):371-380.42(1):75-84. Dec 2001. Health Serv Res. 1346. 1990. 1344. J Nurs Manag. Nov 11-17 1998. Howse E. Radrizzani D.28(4):317-325. Patterns of parental stress in PICU emergency admission.90(34):44-45. Nurs Econ.8(47):40. Marcantonio RJ. Chang BL. Nurs Stand. Case management: is it another passing fad? Nurs Sci Q.14(4):305-310. Hunter PR. Spring 1993. 1352. Nurs Times. Not eligible target population.23(6):197-211. Int J Nurs Stud. Aug 24-30 1994. Oct 1991. Nurs Manag (Harrow). Not eligible outcomes. Review. 1342.17(3):12-6. B-39 .17(3):135-144. J Hum Lact. Nurs Manage. Hughes R. 1350. Dec 1998. Intensive care nursing requirements: resource allocation according to patient status. Not eligible exposure. Breastfeeding and health professional encouragement. Hurst K.13(1):73-74.27(1):131-136. nursing workload and quality. Leach V. Pasetti G. Vigilant watching over: mothers' actions to safeguard their premature babies in the newborn intensive care nursery. Not eligible exposure. Establishing and maintaining trust during acute care hospitalizations. Not eligible target population. RNs press California to finalize ratios. Nurs Econ. 1345. Gastroenterol Nurs. 1358.12(6-7):293-308. Workforce. Sep 2002. Aug 17-23 1994. Bailey J. Pezzi A. 1329. Hunt JM. 1357. Milne JM.10(38):22-24. Int J Health Care Qual Assur Inc Leadersh Health Serv. Bertolini G. Porta F. Blyth D.1328. 1337. Not eligible outcomes. Harrison GA. 1999. Jan 2001. discussion 243-228.11(1):59-63. 1333. Jan 2003. Not eligible target population. A cyclical schedule of 10-hour. A primary shift rotation nurse scheduling using zero-one linear goal programming. Eves A. Dec 1995. Not relevant. 1353.18(2):36-42. Huang PY.39(4 Pt 1):887-904. 1361. Yano EM. Cross-infection and diversity of Candida albicans strain carriage in patients and nursing staff on an intensive care unit. Humenick SS. Melamed S.21(10):46-52. 1349. Dimens Crit Care Nurs. Nurs Stand. Hundley VA. Hung R. 1351. four-day workweeks. Hunt J. 1341. border. Jan 2005. Sep 1991. Sep-Oct 2003. Hughes KK. Humm C. Morse JM.20(1):37-39. Hendel T. Turner M. Huarng F. Intensive Care Med.12(2):47-53. Midwifery. Mollison J. Kipps M. Influence of a merger on nurses' emotional well-being: the importance of self-efficacy and emotional reactivity.7(2):69-75. Not eligible exposure. The perils of shift work: evening shift. Variations in nurse practitioner use in Veterans Affairs primary care practices. 1347. Merlob P. Sch Inq Nurs Pract. Huckabay LM. 1335.33(1):39-47. Not eligible outcomes. Hupcey JE.27(3):100-103. Not eligible target population.3(6):10-12. Lee ML. May-Jun 1996. Nurs Times. Young WB. Staffing issues in the gastroenterology setting.28(1):4344. Brogna MJ. The clinical practice of supplemental nursing personnel. Hospitals step up attack at public hearings. Lantiegne K. Not eligible target population. Bilodeau K. Nov-Dec 2002. Lang GD.22(9):30-33. Fall 2000. Spiegelberg PL. 1330. Jun 12 1996. 1359. Cruickshank FM.S.94(45):6366.104(9):60-63.21(5):233236. Aug 2004. 1339. Marcantonio RJ. The cardiac surgical patient's expectations and experiences of nursing care in the intensive care unit. 1355. Nurs Adm Q. Confidentiality during staff reports at the bedside. 1334. Desombre T. Jun 1999. 1338. News. Relationships between patient dependency. Not eligible exposure. Kaplan B.14(3):227-242. 26. Idel M. Leapfrog standards: implications for nursing practice. J Med Vet Mycol. Hughes KK.17(3):83-87. Caruthers TE. Miranda DR. Jan 2000. Jan-Feb 2002. Hurst K. Not eligible target population. use of resources and quality of intensive care assistance. Stone P. Review. Not eligible target population. and rotating shifts: are they for you? Am J Nurs. Hurst I. J Contin Educ Nurs. Howenstein MA. 1354. 1340. Recruitment. J Nurs Adm. Revolution. 1348. Case Reports. A note on nurse self-scheduling. Comment. Howell M. retention. Hosp Health Netw. Nellestein I. Hughes KK. News. Crossing the U. Home and away. Huff C. Successful strategies in recruitment and retention of overseas nurses. Not eligible year. Not eligible target population. Crit Care Med. Jan-Feb 2005. Editorial. Multi-skilled health carers: nature. 1332. Comput Nurs. night shift. Not eligible target population. Huber DA.

Costello D. 1395 Jacobson SF. Nurs Manage. Governing the conduct of conduct: are restraints inevitable? J Adv Nurs. Mod Healthc. Balancing and compromising: nurses and patients preserving integrity of self and each other.40(4):405-412. Intensive Care Med. Benedict S. Comment. May 2000. Jun 2001. Irurita VF. Factors affecting the quality of nursing care: the patient's perspective. Employee response to major organizational redesign. Am J Nurs. Not relevant. JONAS Healthc Law Ethics Regul. May 2004. J Soc Health Syst. Not eligible target population. Not eligible target population. 1997. Irving K. Not eligible exposure. How to plan for times of high patient census. No association tested.15(4):227-234.15(4):509-515. Rothen HU. 1397. multisite designs. Not eligible target population. 1394. Not eligible target population. Comment. Dekel R. Pesanti L.30(1-2):7176. Sep 2002. Aug 1993. Jordan KF. Nov 29 1999. Comment.11(9):22-24. Nurses' attitudes toward parental visitation on the postanesthesia care unit. patient satisfaction. 1377. nursing workload and outcome.12(1):2-6.7(10):1. Law allows some hiring of foreign nurses. RNs win court fight. J Hum Ergol (Tokyo). Becket N. Suel P. Fischer MS. Irurita VF. Ito H. Hoffere DA. Mar 2003.38(5):579-589. Petryshen P. 1379. 1383. Not eligible target population. Dec 1991. Professional practice model research collaboration. Empowerment.6(3):8-9. Nurs Econ. Int J Nurs Stud.33(3):134-135. Idelson C. Ikegami A. Applied Nursing Research Feb 2001. Jackson A. and a fixed staff size.17(1):55-59. Nov 2002.1362. Int J Nurs Pract. West J Nurs Res. Jaklevic MC. Appl Nurs Res. J Nurs Care Qual. Not eligible outcomes. News. Nov 1999. Jan 1995. Jackson BS. Jackson AL. 1372. Jackson M. Nursing. 1380. Jan 1999. 1368. Jacobs L. Jabez A. Letter.6(1):10-15.84(7):782-785. A prospective study of cost. J Perianesth Nurs.29(48):38. A preceptor incentive program. Stone T. 1991. 1370. Hamrin E. Marcell J. Sjostrom B. 1378. Holson D. 1391. Not eligible exposure. Comment. 1388. 1373. A study of nurse scheduling in Japan. Editorial. Relative satisfaction with nursing care of patients with ostomies. Nurs/patient ratio too high. J ET Nurs. Not eligible target population. Kasoff J. 33. 1375. Maruyama T. 1374. 'Saint B' gets an A in ratios. Revolution. Nurs Stand. Ross B. Hancock WM. Not relevant. Pokorny ME. Jakob SM. Int J Nurs Stud. 1386. skills. Zellermeyer V. Egashira K. May-Jun 2005. Itzhaky H. 1392. Not eligible target population. Apr 21-27 1993. Jul 2000. 1366. Nozaki M. Ind Health. Charles J.27(6):7-9. 1382. Irurita VF. No association tested. Iliffe J. Feb 1996. Premium pay cuts agency costs. Paediatr Nurs.5(2):86-94. Comment. Not eligible outcomes. Issues in longitudinal.79(23):231-236. Not eligible outcomes. Attitudes and behaviors of hospital staff toward elders in an acute care setting. Ingersoll GL. Iverson J. Jackson L. Patient satisfaction and pain management: an educational approach. How far do we go to protect patient welfare? Breaching unit staff confidentiality and trust.19(4):322-327. Jackson NV. 1363. and values: a comparative study of nurses and social workers. 1367. A survey of part-time faculty in baccalaureate schools of nursing and their learning needs.41(4):447-455. Jacobs C. Jun 1997. 1387. Not eligible target population. 48-51. Hartung DA. Williams AM. et al.33(5):46. Inwood H. Lodge RH. Jan-Feb 1999. Ichii S. Oct 1992. Parrinello KM. Shift work modifies the circadian patterns of heart rate variability in nurses. Not eligible target population. Patient and nurse assessment of quality of care in postoperative pain management. Ingersoll GL. 1389. 1369. 1385. Tsuda Y. Jacobson AK. 1364. Hoffmeister R.11(4):327-334. Aust Nurs J. Gerber P. Ciccarelli L. Comment. Brooks AM. 1381. 1390. Intensive care 1980-1995: change in patient characteristics. Seltzer JE. Not eligible target population. Kiernan ME. Intensive Crit Care Nurs. Oct-Dec 2004.23(11):1165-1170. J Nurs Adm. Vincent P. 1396. Comment.4(3):57-66. Kaji Y. Nov-Dec 1993. Bikaunieks N.21(12):6. J Nurs Adm. urgent demand. Idvall E. Nov 1997. Int J Cardiol. Jul 2001. J Nurs Adm. 1365. Nurses' reasons for participating in a longitudinal panel survey. 1376. A heuristic approach to nurse scheduling in hospital units with non-stationary.7(31):18-19. Unosson M.2(2):24-41. Collegian. Comment. Feb 1997.12(1):33-39. Beun L. Oct 2001. Hospital industry still resisting ratios. Jan-Feb 2004.22(10):8. and outcome of treatment of chalazion by medical and nursing staff. Revolution. Iwata N. Jackson TL. Jan-Feb 2004. Nursing abroad: a place of extremes.5(1):6. Kirklin S. J Nurs Adm. Surviving the perfect storm: staff perceptions of mandatory overtime. Annella EJ. 1371. Dam EJ. Not eligible target population. 1384. et al. Knowledge of resuscitation.5(1):22-26. Robley LR. News. 24E. Raising the bar and keeping it there. Br J Ophthalmol.35(1):41-47. The problem of patient vulnerability. Fisher M. Cortes TA. Jackson BS. Isken MW. Campaigning for quality health care. Farley J. Jacelon CS. Jacobsen C.101(6):24A-24C.20(6):233-238. Not eligible exposure. Dec 2001. Jackson LB. Not eligible target population. Improving staffing and quality: a nursing support team. Not eligible exposure. Jun 1999. Wigsten KS. B-40 . Revolution. Idelson C. Niwa A. Dec 2002. Nov 2002. keep ratios. Effects of bright artificial light on subjective mood of shift work nurses. Qual Saf Health Care. 1393.14(1):18-28. Casavis L. Innis J.25(1):39-46. May 2002. New methodology for analyzing fluctuating unit activity. Not eligible target population.

Jan 2003. Sep 2004.49(1):39-46. Uusitalo T. J Med Syst.14(1):95-101. Smithson S. A study of associated factors. 1400. 1399. Not eligible target population. Fineberg NA.10(1):51-57. Not eligible exposure. Self-management for nurses. author reply 281-282. Hildreth P. Johnson JE. Garbutt J.13(2):35-44. Jickling JL. Fraser VJ. Health Serv J. Job rotation in nursing: a study of job rotation among nursing personnel from the literature and via a questionnaire. Young SW. Aug 7 1995. 18-19. Jaworski Miller L.17(2):155-161. 1414. Comment. Jan 2005. Self-administered cardiac medication program evaluation. Janssen PA. 1426. Johnson J. Int J Nurs Pract. Management perspectives. Jun 1994. 1408. Harris SJ. Heart Watch: national survey of continuous electrocardiographic monitoring in U. Apr 1995. (Relatively) painless downsizing. Oleni M.5(16):5. Dunagan WC. No association tested. 2003. hospitals. Jenkins R. Health Aff (Millwood). 1403.18(3):125-138.1398. Nurs Spectr (Wash D C).47(3):184-190. Jennings BM. Int J Nurs Stud. Am J Phys Med Rehabil. 1416. Dec 2004. Not eligible exposure. Priest RG. 2003. No association tested. Zielinski V. A client-centered model: discharge planning in Juvenile Justice Centres in New South Wales. Sep 1991.28(3):36-39. Sep-Oct 2003. Shah AK. Not eligible exposure. 1411. 1429. No association tested. Jt Comm J Qual Saf.31(3):121-129. Health Care Strateg Manage. J Adv Nurs. Br J Psychiatry. Heath J. Comment. J Nurs Adm. 1413. Jarvis R. Beale B. 1422. Bommarito K. x. Johnson DE. Johanson W. 1401. Herold M. Sep 2000. Res Nurs Health. Keen L. Perinatal nursing education for single-room maternity care: an evaluation of a competency-based model. Journey to the Beacon Award: the Georgetown University Hospital perspective. Sep-Oct 1997. Soolsma J. Not eligible target population. Hardy P. Jevitt CM. Jeffe DB. 1421. Corbett G. 1405. Not eligible target population. Jun 1992. Review. Kirchner L. Review. Aug 1996. Jerant AF. Not eligible target population. Flexible nursing staff planning with adjustable patient demands. Retirement among Florida's certified nurse-midwives: an impending workforce crisis. Graydon JE. Home Health Care Serv Q. James DV. Jeppesen HJ. Int Nurs Rev. The role of research in the policy puzzle: nurse staffing research as a case in point. Flexible nursing staff planning when patient demands are uncertain. Azari R. Jul 4 2002. Sep 2004. Using focus groups to understand physicians' and nurses' perspectives on error reporting in hospitals. 1415. Leapfrog's report is incomplete. 1427. Nurses' assessments and patients' perceptions: development of the Night Nursing Care Instrument (NNCI). J Nurs Adm. Australia. Gallagher TH. Not eligible target population. Hill PR. Jarvi M. Crit Care Nurs Clin North Am. Johnson DE. Jacobs E.12(5):337-347. Johansson P. The public health roles of health visitors and school nurses: a survey. 1412. Johnson F. 1428.24 Suppl 3:81-87. Tavares D. Martin K. Beckstead JW. A randomized trial of telenursing to reduce hospitalization for heart failure: patient-centered outcomes and nursing indicators. Jette DU. News. 1424. Comment.48(6):622-631. Management of health and safety in the organization of worktime at the local level. Feb 2002. Can J Cardiovasc Nurs. Jarman H. Wirtalla C. Not eligible target population. J Cardiovasc Manag. Sep 2004. Journal of midwifery & women's health Jan-Feb 2004. Review. Not relevant. James G.156:846-852. How severe is the nurse shortage? Health Care Strateg Manage. DePaul D. 1409. 1417. Neal K. Boggild H. Comment. International recruitment.22(1):1-20. Nov 2003. 1407. Jun 2005. Nesbitt TS. George V.14(5):16-20. 1410. 1419. Jenkins CG. I am a nursing executive in an institution whose goal is to change its culture to become more customer oriented. Jensen L. An increase in violence on an acute psychiatric ward.22(6):59-63. Medication study supports registered nurses' competence for single checking.25(4):38-44.21(1):2-3. Jennings BM. Brown KK. Scand J Work Environ Health. Heart Lung. Ashdown-Lambert J. 1402. Klein MC. Not eligible exposure. Lessons learned while collecting ANA indicator data.83(9):704-712. Implementation of a patient classification system: using current resources to achieve organizational goals. Not eligible exposure. misleading. Br J Community Nurs. Jinks A. Editorial. Jan-Feb 2003. Burroughs TE.20(4):173-182. Jeang A.22(1):281.8(11):496501. Not eligible target population. 1404. Not eligible target population. 1998. Jenkins LS. Warren RL. Jarvis LA. J Med Syst. Stressors. Hospitals can control patient days to stem nurse demand. Jul 2001.S. 1406. 1420. Ward S. Martinez C. Mar 2001. Not eligible target population. J Nurs Manag.20(2):2-3. Health Serv J.24(6):443-445. MLO Med Lab Obs. Health Care Superv. Elliott P. Health Care Strateg Manage. Travellers' checks.8(6):330-335. J Nurs Adm. Harris CB. Not eligible target population. Comment. Smith M.101(5252):24-25. Jeang A. J Clin Nurs. Reime B. May 16 1991. Nursing precious resources. Nurse staffing. Jun 1990.26(5):350357. Jul 2005. Fridlund B. 1425. Johnson DE. Brosch LR. Mar 1996.42(5):569-578. B-41 . Maldonado T. The information needs at time of hospital discharge of male and female patients who have undergone coronary artery bypass grafting: a pilot study. Designs that make a difference: the Cardiac Universal Bed model. Jannotta M. Loan LA. measuring nursing care at night. Dec 2002. Not eligible target population.112(5812):25. 1423. Rehabilitation in skilled nursing facilities: effect of nursing staff level and therapy intensity on outcomes. 1418. Not eligible target population. Seymour LC. Not eligible target population.19(7):1.30(9):471-479. Dec 2001. burnout and social support: nurses in acute mental health settings.

Kawashima M. Feb 5-18 1997. Associations of sleep problems and recent life events with smoking behaviors among female staff nurses in Japanese hospitals. 10. Improvement in clinical work through feedback: intervention study. 1440. J Natl Black Nurses Assoc. 1458. B-42 . Not eligible target population. Kageyama T. Jones J.24(3):42-47. 1450. Easton M. Hartmann B. Congressional outlook: nursing shortages. Thanassa G. 1448. Okla Nurse. Not eligible target population. Clin Med. Mar 1995.12(4):396-404. Comment. Johnson M. Editorial. Jul 2004. Not eligible exposure. Ind Health. Jones S. Comment. Phillips JL. Galbraith P. Kageyama T. Lowe T. Jones GJ. Oct 1998. Jung FD. 1451. 1444. Comment.30(7):1487-1490. European practice database: results from Greece.57(3):112. Jones M. Kaissi A. activities and perceptions of gynaecology nurses. Letter. 1445. 1435. No association tested. 1431. Intensive Care Med. 1437. Kourakos M. Paediatr Nurs. Kobayashi T. 1461. Johnson SH. 1433. Jordan CB. 1443.21(10):36-37. 1438. Brenck F.6(1):51-52. Tex Nurs.29(10):48L. Efficacy of feedback from quarterly laboratory comparison in maintaining quality of a hospital capillary blood glucose monitoring program. Hall J. Johnson M. Laskari A.74(2):4-5. Oga J. McGinley SJ. 1455.79(17):115. J Hum Ergol (Tokyo). 1447. Dec 2000. Measuring teamwork and patient safety attitudes of high-risk areas. Jones A. Attitudes and cultural self-efficacy levels of nurses caring for patients in army hospitals.74(8):4-6. Not eligible target population. Hempelmann G.41(2):20-21. In the same boat? Nurs Times. Hosp Outlook.11(3):69-77. Higgins A. Night moves. Metered-dose inhalers: do emergency health care providers know what to teach? Ann Emerg Med. Jones HE. O'Brien H. Comment. Comment. Dec 2001. Mar 1994. Preparing for the 2001 Texas Legislative session. Kamineni S. Coping with census fluctuations. Szalai JP. Holist Nurs Pract. 1442. Bergquist T. Kelly P.21(5):211-218. Jan 2003. Not eligible target population. 1463. Huida O. Leenane M. 33. I am that agency nurse. 1446. Elseviers M. Wellman N. Your liability for a nurse's mistake. No association tested. Langdon R. Jones JS. Edmunds C. Sep 2000. Kobayashi T. Collegian. Jones D. Rohrig R. Tsougia P. Jones J. Ward M. 40. Feb 2000. Nichol HL. 1434. Specialist surgical nursing assistant. Comment. White L. Nurse staffing: are the answers emerging? Tex Nurs. Not eligible target population. 1456. Jones IH. Comment. 1460. A United Kingdom perspective. Oct 1990. Apr-Jun 1996.13(1):20-24. Kirschbaum MS. Junger A. Oga J. Review. 1453. Individual flexibility: an essential prerequisite in arranging shift schedules for midwives. Jul 2004. Sep-Oct 2003. Automatic calculation of the nine equivalents of nursing manpower use score (NEMS) using a patient data management system.36(2):246-255. Not eligible exposure. Jan-Mar 2005. Oct 2001.86(18):21.25(3):5. 1439. Jan 2005. May 2000. Evaluation of a program to improve nursing assistant use. Jorde R. Dimens Crit Care Nurs. Jan-Feb 1993. Kane D. 1454. Holstege CP. Black N. Cross-sectional survey on risk factors for insomnia in Japanese female hospital nurses working rapidly rotating shift systems. Pearcey LG. Jolley S. Kafkia T. Sep 1995. Johnson SH. Nurs Times. Stress and burnout in nursing: causes and prevention. Riekse R. Eleftheroudi M. Jul 1996. Not eligible exposure. Reid WM. May 2-8 1990. Aug 2005. Jan 1998. part 2: application of the Nursing Turnover Cost Calculation Methodology.19(2):168-170. Br J Hosp Med.31(1):4348.35(1):41-49. Nurse staffing. De Vos JY. 1449. Psychiatric inpatients' experience of nursing observation. The right balance. Bmj.89(27):30-31. Promoting teenage sexual health: an investigation into the knowledge. 1441. J Nurs Adm. Feb 1995. Diabetes Care.43(1):133-141. Achieving compliance with the European Working Time Directive in a large teaching hospital: a strategic approach. Nordoy A. Yong L. Sep 9 2002. 1462. Sep-Oct 2004. Not eligible target population. Edtna Erca J. Joseph HJ. Not eligible outcomes. 15. Johnson N. Jones K. Michel A. Not eligible target population. Kandolin I. Kawashima M. Nurs Manage.7(1):21-24. Vanderpump MP. Mandatory overtime and on call: growing concerns for nurses.15(1):2-3. 1457.4(5):427-430. Johnston CL.10(1):30-34. Jordan CB. Accid Emerg Nurs. Sr Nurse. Johnstone L. J Adv Nurs. Stewart H. J Nurs Adm. An agency-staffed nursing unit project. Sanderson C. Managing pain using the partnership model of care. Jul 7-13 1993. Comment. Mental health. Jan-Feb 1996. Changing care patterns and registered nurse job satisfaction. Johnson LJ. Doula M. Yancer DA. Apr 1997. Jones CB. Jun 26 1999. What's adequate? What's safe? Tex Nurs. Klasen J. Levels of nurse staffing. Baker DM.26(3):308-311. Cleave B. Tabone S. Jan 2005. Johnson T. 207. Lagkazali B. Job sharing as a part-time employment alternative.318(7200):1738-1739. Ball C. Nishikido N. Jordan C. Not eligible target population. Women-centred care and caseload models of midwifery.4(4):213-217. Nurs Econ. 1436. Else M. Not eligible target population. Feb 2001.1430. Comment. J Nurs Adm. The costs of nurse turnover. Perceptions on individualized approaches to mental health care. Hoffman BR. Zinman B. 1432. Benson M. 1452.15(1):5-16. Quinzio L. 1459. J Psychiatr Ment Health Nurs. Comment. Nishikido N. Nurs Manage. Not eligible target population. Comment.30(1-2):149-154.4(2):7. J Nurs Manag. Feb 1996. Comment. J Psychosoc Nurs Ment Health Serv. Turner N.74(5):4-5.38(12):10-20. Not eligible exposure. Not eligible target population. Med Econ. Not eligible target population.

Swanson E. Kanji Z. Mar-Apr 1999. Karabeyoglu M. Eriksson K. 1499. Not eligible exposure. 2003.99(4):68. Winter 1991. Review.20(3-4):313-316.8(1):12-16. Healthc Trends Transit.24(4):362-366. May 2001.4(2):76-77. 1496. Hospital caregivers are in a bad mood. Environ Mol Mutagen. Kane-Urrabazo C. Karkkainen O. Comment. Dec 2001. Aug 1999. Vural G. Szeremi M. Comment. Aug 2001. Feb 1995. Giuliano KK.101(12):22. Res Nurs Health. Kauffmann E. Nov-Dec 1999. Miller LH. Theorizing about nurses' work lives: the personal and professional aftermath of living with healthcare 'reform'. Mancini ME. 2002. J Gerontol Nurs. B-43 .14(1):28-36. and patient satisfaction with nursing care. Aug 2000. Case Reports.100(3):25. Chuwers P. Jan 1999. Kellett J. Kany K. Kelly AM. Not eligible target population. Nagid DM. Strengthening the in-hospital chain of survival with rapid defibrillation by first responders using automated external defibrillators: training and retention issues. Nurses' and parents' perceptions of participation and partnership in caring for a hospitalized child. Keatinge D.13(3):202-208. Sawyer-Silva S. Comment. Kangas S. Gilmore V. McKee-Waddle R. Jun 1998. Kelly AM. Eroglu K. 20. 1483. Nurse-managed analgesia for renal colic pain in the emergency department. Work environment factors influencing burnout among third shift nurses. Kater V. Keller LO. Should you dive into that float assignment? Nursing.9(3):29-32. What did you say? I can't quite understand your spoken order. Restuccia JD. 1468. 22-15. Nurs Stand. Not eligible exposure. Sezer K. Public Health Rev. 1486. 1491. McMurray JL. Int J Clin Pharmacol Res. Ann Emerg Med. Szeles G. Pediatr Nurs. Burke SO. 1478. No association tested.6(1):58-64. Tompa A. 1485. 1475. reality. Not eligible exposure.42(1):59-60. 56.20(1):13-15. Apr 1990. Kawik L. Norms and nurse management of conflicts: keys to understanding nurse-physician collaboration. Karlowicz MG. 1482. Nurses' perceptions of medication errors. Cooke R. Nov 1996. Engstrom JL. Not eligible target population. The management of stress and prevention of burnout in emergency nurses. Policy vs. Not eligible target population. Kaplow R. Jun 2004. Kavanaugh K. RN staffing is key.154(11):1123-1126. Shared care: a partnership between parents and nurses. Not eligible target population. Not eligible exposure.21(2):22-25. 1498. Not eligible exposure. Am J Nurs. Comment.75(8):16. Hillis SL. Strohschein S. Feb 2003. Kane D. et al. Acclimating to shift work--a survival kit. Kelly B. Keim J. Arch Pediatr Adolesc Med. J Nurs Adm. Can J Nurs Leadersh.34(6):64. Oct 1990. Aug 1999. Not eligible exposure. Keenan GM. Comment. 1474. 1477. 1467. 1471. Am J Nurs. 1476. Feb 1998. Kaya S. How can nurses combat mandatory overtime? Am J Nurs. Comment.25(2):14-21. Apr 1996. 1473. Kaplan M. Comment. J Nurs Adm. 1492. Comment. Karch FE. Restraint or martial arts: should nurses tie people down? Ky Hosp Mag.15(3):207-215. Meier PP. Comment. J Nurs Manag. Lysakowski TY. Todays Surg Nurse.5(7):430-437.21(1):59-72. Crit Care Nurse. Gombkoto G. Not eligible exposure. Karch FE. Karas C. Dec 11 1996. Not eligible exposure. Richards N. Nov 2000. 1493. Wong C. J Nurs Care Qual. Apr 11-24 1996. Public Health Nurs. Organizational factors. Marler CA. And eight other common errors that can be avoided. Gregor F. Kany K. Aust J Adv Nurs. Comparison of neonatal nurse practitioners' and pediatric residents' care of extremely low-birth-weight infants. Kardos L. Am J Nurs. Combating staffing problems.29(1):32-42. 1470. Not eligible exposure. Not relevant. Hospital nursing: 'it's a battle!' A follow-up study of English graduate nurses. Karch AM. No association tested. 1494. 1484.101(5):87.24(5):1063-1069.12(4):16-22. J Adv Nurs.Suppl:27-30.1(5):18. Cancer deaths among hospital staff potentially exposed to ethylene oxide: an epidemiological analysis. Turkkani B. Foster S. 1472. Job sharing: a retention strategy for nurses. Feb 1999. 1466.99(8):77. J Emerg Nurs. 1479. Recording the content of the caring process. 1465. Apr 1999.23(2):185-189. AACN Synergy Model for Patient Care: a framework to optimize outcomes. Liability and validity of the Appropriateness Evaluation Protocol in Turkey. Not eligible target population. 1497. Taking the blame. Am J Nurs. Kautzman L. Hosp Health Netw. Cakmakci A. 2000. Family visitation on special care units. 1487. Not eligible exposure. Jan-Mar 2005.16(2):90-95. Aust Health Rev. Kelley LS. Case Reports. nurses' job satisfaction. 1490. Lia-Hoagberg B. Not eligible exposure. Karadeniz G. The naked decimal point. How reliable are scales for weighing preterm infants? Neonatal Netw. Growing replacements for our 'graying' perioperative nurses. Sain G. Braverman N. SepNov 1996. Ashton W.99(8):12. Nursing inquiry Mar 1999.12(4):325-329. 1488. Kayuha AA. Mersin H. Schaffer M.1464. May 2005. Not eligible exposure. 1481.22(3-4):111-116. Not eligible exposure. Adany R. Not eligible target population. Not eligible target population. Kany K.22(11):52. 1469.25(2):163-168. Robinson S. Karch AM. Kaprowy J. Harrison MB. Not eligible target population. 1992. 1489. Would provision of childcare for nurses with young children ensure response to a call-up during a wartime disaster? An Israeli hospital nursing survey. Maas ML. Am J Nurs. Keddy B. Jul-Aug 1998. Nov 1992. Stress-point intervention for parents of children hospitalized with chronic conditions. Population-based public health nursing interventions: a model from practice. Keller KL. Plaster checks by nurses: safe and efficient? Accid Emerg Nurs. Implementation of a sedation and analgesia scale. Kaye W. Tripp-Reimer T. MarApr 1990.11(12):21-23. Miljesic S. 1480. Mar 2000. Int J Qual Health Care. Br J Nurs. Kee CC. Mant P. 1495. Schilder E.

King S. Clin Pediatr (Phila). Little B.64(3):3. Reilly C. Chandy R. Oreg Nurse.91(4):50-56. Kinley H. Cox M. Safe staffing levels for children's wards. Oncol Nurs Forum. Chest. Healy C. Acting against discrimination. May 1995. Healy C. Dec 7 2002. Mich Nurse. AACN Clin Issues. Norman J. Primrose J. Am Nurse. Comment. Pediatr Emerg Care. Caldwell K. Editorial. No association tested. Mycoses. Metwali KE. Jun 1427 2001. Kerfoot KM. Not eligible exposure.67(3):1. Jan 2002.10(11):704-709.5(20):1-87.1500. Janke E. Effectiveness of appropriately trained nurses in preoperative assessment: randomised controlled equivalence/non-inferiority trial. Jul 1992. Androutsopoulou C. Nutritional awareness of critically ill surgical high-dependency patients. 1508. Comment. Read S.325(7376):1323. Candida albicans strain carriage in patients and nursing staff of an intensive care unit: a study of morphotypes and resistotypes. Kern D. Feb 2001. Comment. Carter WH. Fernandes N. Czoski-Murray C. May 1998. Appropriate staffing: our right. King S. Murdoch I. Feb 1999. Entwistle M.9(3):146-153. Kinn S. Aug 1996.18(12):714-715.12(2):28-31. Cardiac rehabilitation in the time of health-care reform. Not eligible exposure. Bmj. Dealey C. Wood R. Summer 2004. Jun 1999. Kemper KJ. Czoski-Murray C. Kerr MP. Kinard J.10(2):15-19. Williams C. Paediatr Nurs.59(3):3. Sep 2002. Kettner P. Aug 1995. Not eligible target population. Br J Nurs.18(3):32-36. Not eligible target population. Shiell A. Kemppainen JK. Ketter J. Comment. Jul 2001. A system with many methods to adjust staffing. Alhameed H. Reilly C. Hilton G. Wood R. King MT. Kelly TM. Not eligible target population. Nicolson P. Alhameed H. Jr. 1527. Jul-Aug 1995. Thomas E. Kenny MF. May 1992. J Adv Nurs. Are hospitals facing a critical shortage of skilled workers? Health Care Superv. Albrizio M.6(3):432-442. Oreg Nurse. Oreg Nurse. Read S. Dec 2003. Hospital nurse staffing--the public's interest. 8. Have you worked through lunch lately? Fair Labor Standards Act protectsRNs against wage abuse.113(5):1175-1177. Not eligible target population. Kelly M.37(2):125-134.14(8):434-438. Not eligible exposure. 1513. No association tested. Comment.31(7):405-408. McCabe C. Comparison of costing tools in paediatric intensive care. An exploration of the variables involved when instituting a do-notresuscitate order for patients undergoing bone marrow transplantation. Maintaining quality care during a nursing shortage using licensed practical nurses in acute care. Sep 1994. King RB.20(10):710-716. Kirkpatrick BV. 1501. Dubbert PM. King S. J Nurs Care Qual. Health Technol Assess. 1524. Sep 1993. Extended scope of nursing practice: a multicentre randomised controlled trial of appropriately trained nurses and pre-registration house officers in pre-operative assessment in elective general surgery. Killeen MB. Sep 2004:13-15. B-44 . Kenney PA. our responsibility. Transforming nursing practice: clinical systems and the nursing unit of the future. Not eligible exposure. J Healthc Inf Manag. Nurs Manage. Rn. Comment. 1530. Primrose J. Gapas J. Khan ZU. Not eligible exposure. Dec 1990.30(2):4. Wasdovich A. 1520. King S. 1506. McCabe C. Interview. Papahatzi A. Sep 1999. Kinley H. Legal Cases.17(4):54-62. Keogh A. 1504. Hospital staffing law effective Oct. Interobserver variability in assessing pediatric postextubation stridor.19(4):635-640. The synergy model: the ultimate mentoring model. Kendig EL. Not eligible exposure. 1. 1503.17(6):439. Kercher LL. 1507. Apr 1991.. Kidner MC. Midwifery. Br J Nurs. Kinney M. Cameron S. Donovan K. ED overcrowdingmeeting many needs. 1515.17(2):109-112. Not eligible exposure. ANA and SNAs tackle hospital restructuring.11(9):14-16. Comment. Shaw K.62(9):35-39. Prof Nurse.27(5):14. 1519. Not eligible target population. Kester-Beaver P. Flexible scheduling and part-time work: what price do we pay? Focus Crit Care. 18. 1517. Fernandez N. 1526.27(2):8. Cross utilization in critical care. Thomas E. Nurs Manage. Aug 2003. Apr 28-May 11 2005. 1516.26(5):48D. Norman J. 1523. Tales from travelers. Nov 1999. Kenny P. 2001. Profiling beds versus standard hospital beds: effects on pressure ulcer incidence outcomes.15(4):60-68. 1502. Paediatr Nurs. Effects of group discussion and guided patient care experience on nurses' attitudes towards care of patients with AIDS. Sep 1999. Kiekkas P. Kinrade S. How to keep float nurses from sinking. Editorial. 1531. 1514. King LA. 1512. George S. Hill FA. Am J Nurs. Jun 2005. Crit Care Nurs Clin North Am. Maliouki M. Scott J. Workload of postanaesthesia care unit nurses and intensive care overflow. Mar 1995. Ketter J. 1525. Comment. 1528. Bishop MJ. McWilliams P. ix. Not eligible target population.24(2):296-302. Oct 2004. J Wound Care. Not eligible target population. Nicolson P. J Adv Nurs. 1510. Goodbye Holladay Park. A qualitative study of shift handover practice and function from a socio-technical perspective. 48F-48I. Am Nurse. 1509. 1518. 1522. 1511. Not eligible exposure. Underreading of the tuberculin skin test reaction. No association tested. Not eligible target population. 1521. Benson MS. George S. 1529. 1505. Prinou A. Not eligible target population. Mar 2000.46(11-12):479-486. Janke E. Satisfaction with postnatal care--the choice of home or hospital. Young C. Poulopoulou M. Adams JG.

Religious perspectives of doctors. Kjellberg K.12(2):86-90. Koenig HG.72(5):845-850. Fall 2004. St John RE.11(3):268-275. McKennett M. No association tested. Harrington C. Development and evaluation of essentials of magnetism tool. Apr 2005. J Nurs Adm.6(6):333-342. Kovner C. Review. 1542. May 2002. J Nurs Manag.102(5):93-94. Elovainio M. patients. Not eligible exposure.. The changing picture of hospital nurses. Hamilton C. Not eligible exposure. Kramer M. preparation. Kovner CT. BakerClinkscale D. Nov 2000. Jan 2001. Apr-Jun 2000. 1551. Sauer S. Kamal AM. Takemura S. Can J Nurs Leadersh. comment. 1536. Nov-Dec 2001. Epidemiol Infect. Not eligible target population. Laschinger HK. Kirchhoff KT. et al. No association tested.116(6):347-352. nurses. Not eligible target population. Mar 2004.82(4):2-9. Not eligible exposure. No association tested.Kirchhoff KT. Laippala P. Stave CM. and wages among nursing occupations in New York state hospitals. Patient safety and comfort during transfers in relation to nurses' work technique. Makinen A. Koivula M. Kosowsky JM. Knight P. Not peer reviewed. Semin Perioper Nurs. Cannt J. 3rd. Nursing documentation time during implementation of an electronic medical record. Koivisto K. An overview and conceptual framework. Not eligible target population. Kramer M. sudden shifts. 1539.5(1):32-35. 1560. Shindel S. Jun 2004.34(7-8):365-378. Lavelle K.21(4):51-55. Prentice D. B-45 . Virtanen M. Not eligible target population. Journal of Nursing Administration Jan 2003. 1535. Hagberg M. Innovations. Medinfo. Kollef MH. Janhonen S. Sep 1990. Aug 2004. Review. Nozaki N. Maguire P. Pancioli AM. Healthtexas. Debbie Cuaresma. Kivimaki M. Kluska KM. Not eligible target population. Staffing outcomes: skill mix changes.35(4):188-198. Nursing. Kobylus K. Essentials of a magnetic work environment: part 3. Dec 2004.8 Pt 2:1382-1385. Mar 2000. Nov 1998.17(1):112-128.33(1):24-30. Nov 2002. RN cardiac nurse.2(6):18-21. J Pastoral Care. Garfink CM. Vaisanen L. Public Health. EusebioAngeja AC.19(1):10-14. Apr 1991. Cassady G. A randomized. Critical care nurses' perceptions of obstacles and helpful behaviors in providing end-of-life care to dying patients. Jun 1995. The University Hospital Nurse Extender Model. sharps injuries and vaccination. Kawahara K. A day in the life . Vardareli E. 122. Mateo MA. Job satisfaction and retention. J Prof Nurs. Outpatient and short-stay patient classification systems.21(1):25-30. Not eligible exposure. Am J Nurs. Not eligible target population. 1548.132(1):27-33. Not eligible exposure. Jul-Aug 2004. Not eligible exposure. Mar 1991. Not eligible exposure. Kooijman CJ. Not eligible target population. J Psychiatr Ment Health Nurs. Schmalenberg C. 1545. 1549. Schmalenberg C. Paunonen M. initiating and cessation factors among Japanese nurses: a cohort study. 30 passim. Talbott J. Hover M. Sickness absence and the organization of nursing care among hospital nurses. State regulation of RN-to-patient ratios. Insights for the '90s. 1538. 1555. Not eligible exposure. Klaassen-Leil CC.25(3):20-7. controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation.1532. et al. Dec 1990. nursing homes. Koncar DR. Kerr MS. Travis JL. Kollee I. Apr 1997. reducing costs. Shapiro SD. Bearon LB. Not eligible exposure. 1562. Liu T. Not eligible exposure.25(4):567-574. J Adv Nurs. Chamorro T. 1553. 1557. Jan 1991. Nurs Manage. Nurs Manage. The relationship between managerial leadership behaviors and staff nurse retention. quiz 476.100(11):61-63.10(4):357-360. Revolution. 1537. 1534 . and diagnostic and treatment facilities. Koch F. Ohida T. Kirkhart DG. Beckstrand RL. Mar-Apr 1996. Roles and responsibilities of clinical nurse researchers.. 1559. Pearson E.34(8):44-47. Kleinman C. Control of infection due to Klebsiella pneumoniae in an intensive care nursery. Not eligible exposure. Kitajima T. Prerequisites for quality improvement in nursing. 1547. 1546. Minaowa M. Extraction. Not relevant. 1995. Challenges of measuring intraoperative patient outcomes. Lagerstrom M. Shared care: improving health care. Shannon W. Nursing. Part 2.9(2):96-105.26(6):26. 1533. Am J Nurs.46(9):15-16. and presentation of patient classificationdata for the benefit of management overviews. Staff nurse empowerment and effort-reward imbalance. Can emergency department triage nurses predict patients' dispositions? Am J Emerg Med. Scand J Work Environ Health. Kramer M. 853. 1554. Not eligible exposure.47(3):251-259. Kleinbeck SV.30(6):468476. Ahrens TS. 1558.21(9):118-119. Kosgeroglu N. Not eligible outcomes. Crit Care Med. 1552. Aug 2004. Kirsch E. Kovner CT. J Nurs Adm. Schmalenberg C. Aorn J. Jan 2004. Schmalenberg C. 1550. An analysis of vacancy rates. Hosp Top. and families. 1561. Revising the Essentials of Magnetism tool: there is more to adequate staffing than numbers. 1556. Vahtera J. local solutions arise from the shortage. Jan 1996. turnover.10(2):26-29. Am J Crit Care. 65. Smoking behavior. Part I. 1540. Fall 1991. 1541. 28. Dincer S. Ayranci U. 1543. Patients' experiences of being helped in an inpatient setting. Korst LM.45(3):254267. Kirby KK. Harano S. Nov 2000. J Perinatol. Not eligible exposure. Firth-Cozens J. 1544. Kramer M. Not eligible target population. Occupational exposure to hepatitis infection among Turkish nurses: frequency of needle exposure. Silver P. Journal of the New York State Nurses Association Sep 1994. Hemodialysis teaching protocols: an educational tool for both patients and nurses. Interview. J Nurs Adm.

Education and training in dementia care. Nelson D. Nurs Times. Nurses' role in patients' discharge planning at the Aga Khan University Hospital. Nursingconnections. 1995. Goran SF. Community Nurse. Not eligible exposure.11(3):5.20(11):47-52. Overmars RF. Krishnasamy M.19(4):336-342.29(10):1028-1038. Development of nursing time standards as a problem of optimalisation of health care system management. Comment. Mental illness and substance abuse. Comment.4(6):429-434. Not eligible exposure.19(9):10-11. Lifting the lid. Lacombe DC. Not eligible exposure. Kromhout H. Krugman M. I. Applying a conceptual model to the results of three workplace surveys. B-46 .56:313-318. Gulzar AZ. Ann Univ Mariae Curie Sklodowska [Med]. In the red. Is this midwifery? Midwifery Today Int Midwife. 1581. Jun 1996. Kupferman K.23(1):65-68. Uitterhoeve R. Nurs Stand. Ann Univ Mariae Curie Sklodowska [Med].5(12):15-16. Murdaugh CL. Biordi DL. Case Reports. II. Jun 1999. 1595.16(8):343-352.17(6):314-319. Does your acuity system come up short? Nurs Manage. Role clarity. J Nurses Staff Dev. Part II: perceptions of the nursing workforce environment and adequacy of nurse staffing in outpatient and inpatient oncology settings.54:79-86.9(4):263-265. Fox DH. May 2003. Lamb LS. Lampat L.29(1):93-100. Gottlieb MS. J Nurs Adm. 1999. 1566. It can happen to you: the firsthand accounts of six nurses accused of and disciplined for professional misconduct. Evaluation of the correctness of patients' classification. Aug 2001. Avoiding a malpractice nightmare. 1583. Comment. and job satisfaction during hospital reengineering. Anzion R. Not eligible target population. Hoek F. Oct 1991. Kyle F. Kumarich D. 1571. Ann Occup Hyg. Jr. Legal cases. Special characteristics of nursing staff scheduling in intensive care units. J Adv Nurs. Ann Univ Mariae Curie Sklodowska [Med]. Not eligible target population. 1569. Kroposki M. Summer 1998(46):42. Biel MH. 1574. Case reports.. Unlicensed hospital assistive personnel: efficiency or liability? J Health Hosp Law. Not eligible exposure. Not eligible exposure. organizational commitment. No association tested. Kutash MB. Oct-Dec 2004. Smith V. 1580. 1565. Comment. 1573.97(39):36-37. J Emerg Nurs. Not eligible target population. Isola A. May 1996. Ksykiewicz-Dorota A. Nurse practitioners' and physicians' care activities and clinical outcomes with an inpatient geriatric population. J Adv Nurs. What do cancer patients identify as supportive and unsupportive behaviour of nurses? A pilot study. Kuhn EM. J Nurs Care Qual. 1590.27(4):369-376.30(6):40A-40C. Boettcher JH. Jun 1990. Nurs Econ. Young D.95(7):30-33. Review. 1564. Tavakoli AS. 1591. Promoting participation of informal caregivers in the hospital care of the elderly patient: informal caregivers' perceptions. Jan-Feb 2002. Lamb J. Kurian VA. Comparative analysis of demand for nursing care. Charge nurse leadership development and evaluation.20(6):42-43. Not eligible exposure. 1568. 1594. Milazzo-Chornick N. Sims J.23(5):942-947. Kristensson-Hallstrom I. Aust Nurses J. Current nursing practice of point-of-care laboratory diagnostic testing in critical care units. J Clin Nurs. Nov 1990. Development of nursing time standards as a problem of optimalisation of health care system management. 1585. Aug 5-11 1998. Not eligible outcomes. Rimm AA.12(46):20-22.33(5):284-292. Dankbar G. 1577.1563. 2001. Parsons M. Lageson C. Am J Crit Care. 1579. Your shift penalties under attack. Laitinen P. Nov 1995. Life-style impact for Christ. Pain management. Ross S. J Am Acad Nurse Pract. Frederick B. 10 ways to help students grow. Not eligible exposure. 1999. Lambert C. J Nurs Adm. 1587. Nurs Times. Kreplick J. 1567. 1588. Vermeulen R. Kubecka KE. Nursing. Simon JM. Lalani NS. Quality focus of the first line nurse manager and relationship to unit outcomes. Nurs Manage. Lancelot A.23(5):861-867. 1589. Lancaster R. Oncology Nursing Society Workforce Survey. Jan 1993. Landergan E.35(4):56. Staffing for census fluctuations. Williams M. Nursing. Not eligible target population. Kydd A.28(5):77-78. Ksykiewicz-Dorota A. 1576. 1592. A patient's perspective. Christ Nurse Int. Not eligible target population. Not eligible exposure. Comment. 1578. The impact of the 23-hour patient on nursing workload. Aug 1999. Comment. May 1997. Pain management knowledge of hospital-based nurses in a rural Appalachian area. 1570. Postulating a dermal pathway for exposure to anti-neoplastic drugs among hospital workers. Ksykiewicz-Dorota A. Kubisiak J. Not eligible target population.8(5):586-592. Oct 2000. Lambing AY. Eur J Cancer Care (Engl). Med Care. Strategies for feeling secure influence parents' participation in care. Sep 1999.28(5):292-309. Wysokinski M.12(1):27-34. 1586. Not eligible target population.44(7):551-560. Not eligible exposure. Apr 1990. Hartz AJ. Lacovara JE.54:87-96. 1593. Adams DL. Huijbers R. Can Nurse. 1584. Sep-Oct 1995. LaDuke S. Nov-Dec 2001. Parrish RS. 1582. Not eligible exposure. Comment. Comment. Oct 27-Nov 2 1999. Lamkin L. Jan 2000. Changing the start of the hospital workweek. Aug 2004. 1572. Pakistan. 1575. Spring 1999. Not eligible target population. May 1996. Optimizing the use of nursing pool resources. Divine G. Sep 27-Oct 3 2001. J Nurs Adm.95(43):16-17. The relationship of hospital characteristics and the results of peer review in six large states.5(2):103-110. Not eligible exposure. Buerhaus P. Rosiak J. Mallory G. Jul-Aug 1991. Oncol Nurs Forum. Apr 2005.

Jan-Feb 1997. Organizational trust and empowerment in restructured healthcare settings.16(8):1004-1008. Nursing liability risk-three perspectives. 1618. Comment. Saiman L. 1599. Three-part model manages care from admission through postdischarge. Jul-Aug 2001. Not eligible target population. ANS Adv Nurs Sci. and work effectiveness. Kravitz RL. Am J Public Health. J Adv Nurs. J Adv Nurs. Comment. 1606. A multifaceted approach to changing handwashing behavior. Le Blanc PM..53(10):19-21.25(2):339-346. Kappeli S. Lanser EG. Larsson G.31(3):34-42. May 2001. Prof Nurse.77(8):54-58. Not eligible outcomes. Lawson S.48(1):22-23. Feb 1997. Bed-blockers. Crit Care Med. Not eligible exposure. Kaufmann C. Nurs Times. Have qualifications. Laurent C. Withrow ML. Lepisto M. Burant C. Olson V. Lang TA. Aug 2003. Not eligible exposure. Arch Pediatr Adolesc Med. 1621. Romano PS.13(2):1. Larkin H. 1619.27(4):254-268. 1616. Gallagher TJ. Rolniak S. 1613. 1614. Milner J. Hicks C.33(78):410-422. Not eligible outcomes. Well-being of intensive care nurses (WEBIC): a job analytic approach. Ward managers. Layon AJ. Leveraging your nursing resources. Larson EL. et al. Oct 2004. J Clin Pathol. Not eligible target population. Hodge M. job tension. Laschinger HK. 52. Tuer-Hodes D. Sep 2001. Case Reports. 1615. 1605.90(9):1444-1448. 1607. 1609. Shamian J. 1622. Larson L. J Nurs Adm. 1620. Achieving outcomes in a jointappointment role.29(5):28-39. Effects on staff nurse commitment. Rose P. Maynard A. Schaufeli WB. Jan 22-28 2003. Not eligible target population. Case Reports. 1611. Baker L. de Jonge J.86(25):33-34. Lawton LC.7(4):248-257. Not eligible exposure. Jul-Aug 2003. Nurs Times. Larrabee JH. Aug 23 2001. Effect of an administrative intervention on rates of screening for domestic violence in an urban emergency department. Hamby B. Legal Cases.96(15):55-57. Comment.1596. Larkin GL. Outcomes Manag Nurs Pract.28(2):163-174. Not eligible exposure. McMahon L. AprJun 2001. 1617. 1627. Laschinger HK. J Nurs Adm. Finegan J. Wong C. Strategies to increase patient control of visiting. Trained nurses can obtain satisfactory bone marrow aspirates and trephine biopsies. How audit can improve provision of inpatient pain services. Feb 1997. Nesin M. Cimiotti J. Larson EL. Disch Plann Update. Lanza ML. Savage R. Used correctly. Comment. Mar-Apr 1993. 55-6. Nov 2001. Wilk P. Fegan CD. Journal of gerontological nursing Mar 2005.12(3):253-265. Linen in the hospital bed: effects on patients' well-being. Aug 2004. Not eligible exposure. Dimens Crit Care Nurs. Do elderly patients overutilize healthcare resources and benefit less from them than younger patients? A study of patients who underwent craniotomy for treatment of neoplasm. Not eligible exposure. Lawler K. 1604. Almost J. Healthc Exec. Blane C. 1602. Feb 1999. J Child Health Care. Trustee. and hospital outcomes. Bloodworth C. Restoring the relationship: the key to nurse and patient satisfaction. 1597. Laschinger HK. 1624.23(5):829834. Workplace empowerment and magnet hospital characteristics: making the link. 1625. Nurse-patient ratios: a systematic review on the effects of nurse staffing on patient.16(4):50-51. Too hot to handle? Health Serv J. Oct 1996. Res Nurs Health. A training program for managing agitation of residents in longterm care facilities: description and preliminary findings. Apr 13-19 2000. Comment. Aston S. Haas J. Vigilance in the OR. Sheldon TA. Oct 1990. Nursing home. Larter J. lower costs and make up for reduced residents' hours. Verrault R.52(2):154-156. Not eligible exposure. Nurs Stand. Not eligible exposure. Kayne HL. Hosp Health Netw. Changing practice in invasive procedures: the experience of the Krishnan Chandran children's centre. Patients' needs in hospital: nurses' and patients' views. Milligan DW. Effect of antiseptic handwashing vs alcohol sanitizer on health careassociated infections in neonatal intensive care units. Casier S.159(4):377383. No association tested. Modernising the 12-hour shift. Shamian J. Della-Latta P. 1603. Not eligible target population. 20-23.17(19):33-36. 1600. May 1999. Not eligible exposure. Bryan JL. Mar 2000. Not eligible target population. Nursing staff characteristics related to patient assault. Impact of structural and psychological empowerment on job strain in nursing work settings: expanding Kanter's model. Jul-Aug 2004. Not eligible outcomes. Hobbs GR. George BE. Lazure LL. J Nurs Adm. Leader behavior impact on staff nurse empowerment. 1612. Lea A. 11. Lauri S. Landreville P. Larrabee JH. Lankshear AJ. Apr-Jun 2005.57(9):8-10. Sep 2000. Review. The case for nurse practitioners. 1623.17(1):41.34(7-8):326-337. 1601. Review. Sep 2000. Langslow A.36(3):460470. 1626. Janney MA. Lark K.31(5):260-272. Aug 1991. nurse employee.30(9):413-425. Jr. MacLeod BA. Jun 20-26 1990. Aust Nurs J. Mental block. 1608.16(1):11-19. they can improve outcomes. J Nurs Adm. Laschinger HK. Ostrow CL. 12-14. Am J Infect Control. Dec 2003. Lawson K.4(4):30-32. Not eligible exposure. J Nurs Adm. Not eligible target population. May 1995. 1598. Fla Nurse. Nurse staffing and healthcare outcomes: a systematic review of the international research evidence. Parides M.111(5769):22-25. Apr 2005. Finegan J. will travel. Mikos CA.5(2):52-56. J Adv Nurs. de Rijk AE. Dicaire L. Larcombe J. 1610.25(1):3-10. Adler LM. Not eligible target population. Rn. Jun-Sep 1991. Leach E. Nursing and the law. Predictors of patient satisfaction with inpatient hospital nursing care. Dean K. Issues Ment Health Nurs. Hyman KB. B-47 . Berg V. Trading places--a seasonal exchange program.

J Health Soc Behav. Not eligible target population. Crockett MS. 1651. Orthop Nurs. Lee GZ. AAOHN Journal Oct 2003. Lee S.12(2):63.14(3):344-353. No association tested. Not eligible exposure. J Clin Nurs. May 2004. Not eligible target population. Noh DY. Women Health.28(8):737-745. Not eligible target population. Sleep among shiftworkers -. Sleep. Lee TH.28(3):269-272. Determining the main risk factors and highrisk groups of breast cancer using a predictive model for breast cancer risk assessment in South Korea. J Clin Nurs.3(2):44. Fendrick AM. 1648. Lee EO. Jan 2004. Niblett DJ. Wolfe EP.37(2):145-154. Not eligible target population. J Nurses Staff Dev. 1647. Nov 2000.15(2):11-19.13(4):534-535.15(4):419-432. Feb 2000. Self-reported sleep disturbances in employed women. 1652. The accuracy of the estimation of body weight and height in the intensive care unit. Breast self-examination performance among Korean nurses.19(17):40-43.17(11):698703. 1657.17(12):803-808. 1654. Jan 5-11 2005. 1632. Not eligible exposure 1640. Women Health. Goor E. Lipscomb J. Lemonidou C. Perceived health care climate. Lee CS. Witkowski KM. Nurses' concerns about using information systems: analysis of comments on a computerized nursing care plan system in Taiwan. Not eligible target population. 1991. diabetes knowledge and self-care practice of Hong Kong Chinese older patients: a pilot study. Decentralizing an overtime budget. Valimaki M.15(6):493-498. Nov 2003. Not relevant. Lee KA. Mar 2005. J Clin Nurs. Lee F. Lee YL. The effects of hospital characteristics and radical organizational change on the relative standing of health care professions. Mar-Apr 2003.21(5):741-747.19(1):65-78. Br J Clin Psychol. Goldman L. Leifer D. Violence in A&E: the role of training and selfefficacy.7(2):69-73. Not eligible target population. Med Care. Lee H. Oct 1998. 1638. Not eligible outcomes. Cesario T. Arndt M. Thrupp L.16(29):16-17. Not eligible target population. Kaljonen A. Jun 2000. Leicht KT. Walters S. 1636. Han W. Lee KA. Nurs Stand. Republic of China. Daly B. Lee TT. 1645. Pashos CL. Lee DS.51(10):418-20. Cho YS. 1643. 1637. Dec 2003. Randomized prospective study of the impact of three needleless intravenous systems on needlestick injury rates. 1641. A comprehensive model for predicting burnout in Korean nurses. Stone G. 1646. Gasull M. 1658. Lee S. Cancer Nurs. Mar 19-25 2003. Tools for building a successful orthopaedic pathway.19(2):81-87. Aug 1990. Dec 1992. Scott PA. Ahn SH. J Adv Nurs. Not eligible target population. Hwang S. 1630. 1992. Lee RJ. Not eligible target population. Shiu AT. Chang PC.42(Pt 4):393-406. Curr Med Res Opin.17(27):16. Lee TT. Aug 1-7 2001. Weisberg MC. 1629. Nasal colonization by methicillin-resistant coagulasenegative staphylococcus in community skilled nursing facility patients. Not eligible target population. Not eligible target population. Lee EH. Am J Infect Control. Leifer D. Dassen T. Standardized care plans: experiences of nurses in Taiwan.35(11):478-81. Eur J Anaesthesiol. Lee L. J Adv Nurs. Feb 2002. Nurs Stand. Fennell ML. Needlestick injury in acute care nurses caring for patients with diabetes mellitus: a retrospective study. Lee KA. Iademarco E. Leggett J. 1656. Journal of Nursing Administration Nov 2005. Shammash JB. Prevalence of perimenstrual symptoms in employed women. Cook EF. A rotation programme that works. Rittenhouse CA. Song R. 1639.1628. Rittenhouse CA. Mills MEE. Aug 1993. 1659. Choe KJ. Not eligible exposure. Jul-Aug 1994.13(1):33-40.27(5):400-406. Not research. 1655.24(8):5253. Not eligible exposure. Nurs Stand. Daly B. Mar 1994. 1634.28(4):859-864. Infect Control Hosp Epidemiol. Not eligible outcomes. Lees L. Nicklasson L.48(6):632-641. 1642. Barr N. Leftridge DW. Relocating elderly people and nursing staff from the NHS to the independent sector. 1633.44(5):534-545.a priority for clinical practice and research in occupational health nursing. Health and perimenstrual symptoms: health outcomes for employed women who experience perimenstrual symptoms.15(46):33-38. Lee KA. Nurs Manage. Effect of assertiveness training on levels of stress and assertiveness experienced by nurses in Taiwan. Lee JM. Maintaining privacy on post-natal wards: a study in five European countries. L'Ecuyer PB. Not eligible target population. Overtime--mandatory or voluntary? Br J Perioper Nurs. Pract Midwife. Kennedy C. Tran C. Leino-Kilpi H. Silvester J.36(2):151167. 1650. Lee G. Impact of initial triage decisions on nursing intensity for patients with acute chest pain. 1631. Issues Ment Health Nurs. B-48 . Leininger SM. May 2005. Apr 39 2002. Not eligible exposure. 1649. Dec 1996.17(3):17-32. Apr 2001. Not eligible target population. International nursing recruitment experience. J Qual Clin Pract. Not eligible target population. Milner QJ. Comment. Kirby L. Lee H. Aton EA. Clinical update. Care staff attributions for violent incidents involving male and female patients: a field study. Anything but magnolia. Fraser VJ. Not eligible target population. Botteman MF. Not eligible target population. 1653. Lee D. You C. Leary TS. Not eligible outcomes. Management issues. Holmes C. The morning tea break ritual: a case study. Lydford CW. Estimating date of discharge at ward level: a pilot study. J Adv Nurs. Nurs Stand. Nonacute casemix in the Illawarra. Kim J. Jan 2002. Lee DS. Comment. Jun 1995. Sep-Oct 2004. The needs of the service. J Adv Nurs. Not eligible target population. Not eligible target population. Dec 2004. 1644. Schwab EO. Int J Nurs Pract.14(1):23-30. Predictors of life satisfaction of Korean nurses. Mar-Apr 1996. Not eligible target population. 1635. Cobden D.

Cheek R. Float pool orientation. Levenstam AK.95(6):14. Lewis L. Review. 1663. Payne K.98(2):12. Comment.97(5):14. Lengacher CA. 1685. Am J Infect Control. Swymer S.17(2):29-39. 1672. MCN Am J Matern Child Nurs. No association tested. Allocation of nursing time. Participation in change: self-reflection of staff in a psychiatric admission unit. Not eligible exposure. Stahlberg MR. Am J Nurs. Case Reports. Not eligible exposure. Mabe PR. Comment.17(2):149-154. 1668. Lin MC. Issue Brief (Mass Health Policy Forum). Brokalaki H. 1670. Heinemann D. Jones CB. Lilley LL. Davis V. 1686. Gastmeier P.97(11):12. How drugs with similar spellings and sounds can lead to serious errors. Aust Health Rev. Aug 2003. Alleman P. J Nurs Manag. Starkhammar H. Apr 1999. Feb 1997. 1683. Lewis EN. Nursingconnections. May 1997. Jan 19-25 2005. Lilley LL. Kent K. 1673. Lilley LL. Hurxthal K. Nurs Stand. Lichtenstein B. Leveck ML. Res Nurs Health. Lewis KK. Guanci R.19(4):331-343. Feb 2003. Lemonidou C. Oct 1992. Discussion & recommendations: safe medication administration: an invitational symposium recommends ways of addressing obstacles. Jan 2004. Lewis JA. Not eligible target population. Letvak SA. Apr 2001. Plati C. 1669. Review. Levy CR. Bengtsson M. Jun 2005.26(3):201-202. Editorial. Nov 1995. Bowling CD. 1679. Guanci R. Kent K. Chapman V. Am J Nurs. Mar-Apr 2005. Comparing patient and nurse perceptions of perioperative care quality. Jun 2000. Lenze D. 1687.10(3):131-136. Levenstam AK. Not eligible target population. Careful with the zeros! How to minimize one of the most persistent causes of gross medication errors.127(5):1775-1783. Editorial. Guanci R. 1661.8(1):81-100. 1678. Collaboration in research: testing the PIPC model on clinical and nonclinical outcomes. Not eligible outcomes. Spring 1997. Am J Nurs. Brumfield C. J Infus Nurs. 1688. Am J Nurs. Guanci R. 1675. J Nurs Staff Dev. 1682. 1664. 1662. Nov 1997. Abanobi B. How to translate nursing care into costs and staffing requirements: part two in the Zebra system. Leinonen T. x. Nurse-to-patient ratios: research and reality. Ely EW. Not eligible target population. Leslie GD.93(4):419-426. 48. Case Reports. Feb 1991. The nursing practice environment. Godine JE. 1996. Applying systems theory. Sep 1999. Lewis T. Am J Nurs. J Adv Nurs. J Nurs Res. Giving birth.10(1):17-30. 1680. Not eligible exposure. Mabe PR.16(1):29-37. Engberg IB. Chen CH. Zolldann D. Improving tracheostomy care for ward patients. 1666. May 1996. Not eligible target population. Look-alike abbreviations: prescriptions for confusion. 1671. Quality of dying and death in two medical ICUs: perceptions of family and clinicians. Cliver S. Leino-Kilpi H. Implantable devices for venous access: nurses' and patients' evaluation of three different port systems. Bolduc PC. Lepola I. Not eligible target population. Engelberg RA. Guanci R. Not eligible target population. Della PR. Lilley LL. Review. 1691. 1677. Health (London). Lilley LL. Lilienberg A. Guanci R. Crit Care Nurs Clin North Am. The Zebra system--a new patient classification system. Appl Nurs Res. Sep 2004. Heinemann D. Mantas J. Effects of the partners in care practice model on nursing outcomes. Case Reports. Med errors: watch those labels. Implementing and evaluating a rotating surveillance system and infection control guidelines in 4 intensive care units.5(2):105114. Sound-alike cephalosporins. Chest. Nov-Dec 1995. No association tested. Lewis T.1(3):171-177. Not eligible exposure. Lilley LL. Comment. Mar-Apr 2005. et al. An investigation on the nursing competence of southern Taiwan nurses who have passed N3 case report accreditation.12(3):203-212. 1690. 46-47. Lutticken R.95(11):14-15. J Nurs Manag. Should a staff nurse's age be a consideration in making patient and shift assignments? Pro. Avoiding heparin dosing mistakes. Nov-Dec 1994.19(19):3337.12(6):300-308. Aust Crit Care. Sep 1993. An in-house registry: a pragmatic approach that works! Nurs Manage. Am J Med. Mar 1997.28(2 Suppl):42-44. VanCott ML. Patrick DL. Nurs Health Sci. Alternative nurse rostering: an evaluation. Laposata M. Mar 30 2005(25):1-19. Lenehan GP. Curtis JR. staff retention. Nathan DM. Not eligible target population. Blom-Lange M. Am J Nurs.11(6):297-299. Comment. Am J Nurs.29(2):8993. Comment. 1674.97(2):12-14. J Emerg Nurs.25(2):77-78. On mandatory overtime and wearing blue ribbons. Guanci R. Libby DL. Not eligible target population. Dec 1997. ED short staffing: It is time to take a hard look at a growing problem and strategies such as standard nurse-patient ratios. Nurs Econ.1(5):229-237.96(5):14. 1692. 1676. 1667. Jun 1995. Not eligible exposure. B-49 . Lertola K. Guanci R. Scand J Caring Sci. 1994. Lilley LL. Lengacher CA. Lewandrowski K. May 2005.19(1):21-28. 1684. Lemmen SW.1660. Engberg IB. Jan 1994.97(12):12. 1665. Oliver G. and quality of care. Lilley LL. Know your staff numbers--and know you're right. Distraction delays a dose.16(3):83. Am J Nurs. Lanara V. 1689. Lenehan GP.22(2):43-44. Not eligible target population. Feb 1998. J Emerg Nurs. VanCott ML. Neuromuscular blocking agents. Implementation of capillary blood glucose monitoring in a teaching hospital and determination of program requirements to maintain quality testing. 1681.30(2):84. Eschenbach K. Comment. Editorial. Aug 1996. going home: influences on when low-income women leave hospital. The Methodist Hospital CCU: a Beacon unit of excellence. Not eligible exposure.

Managing unnecessary variability in patient demand to reduce nursing stress and improve patient safety. An evaluation of two systems of in-patient care in a general hospital psychiatric unit. News. Study: RNs can bolster outcomes. Davidoff F. Little M. 1713. Lindsey T. 1697. 1991. Chronic blood transfusion therapy practices to treat strokes in children with sickle cell disease.21(1):1117. Livingston C. 30. Nursing. Lipley N. 2211. 1710. Review. 1727. Philippine Journal of Nursing Jan-Jun 1997. Jul 1991. Southwood E. Lukman D. Comment. Dec 2003. Lookinland S. Not eligible outcomes. Wilkinson K. Comment. J Soc Health Syst. Caring and curing orientations of foreigneducated professional nurses. Not eligible target population. Not eligible target population. Health Serv J. 94-85. Not eligible exposure. Triage nurse requested x rays--are they worthwhile? J Accid Emerg Med. 1715. 1698. Liu JJ. Issues surrounding early postpartum discharge: effects on the caregiver. Aust N Z J Surg. Apr 1999. Mod Healthc.109(5676):28. McLauchlan A. Feb 1992. Not eligible target population.DAI-A 64/06. Not eligible exposure. Outcomes Manag. Not relevant. Lininger RA. Midgley M. Little K. Shift up. Not eligible target population. Steinmann M. Pointing out medication errors. Brown E. Dissertation. Feb 1990.54(3):17-19. Gattuso MC.14(7):12. Chicago jobfocus. Lea G. Lomas C. Lloyd G. Oct 26-Nov 1 1994. News. Goulding J. Jt Comm J Qual Patient Saf. J Clin Nurs. Pressure gauge.67(1-2):27-32. Stop announcing JCAHO inspections. Lovett RB. 1718. Not eligible target population. Lindsay M.70(5):329-332. J Obstet Gynecol Neonatal Nurs. Not eligible exposure. J Contin Educ Nurs.17(7):277282. J Pediatr Oncol Nurs. Pediatr Nurs. A forceful health care community. 1717. McMillan SC. Livne M. Jul-Aug 1996. Dec 2003:AAT 3092765. 1696.6(3):99-102. Not eligible exposure. Sugrue M. Aspens Advis Nurse Exec. 1726. Nurses' attitudes towards management of pain. Not eligible Target population.10(3):1-4. Crenshaw J. 1699.33(3):320-327.17(1):64-71. Jun 1991. Ludwig-Beymer P. May JH.8(3):122130. Oct 10-16 2001. Apr 30 2001. Not eligible exposure. The effect of testing on the reported incidence of medication errors in a medical center. Lovern E. McMillan S. Jones SE. 1723. Livesley J. Lipley N. Lu WH. Long CG. Breaking the cycle of bad news. Central line exit sites: which dressing? Nurs Stand. Am J Hosp Pharm. Not eligible outcomes. Assessing the relationship between staffing levels and quality outcomes in nursing facilities. 1704. Palmer D.17(2):103-107. Jan-Feb 1990. Jan 1992. No association tested.15(4):206-215. Telling tales: a qualitative exploration of how children's nurses interpret work with unaccompanied hospitalized children. Czurylo KT. Ludkin H. Am J Nurs. Litvak E. Not eligible target population. Lincoln LL.92(2):76-78. 1695. 2003. Nov 3-9 1999.2(2):42-64.91(3):89-90. Quinn P. Is the postanesthesia care unit becoming an intensive care unit? J Perianesth Nurs. Beatty J. Nurs Times. Dimens Crit Care Nurs. Sep-Oct 2003. Dec 1990. Not eligible exposure. 1712. Measuring the benefits of bedside documentation systems.12(48):42-44.68(22):26-28.19(4):220-222. 1703. Buerhaus PI. 1709.15(12):14361442. An evaluation of trauma team response in a major trauma hospital in 100 patients with predominantly minor injuries. Lloyd R.16(4):13. Oct 1993. Comment. Oncol Nurs Forum. et al. Crash course: piecing together the continuum of care. Make the most of flexible working. Lumsdon K. Lough-Miramontes A. 1707. 1701. 1721. Lovett RB. Nurs Stand. Blackwell CC. Ryan CJ.90(43):40-43. Not eligible target population.20(9):1385-1392.31(18):4-5. Comment. Lipley N. Kolkman K. Seger M. B-50 . Lindley-Jones M. Validity and reliability of a bone marrow transplant acuity tool. Mar 2000. Phillips M. Long T. 1705. Prof Nurse. When do you 'say no' to work assignments? Tenn Nurse. Finlayson BJ. May 2000. Not eligible target population. J Am Acad Nurse Pract. No association tested. Pediatric peripheral i. Potential effect of oral antimicrobial therapy on nurse staffing requirements. Lund CH. 1716. Knowledge-based schedule formulation and maintenance under uncertainty. Blackwell CC. insertion success rates.v. Shuman LJ. Jul 2005. Not eligible target population. Not eligible exposure. Dudley MN. 1702. 1722. 1719.101(18):76-77. Hennessy KA. Mar 1991. Validity and reliability of a pediatric hematology oncology patient acuity tool. 1711. 1714. Validity and reliability of the neonatal skin condition score. Routhieaux J.47(2):386-388.5(1):33-42. Midgley M. 1725.31(6):330-338. Watts-Tate N. Dec 1994. Millennium bed bug. Wolfe HB. Comment. Long CG. Aug 19-25 1998.14(2):73-77. J Adv Nurs. Comment. II: Measures of staff and patient performance. Not eligible exposure. May 3-9 2005. Jun 2005.14(21):12-13. p. Jun 1991. 1700. 1706. Nurs Stand. Osborne JW. Nurs Stand. Jul-Sep 2002. May-Jun 2004. Diane C. Long G. Nov 20 1994. 1724. J Perinat Neonatal Nurs. Am J Nurs. Feb 9-15 2000.29(5):351354.32(9):12. Rewarding clinical competence in the ICU: using outcomes to reward performance. DeBaun MR. Letter.1693. Comment. Nursing rotas. Oct 14 1999. An evaluation of two systems of in-patient care in a general hospital psychiatric unit I: staff and patient perceptions and attitudes. Sep 2002. Comment. 92. Jan 2005. Pressure ulcer prevention project: an international outcomes report from Israel. 1708. 32 passim. Nurs Times.14(1):43-50. The benefits of setting up a nurse hysteroscopy service. Locsin RC. Lukacs A. J Adv Nurs. Wagner L. Hosp Health Netw. 1720. 1694.

Take the medical model out of the menopause. Helmreich RL. Murphy P. OR Manager. Hopkins M. J Adv Nurs. 1997. Not eligible outcomes. Gerbis PR.. Mackie PL. Not eligible target population. J Nurs Manag. Joannidis PA. J Clin Nurs. Segesten K. Luther KM. Nurs Times.95(41):4546. Raines DA. Not eligible target population. MacDonald MR. Lane AT.8(4):157-166. MacDonald M. 1759.29(3):237-241. Not eligible target population. J Nurs Manag. Beattie J. Not eligible target population. 1745. Lundgren A.12(4):464-471.3(4):1. 1734. Not eligible exposure. Lupton D. Bodzak W. Ifs and cuts. Hospital networking. May 2001. Jan 2001. Engaging nurses in patient safety. Mahon A. Wahren LK. 1729. Factors that influence nurses' job satisfaction. Comparing the work of nurses with flexible and traditional schedules. J Clin Nurs. Developing a collective future: creating a culture specific nurse caring practice model for hospitals. nature. Dec 11 2003. News. MacStravic S. Kelley B. Aug 2005. Segesten K. Effect of education on evidence-based care and handling of peripheral intravenous lines. Journal of Emergency Nursing Oct 1991. Nurs Times. Jordan K. Lyon JC.13(5):65-74. Ma CC. Comment. Oiling the wheels. Jul 2005.44(4):3. 1756. Not eligible target population. Lunney M. Health Serv J. May 2003. 1750. 1744. Comment. HSJ people. Nurses use of health status data to plan for patient care: implications for the development of a computer-based outcomes infrastructure. work satisfaction. Simulated home delivery in hospital: a randomised controlled trial. Samuels ME. Not eligible target population. Lundgren SM. Apr 1991. 1748.9(1):19-22. Oct-Dec 1997.11(2):197-204. Jagger C. Nov 1995. Not eligible target population. Not eligible target population. 1732. Not eligible target population. Oct 13-19 1999. Constant or special observations of inpatients presenting a risk of aggression or violence: nurses' perceptions of the rules of engagement. Walsh K. Moving out of the red zone: addressing staff allocation to improve patient satisfaction. Employing foreign nurses. Fenwick J. Mar 1992. Not eligible exposure. Not relevant. No association tested. Not eligible target population. Nordholm L. Macleod AJ. 1758. Macready N. Apr 1993. Mahony C. Segesten K. Soc Sci Med. Mar 1999. Not eligible exposure. Not eligible exposure. 1757. Cassells C. 1737. Not eligible target population.97(36):10-11.4(4):18. B-51 . Nurs Diagn. Apr 2000. 1743. Mackintosh C. Dec 2002. Sep 1999. 1741. Miller-Grolla L. The performance of a self-managing day surgery nurse team.17(5):282-94. J Hosp Infect. 1747. and response to victimization of emergency nurses in Pennsylvania.30(1):41-51. Not eligible target population. J Nurs Adm.33(5):293-299. 1997:136-140. Mazabob J. Oct 2001. Mar 2002. Comment. Aug 2002. Br J Obstet Gynaecol. 1731. Not eligible exposure. Jt Comm J Qual Improv.15(3):32-33. Discharge planning. Mackay I. Luther KM. 'They've forgotten that I'm the mum': constructing and practising motherhood in special care nurseries. Lott JW. Alexander JW. Not eligible target population. 1742. MacPhee M. Image J Nurs Sch.9(1):13-20. Can J Nurs Adm. Proc AMIA Annu Fall Symp. Thomas E. Freeland P. Nurses' altered conceptions of work in a ward with all-RN staffing.48(1):66-71. Owen-Johnstone L. Jan-Feb 2001. Mahoney. Nov 1994. Power napping and work performance. J Psychiatr Ment Health Nurs. The extent. Lilly CC. Lupfer PA.8(5):577585. J Nurs Adm. 1735. Lush MT. Mar 1991. Dobbie G. Obstetric and Neonatal Nurses and the National Association of Neonatal Nurses. McMillen BJ. 1755.3(7):342-347. Oct 23 1997. Effects of case management on the nursing context--perceived quality of care. Lyon J. 1754. Sep 6-12 2001. Not eligible target population. Lunetta C. Maguire L. 1733. 15-19.113(5885):36-37. Association of Women's Health. Lund CH. Nurses' use of time in a medical-surgical ward with all-RN staffing. J Obstet Gynecol Neonatal Nurs.53(8):1011-1021.100(4):316-323. Should nurses be allowed to request X-rays in an accident & emergency department? Arch Emerg Med. 1736. 1738. including commentary by Lanza ML with author response. Comment. Employee success management: a cure for the staffing crisis? Health Care Strateg Manage. Not eligible exposure. Job satisfaction in relation to change to all-RN staffing. Kuller J.25(7):363-368. Apr 1999. Not eligible target population. Sexton JB. Watchdog's verdict: millions squandered. Jul 1999. MacWhannell D. Not eligible exposure. Lundgren SM. 1751. Neonatal skin care: clinical outcomes of the AWHONN/NANN evidence-based clinical practice guideline. 1753. Karlik BA.9(2):127-130.8(3):78-95. Patient flow in the emergency department: the chest pain patient. Not eligible exposure. Not eligible exposure. Trustee. Paterson B. Kiss M. 1730.107(5576):3233.14(4):341-346. Trial of Denver nurses points up system flaws.29(4):859-868. Lundgren S. 1752. Do nurses provide adequate postoperative pain relief? Br J Nurs. MacKenzie J. Do nurses know what patients think is important in nursing care? J Nurs Care Qual. Altieri M. Henry SB. Accuracy of nurses' diagnoses of psychosocial responses. Am J Emerg Med.20(8):1. Lynn MR.30(4):190-198. Health Serv J.13(4):322-328.1728.. Sep-Oct 1995. Acuity vs staffing mix. Jun 1999. Evaluation of an acute point-of-care system screening for respiratory syncytial virus infection. 1746. Nev Rnformation. 3. 1739. Apr 14-27 1994. Osborne JW. MacVicar J. Kennedy J. Sheridan MJ. nurses neglected. and control over practice. 1740. 1749. Nev Rnformation. Lynn MR. Crit Care Nurs Clin North Am.

Mark BA. Attitudes of Australian nurses toward the implementation of a clinical information system. Marcus N. p. Market. Medication management by graduate nurses: before. Sep 2003. Agency nursing work in acute care settings: perceptions of hospital nursing managers and agency nurse providers. Nov 2000. Comput Nurs. Comment. Manning ML. Aug 2001. Comment. Not eligible target population. Colleagues in caring. Kenney C. Staffing and productivity. 1786.3(9):26-27. 1763. Aorn J.92(1):7. 1783. Agency-nursing work: perceptions and experiences of agency nurses. Hosp Community Psychiatry. Apr 29-May 5 1998. Mamaril M. Characteristics of nursing practice models. The demand for hospital nursing personnel. 1080.. Oct 1997. Not peer reviewed. 1993:AAT 9432310. Makowiec-Dabrowska T. Jan 1995.6(3):393-403. Editorial. Malik U. 1782. Editorial.41(6):670-672. Night shifts and breast cancer risk: policy implications. Sep 2001. Williams S. May-Jun 2004. 1791. 1784. 2000. J Clin Nurs. Sindhusake D.11(7):20-22. J Nurs Adm. Sep 1999. 1778. Manias E. Not eligible target population. 1770.72(2):22-3. Assessment of acute pediatric pain: do child self-report.6(2):83-91. DAI-A 55/07.91(2):7. J Nurs Adm. Conovaloff A. Int J Nurs Stud. Marasovic C. and it works! Nurs Manage. Pract Midwife. Nurs Health Sci. 348. Comment. Jul 1994. Let's identify the Yellowhearts in our midst.30(11):552-560. Comment. 1779. J Emerg Nurs. Not eligible target population. Night duty: sleeping sickness. The relationship of empowerment and selected personality characteristics to nursing job satisfaction. Mancher T. 1766. Malloch K. Nurs Times.55(4):10741077. Spence Laschinger HK. Marchewka AE. Peerson A. Regional variation in Medicare hospital mortality. 1775. Peerson A. Not eligible target population. Apr 2001. What explains nurses' perceptions of staffing adequacy? J Nurs Adm. Can nurses be employed in 12-hour shift systems? Int J Occup Saf Ergon. 1769. Not eligible outcomes. Dykes AK. Not eligible exposure. Banerjee SN. Jan 1992. Comment.32(7):7. Nov 1992. Inquiry. Manthey M.15(2):91-98. Management of relatives of patients who are dying. Mar 2003.22(12):20-21. Lavender T. Clients' health needs: nurses' concern.29(7-8):49-56. Pediatr Nurs. Not eligible exposure. Aitken R. J Nurs Adm. 1781.40(3):269279. Short-term psychiatric inpatient treatment of preschool children. Apr 2002. Nurs N Z. Manchester A. No association tested. 1777. A core incremental staffing plan. Mansson ME. May 2002.9(22):56. Kivimaki M. Jun 2004. 1780.28(2):169-171.94(17):24-26. Parker J. Not eligible target population. Jul-Aug 1999.29(9):33-42. Malone JA. McMurry C. 1789. 1774. Not eligible outcomes. Meeks L. Nurs Stand. Visiting on the maternity wards. Mansley A. J Nurs Adm. Virtanen M. Dunning T. Manne SL. 1762. Mar 1999. Neeld AP. Wallach M. Aitken R.32(5):45-47.87(2):29-32. Jun 1990. B-52 . 1788. A better model by design . Am J Nurs. Salyer J. Elovainio M. Part 2: The third generation. Not eligible exposure.16(4):274-277. Salyer J. The official ASPAN position: ICU overflow patients in the PACU. Cadillac or Chevrolet nursing? Look under the hood. hospital. Not eligible target population. Elliott D. Wong K.32(11):586-595.1760. Milieu and part-time nurses: a contradiction? J Psychosoc Nurs Ment Health Serv. Mallison MB. Malloch K. 229. Main J. Connecticut Nursing News Jun-Aug 1999. Aitken R. parent ratings. Comment.29(2):115-119. Nov 2002. Feinglass J. One manager's experience.32(5):234-242. 1767. Feb 1991. Manias E. Jarvis WR. One bright initiative. and nursing unit characteristics as predictors of nursing unit skill mix: a contextual analysis. 1761. Feb 22-28 1995. Malcolmson L. 1790. May 2001. Not eligible exposure. Nurs J India. Bell LM. Redd WH.2(3):20-23. Krawczyk-Adamus P. Jacobsen PB. Practices for preparing children for clinical examinations and procedures in Swedish pediatric wards. J Perianesth Nurs.. 347. Mater Manag Health Care. Patient classification systems. 1764. Makinen A.29(1):55-66. Mansheim P. 1768. Marden W. 24. Comment. Review. Jan 1992. 1772. Serratia marcescens transmission in a pediatric intensive care unit: a multifactorial occurrence. 1773. Not eligible target population. Walkinshaw S. Not eligible target population.12(4):457-466. Mar-Apr 1997. 2087. Mallison MB. Editorial. Hughes EF. Apr 1992. Harless DW. Not eligible outcomes. 349. during and following medication administration. Dec 1991. 1776. Jul 2002. Jul 2003. Am J Nurs. Not eligible target population. Maras V. Part 1: The third generation. 1765. 1785.48(1):45-52. Bond S. Not eligible outcomes. Not eligible target population. Jozwiak ZW. Organization of nursing care as a determinant of job satisfaction among hospital nurses. Shortell SM. Nov 2002. Archibald LK. J Nurs Adm. Spring 1992. Nurs Manage. Parker J.30(3):182-187. Implementing cluster staffing. J Nurs Adm. J Nurs Manag. Mark BA. Wong K. Manheim LM. Mark BA. 1771. Manthey M. News. and nurse ratings measure the same phenomenon? Pain. Manias E. Manojlovich M. J Clin Nurs. Patient classification systems. Caring for rape survivors. Malone RE. Am J Infect Control. Feb 1996. Case Reports. 1787. Sprusinska E. Conovaloff A.11(6):794-801. Not eligible exposure.11(5):299-306.31(9):424-425. Mahrenholz DM.22(11):57-63. Wan TT. New care model threatens patient safety. Not eligible exposure.

No association tested.21(5):1. Maxwell M. ED Manag. Editorial.17(49):16-18. Maurier WL. Jul 2003. 1810.36(3):364-375.22(6):8-16. 1803. J Emerg Nurs. Dec 2004. Jul 2004. Comment. Mason DJ. Rn. Psychosom Med. 1824. Uddin DE. 26. Are you an HR star? Test your knowledge. Dec 1998. Victorian Emergency Minimum Dataset: factors that impact upon the data quality. Job uncertainty and health status for nurses during restructuring of health care in Alberta. Nursing science: who cares? Am J Nurs. Nimmo CR. Risner P.103(11):7. 1802. White TL. Summer 2003.66(6):938-942. 1828.14(2):133-142. NovDec 2004. discussion 441-422. Martin BJ. Mason DJ. Am J Crit Care. 1808. Mar 11-17 1998. Issues 1991. Iwasiw C. and precipitating factors of nurse assault among three groups of registered nurses in a regional medical center. Mar-Apr 1994. nature. Editorial. Not eligible exposure. Nurs Econ. 1827. Jewesson P. Balderson K. Klipstein A. Analgesics for cardiac surgery patients in critical care: describing current practice.3(1):31-39. 1809. Am J Crit Care.24(11):845-847. Organizational dimensions of hospital nursing practice: longitudinal results. Steinberg R. Not eligible exposure. Maul I. Petryshen P. Course of low back pain among nurses: a longitudinal study across eight years. Krueger H. Wasylenki D. Gatekeeping and legitimization: how informal carers' relationship with health care workers is revealed in their everyday interactions. Hunter JJ. Axone. Gutsch HM. J Gerontol Nurs. OR Manager. Applying the synergy model: clinical strategies. Mastorovich MJ. Nov 2003. Cates R. Lancee WJ. Mason DJ. Am J Nurs. Kashyap SK. Striking nurses win from coast to coast. Editorial.10(12):142-144. Mattera MD. Comment. 1806. J Hum Ergol (Tokyo). 1812. 1816. J Adv Nurs. 12. Mathisen L. Nurs Times.28(1):11-17. Dec 1999. 1804.27(12):29-31. Promoting quality and cost-effective care to geropsychiatric patients. Not eligible exposure. Marson R. Am Nurse.43(5):427-440. Direct nursing care given to patients in a subacute rehabilitation center. Comment. Feb 2002. 1823. Hospital nurses' views about physical restraint use with older patients. Taylor DM. Emerg Med Australas. Goldbloom D. Maunder RG. Nurs Manage. 1822. Apr 1997. Editorial. Munsat EM. Not eligible exposure. Mason DJ. Mattera MD. Mar-Apr 2002. Not eligible exposure.12(2):7. Not eligible outcomes.17(2):104-112. Lamb KV. Defining what nursing is. Martin PA. 1818. Codman Award Paper: self-efficacy of staff nurses for health promotion counselling of patients at risk for stroke. Sep-Oct 1998. West J Nurs Res. Workforce diversity in hospitals. Correlation between healthcare workers' knowledge of influenza vaccine and vaccine receipt. 1820. Mathias Judith M.60(4):7. Infect Control Hosp Epidemiol. Martin SD. Buckley RF. Not eligible exposure. Rn. Apr 2005. Guts. Laubli T. Editorial. The state of the science: focus on work environments. Not eligible exposure. A prospective survey of knowledge and perceptions of ondansetron: what do health care workers know about this drug? Can J Hosp Pharm. Nurs Leadersh Forum. Use of physical restraints in adult critical care: a bicultural study. OR Manager. 1800. Nurs Stand. Smith SP. 1798.18(9):20-22. Bhattacharya SK. 1801. Hackney NW. 1817. Mathur K. Sharing OR staff can help meet unpredictable staffing demands. Ashby K. Marra C. Kany KA. Grubbs LM.105(3):33-34.22(5):623-641. A successful approach to absenteeism. Emergency department patient satisfaction: customer service training improves patient satisfaction and ratings of physician and nurse skill. 1807. Night cover. Comment. 1794. Not eligible exposure. Not eligible target population. 1811. 1815. Dec 1996. Not eligible exposure. Aug 20-26 2003. Mayer TA. Gustin TJ. May DD. Nov 2001.94(10):21. Jun 2001. Wilkie DJ. Jun 2005.24(1):1-11.99(12):7.21(8):45-48. Not eligible target population. 1797. Mathew LJ. Comment. Fones CS.62(11):7.34(12):554-561. Leaders find ways to tackle staff shortage. Ellis-Hill C.15(2):169-185. Not eligible outcomes. Maxam-Moore VA. Mar 2000.26(4):14-21. Implementing a patient classification system. Jan 1994.21(3):72-76. Not relevant. Payne S. Rehabilitation Nursing Mar-Apr 1990. Jones L. Masta O.7(4):143-149. Not eligible exposure. A look at licensure of foreign-educated nurses. Matthiesen V. Outside the box. Mar 2005. No association tested. The extent. Aug 2000. Rourke S. 1821. Fee-for-service nursing: an idea ready to be tested. 1805. Koh D. McCann J. Hollinger-Smith L. 14. Woods SL. Maroun VM. 1813. Nov 2003. Jun 1996. Aug 1990. Case Reports. May 2005. That's nursing! No. Crit Care Nurse. Markey DW. Behavioral effects and body activity level in female hospital staff nurses during work hour. 1814. Markwick A. Cassell E. Cates RJ. Issues Ment Health Nurs.15(2):86-8. Comment. Sep 2002. Walton JC. Comment.104(7):11. Martorella C. Martin B. Mateo MA. Martinello RA. Dec 1995. 1819. Editorial. Jul-Aug 2004. B-53 . that's appalling. J Healthc Manag. How many patients are too many? Am J Nurs. Topal JE.34(2):8.1792. Not eligible exposure. Patterson P. Mayer C.60(7):497-503. Not relevant. Occup Environ Med. Andrusyszyn MA. 1796. 1793. Comment. 1825. Factors associated with the psychological impact of severe acute respiratory syndrome on nurses and other hospital workers in Toronto. Northcott HC. 1799. Not eligible exposure. Flinn R. Am J Nurs.48(6):336-342. Jun 1995. Mathias JM.63(3):7. Nurs Manage. 1826 Mayer GG. Mar 2005. Strike? Rn. Nov 1999. Mattera MD. Royalty DL. Mayer T.22(4):214-215. J Nurs Adm. Not eligible exposure. May J.

Cooper R. An ethical dilemma: risk versus responsibility. Hosp Case Manag. McElligott D. McEndree B. Not eligible target population. Okla Nurse. Not eligible association presentation.13(1):41-49. Not eligible exposure. A comparison of agency and hospital nurses. 1838. Jul-Aug 1995.18(2):165-172. Merkh K. 34. Sutherland S. May-Jun 1992. McConnell EA. Not eligible exposure. McDaniel C. Comment. Donner GJ. Jun 1999. Chart reminders increase referrals for inpatient smoking cessation intervention. McCrea J. B-54 . N Z Nurs J. Centering pregnancy: a renaissance in prenatal care? MCN Am J Matern Child Nurs. Willingness to provide care and treatment for patients with HIV/AIDS. McCoy AK. 1840.25(3):187-191. Not eligible target population. McDonald S. Not eligible target population. ii. Mayne JE. Sidani S.41(4):13. Harless DW.23(2):322-328. Not eligible exposure. J Emerg Nurs.25(11):15-21. McAlpine LC. Organizational culture and ethics work satisfaction. Jun 1999. Comment. How and what staff nurses learn about the medical devices they use in direct patient care. 1847. Biomed Instrum Technol. Canadian journal of nursing administration Sep-Oct 1992. Int J Palliat Nurs. Zimmermann PG.21(4):16. Smith C. 1856. Balancing the 'heart' of patient care. education needs for MI.. Patients. complex devices. 1841. Jan 2004. J Health Care Finance. McDonald J. 1833. A journey to excellence.1829. Barriers among nurses to providing smoking cessation advice to hospitalized smokers. Nicotine Tob Res. Not eligible target population. Am J Health Promot. and financial performance. A comparison of Australian and American registered nurses' use of life-sustaining medical devices in critical care and high-dependency units. No association tested. 1835.Flextra and incentive compensation. J Adv Nurs. Hennrikus DJ. Oct-Dec 1996. 1852. Holz MB. Baggett M. Not relevant. J Adv Nurs. McCormack B. Res Nurs Health. Justifying our practice. Doran D. and patient safety outcomes. 1839. Summer 1995. 1853. J Clin Nurs. McConnell EA. A case study identifying nursing staffs' perception of the delivery method of nursing care in practice on a particular ward. 1848. 1842. Jul-Sep 2004. Nurse perceptions of medication errors: what we need to know for patient safety. Bowers L. Not eligible exposure. Pink GH. Mark BA. Feb 1996. Jan 2004. Nurse staffing models as predictors of patient outcomes. McGillis Hall L.34(1):41-45. Apr 2005. Not eligible target population. Four honoured for rescue role.1(2):175-180. Nurse staffing models.3(11):171-174. Carollo L. Not eligible target population. Not eligible exposure.12(2):215-222. Nov 1995. Kristeller JL. Hudson DM. 1850. Third Annual Nursing Administration Recognition Program. Summer 2003. McCartney PR. McCormack PJ. Lando HA. 1836.11(3):585-594. nursing hours. Feb 1992. Walden-McBride D. Bloom T.27(3):240-248. 1858. Not eligible exposure. Review. Oct 1998. Can Nurse. 1845. McConnell EA. J N Y State Nurses Assoc. Not eligible exposure.85(5):9. Nissen JH. Nurse staffing.13(4):46-49. 1843. 1837. Heart Lung. Comment. Cargill G. McDaniel AM. machines.46(5):199-200. Fletcher J. McConnell EA. Jul-Sep 2003. Not eligible exposure.32(1):19-25. Med Care. Gender and ethnic stereotyping and narcotic analgesic administration.. Duncan D. McBride L. Cattonar M. JulAug 2004. Int J Technol Assess Health Care. Comment. 1846. Home Healthc Nurse. Shoes. Fletcher J. Effects of summer employment on student nurses: implications for recruitment and retention of staff nurses. Sep 2003.34(1):1624. Nurs Adm Q. 1857. Nov-Dec 2001. Medical device education among Australian registered nurses. J Psychosoc Nurs Ment Health Serv. Atkinson M. Spring-Summer 2003. McGavock MB. Summer 1997. McGillis Hall L. quality. 1855.41(9):1096-1109. Dec 2001. Kuzniewski S. Apr 1991. American registered nurse medical device education: a comparison of simple and complex devices. J Psychiatr Ment Health Nurs. Teaching path balances LOS. News. J Nurs Care Qual.17(1):45-49. Manning J. 1854. Not eligible exposure. Nurse-patient communication: an exploration of patients' experiences. Res Nurs Health. Feb 1994. McCabe C. J Nurs Adm. 1861. Najera IL. McCann E. 1849. Not eligible target population.10(2):5-11. Australian registered nurse medical device education: a comparison of simple vs. Not eligible association presentation. Not eligible outcomes. The safe use of syringe drivers for palliative care: an action research project. 1832. and staff nurses. McDonald DD. Nurse staffing and patient outcomes. May 1997.29(4):54-76. Not eligible exposure.7(12):574-580. McCue M. Training in cognitive behavioural interventions on acute psychiatric inpatient wards. McCloskey JM. 1834. The healing energy of relationships. Pink GH. ED customer satisfaction survival skills: one hospital's experience. Not eligible exposure.11(3):152-156. Somerville S. A pilot feasibility study of the effects of touch therapy on nurses. McConnell EA. McCrea MA. 1860.29(6):520-526. Baker GR. Jan 1994. Sep-Oct 1993. Jun 1992.29(4):261.22(5):421-427. McCarty MC. Zander KM. Nurs Outlook.19(3):209217. 1859. Apr 1995. Third Place. Stewart H. Nissen JH. McCann TV. Mayer TA. Mayo AM. J Adv Nurs. Nov-Dec 1995. Not eligible exposure. J Nurs Adm. Doran D. 1844.17(2):187-197. Dimens Crit Care Nurs. No association tested. Nursingconnections. 1851. 1830. 1831. McConnell EA. Nov 1995. Sep-Oct 1998. Not eligible target population. Developing self-scheduling in critical care.25(5):1033-1039.16(2):85-87. O'Brien-Pallas L. Shi Q.5(3):23-7. J Nurs Adm.94(9):47-48. Comment.

Perceptions of control. Colo Nurse. MCN Am J Matern Child Nurs. An evaluation of the critical care assistant role within an acute NHS Trust Critical Care Unit. McKenna HP. Dow KH. Bottom line concerns eroding quality health care. How to cope with life in the shadows. 1889. Limitations on employment protection provided by the Americans with Disabilities Act (ADA). Meehan TC. Developing an enhanced minor injury unit for support of urban festivities.28(3):304-309. Not relevant. McKay S. Cook DJ. Orthop Nurs. shortest: continuing to improve the hospital stay for mothers and newborns. Hospital workforce shortages--a glimpse at the reasons and possible solutions. 1876. What to tell families about drug errors. 1869. A study of skill mix issues in midwifery: a multimethod approach. Clinical estimation of trunk position among mechanically ventilated patients. Not relevant. Short. Not eligible exposure. Browne G. Not eligible exposure. van de Berg AA. Meikle K. Knowledge and attitudes of nurses in veterans hospitals about pain management in patients with cancer. 1875. and depressive symptomatology: a replication and extension.63(3):490-494. 64. Not relevant. 1883. 1892. Careful nursing: a model for contemporary nursing practice. 1865. Jul 19-25 2001. Huyer Abu-Saad H. Nursing skill mix substitutions and quality of care: an exploration of assumptions from the research literature. Flexible client-driven in-home case management: an option to consider.14(6):63-67. News. Oct 2003. Should a staff nurse's age be a consideration in making patient and shift assignments? Con. Hoch J. Comment. Philipsen H. McWilliam CL. Comment. Jun-Aug 2003. 1885. 1891. Mee CL.97(29):40-41. Philipsen H. Curia M. Nov 1995.98(4):20-21.20(3):142-147.8(1):18-19. Jul-Aug 2005. Rix G. "What are they talking about? Is something wrong?" Information sharing during the second stage of labor. Loerzel VW. Not eligible exposure. 1890. J Consult Clin Psychol. 1867. Jan 2002. van den Berg AA. Dec 1998. Oncology nursing forum Oct 2000. Comment. 1872. Issue Brief Health Policy Track Serv.27(4):34. J Adv Nurs. Comment.24(4):694-702. Nurs Crit Care. Coulter M. McLain SR. Chadderton H.5(2):73-86. 1877. 38. 1887. Halfens RJ. Interview by Jenine Willis. Sep 1993. Jul-Aug 1996. Tittle M.10(4):210215. Mar 1995. Higgins DA. Cost-effectiveness of clustered unit vs.54(6):399-405. McGuire LC.21(3):452-459. Not eligible target population. Jun 1995. Jul-Sep 1996. et al. Birth. Oct 1996. Impact of organizational restructuring on nurses' facilitation of parental participatory care. shorter. Feb 1999.1(10):20-21. Not eligible target population. Nurs N Z.22(3):15-18. McGuire T. Intensive Care Med. 1868. 1893. Can Oper Room Nurs J. Haynes DE. Not eligible exposure. Not eligible target population. Sabbatical leave: a creative retention strategy. McLennan CA.17(6):49-54. Haas D. Coyte P. Ward-Griffin C. Melchior ME. McVay K. Carey N. Guyatt GH. unclustered nurse floating. 1871. Sep 2001.15(6):294-300. Okla Nurse. Miracle worker. Nurs Times. J Adv Nurs. Comment. 1863. Thomas SA. J Adv Nurs. 36. Nurs Manage. Perceptions of registered nurses working with assistive personnel in the United Kingdom and the United States.44(1):99-107. Melchior ME. Apr 1996. MarApr 1994. McSharry M. Gassman P. Feb 2000. Letelier LM. Not eligible exposure. Not eligible target population. Care Manag J. Melifonwu R. Ward leaders. Workload measurement tool for an integrated OR/PACU. McKenna H. Dec 31 2004:112. Not eligible target population. Support role spreads the workload in intensive care. 1864. Glass DC. McGregor LA. 1894. Revolution. Apr 1997. Gassman P. Alta RN. The effectiveness of primary nursing on burnout among psychiatric nurses in long-stay settings. 1881. Stewart M. 1880. Feb 2002. McNeal LJ. Not eligible target population. 1873. 1866. 1886. Hosp Health Netw.32(3):158-164. Hagan S.8(3):193-197. McLaren BJ. 1884. Mar 2002. Eur J Emerg Med. Summer 2004. Nursing Economics NovDec 1997. burnout. Comment. MERG: medication event rating grid. McNees P. Health care providers and facilities issue brief: health facilities: year end report-2004. Nov-Dec 1998. Not eligible target population. 1888. Quality of life: but in whose judgement? Edtna Erca J. McLeod A. Abu-Saad HH. Jun 23-29 1999. Legal Cases.95(25):30-31. Not eligible target population. Mehn J. McMillan SC. 1870. Comment. Vingilis E. McKnight JD.15(1):14-17. Kahmamoui K. J Adv Nurs. Interview. MCN Am J Matern Child Nurs. Nurs N Z. A clinical pathway for the secondary diagnosis of alcohol misuse: implications for the orthopaedic patient. Winter 1997. Crit Care Nurse. Int J Nurs Pract.7(4):11. Smith SY. Anderson K. Cirone NR. McKillop A.30(2):85.12(1):28-31.57(5):9. The role of health care assistants in hospitals. Oct 2001. Marcon J. McGloin S. 1878. Comment. Meade MO. Dec 1994. Not eligible target population. Levinger CV. McLaughlin FE. Knowles J.37(1):52-61. 1874. Barter M. Application of the CuSum technique to evaluate changes in recruitment strategies. Not eligible target population. Mar-Apr 2005. Weaver BR. Comment. Comment.1862. Can J Nurs Leadersh. Not eligible target population.27(9):1415-23. McMullin JP. Burnout and the work environment of nurses in psychiatric longstay care settings. Medland JJ. Halfens R. McKinley A. Casual nurses meet a demand. Not eligible exposure. 1882. Jan-Feb 2002.73(2):30.21(4):191-196. Nurs Times. Soc Psychiatry Psychiatr Epidemiol. McKiel E. Meehan AJ. B-55 . Hasson F. Nursing research Nov-Dec 2005. McHugh ML.48(2):14-16.6(1):46-57. Donner A. Shiftwork. 1879. Bell AZ.

NLN Publ.17(1):22-27. Merkouris A. No association tested. News. Case Reports. Ngeo C. Coulis N. Not eligible exposure.18(2):44-49.65(8):67-70. Winter 2003. 1910. How much is enough? Agency nurse orientation. Grindel CG. their mothers.14(4):14-21. Comment. 1926. Post procedural interventional cardiology patients on the progressive care unit.12(1):45-50.6(2):4. Jan 16 1996. Miller KH.30(6):471-472 . Gray B. Miller DL. Patient-focused care and human becoming thought: connecting the right stuff.97(12):24-26. et al. Nurs Manage. Mar-Apr 1999. 1914. 1922. Johnston M. Meyers S. 36. Not eligible target population. Eff Clin Pract. 1908. Winter 1999. Grindel CG.2(2):123-129. Winter 1991. The road taken. 1911. Flexible working: banking your assets. May 2003. Feb 1996. Nov-Dec 2001. Vincent CA. Revolution. 1906. Michie S. Psychiatr Serv. Sep-Nov 1999. Jul-Aug 1993. 1919. The impact of patient point-of-view pharmacy delivery on labor and quality. Pistolas D. Minnick A. executives look for ways to bridge cultural gap. Carnevale FA. Jun 1992.8(30):90-91.. Mar-Apr 1996. Comparison of liaison and staff nurses in discharge referrals of postpartum patients for public health nursing follow-up. Ciliska D. Int J Nurs Stud. Millar B. Auerbach AD. Critical care nurses' perceptions of futile care and its effect on burnout. 1923. Not eligible exposure. Not eligible exposure.13(3):216-224. Burn size estimate reliability: a study.30(7):34-36. Haber J. News. 11.56(5):18-21. Siegel M.S. 1902. Not eligible exposure.noise levels in a pediatric intensive care unit. Oct-Nov 2003. Not eligible target population. Waltman M. Ridout K. Sexual abuse assessment on admission by nursing staff in general hospital psychiatric settings. Not eligible outcomes. Eur J Cardiovasc Nurs. Jul-Sep 1991. Am J Crit Care. Menzel NN.47(2):159-164. 1896. Nurs Manage. Not eligible Exposure.12(1):41-42. Miller KH. Trustee. Hosp Health Netw. Papathanassoglou ED. 1904. Dynamics. Creason NS. Merrion P. Three lessons show how nurse leaders can influence the use of physical restraints. Patsdaughter CA. Leapfrog Group: a prince in disguise or just another frog? Nurs Adm Q. Nurs Stand. 1927. A comment on the Duke University Center Health Profile.5(16):1002-1006. Byrne MW. 1915.22(2):145-149. Floros J. News. Minnick A. Michael JE. The helper model: nine ways to make it work. Baumann A.2(3):119-125. Comment. Not eligible target population.Editorial. The experience of caring in the acute care setting: patient and nurse perspectives. Comment. Wachter RM. May 2004. Middleton S. Leipzig RM. J Adv Nurs.4(5):18-23. 1897. Comparisons of pain ratings from postoperative children. Mar 22-28 2001.27(45):56. Not eligible exposure. Nursing relief. Jul 2003. Aug 2002. Papathanassoglou ED. Patsdaughter CA. Record snowstorm transforms hospitals to RN "dorms". van Harteveld J. Milette IH. 1913. Merkouris A. Sheppard K. Nurs Econ. Staffing. Staffing and organisation of nursing care in cardiac intensive care units in Greece. Risk classification. Nurs Sci Q. Edwards N. Mod Healthc.26(1):111-119. The physical workload of nursing personnel: association with musculoskeletal discomfort.26(4):16-25. bill would allow some foreign nurses to work in U. Nurs Times. Real men choose nursing.32(3):37-39. Aust J Adv Nurs. 1905.4(6):250-255. 32. 1901. 1909. Meurier CE. Mistiaen P. Caregiver perceptions of the reasons for delayed hospital discharge. Jul 2000. Adam V. 1907. Mar 2001. Metcalf KM. clinical outcomes. 1912. J Burn Care Rehabil. Evaluation of patient satisfaction with nursing care: quantitative or qualitative approach? Int J Nurs Stud. Melville E. Milstead JA. J Nurs Staff Dev. Not eligible target population. Jan-Feb 1996. Miller E.41(8):859-867. Miller SF. Apr 2005. Comment.8(1):10-11. Miracle K. Cardiac surgery's calculated risk. Finley RK. Jan-Feb 1994. Comment. Brooks SM. Sep 12-25 1996. Not eligible target population. Nelson A. Parmar DG. Not eligible exposure. Flint F. Mitchell A. Dec 1992. Minichiello TM. Miller K. Summer 2002.12(6):546-559. Apr 20-26 1994. Not eligible exposure.79(4):30. Stress in nursing and patients' satisfaction with health care. Not eligible exposure.13(3):202-208. Comparing professional and patient outcomes for the same episode of care. Nov-Dec 1991. Not eligible target population.42(4):245-249. Meyer MS. Is it patient abandonment--or not? Rn. Not eligible target population. 1918. Nurs Spectr (Wash D C). Pediatr Nurs. Nursing schools and hospitals target men in their recruitment efforts. Lumby J. Behind every great nurse. Jul 1997. Pischke-Winn K. Papagiannaki V. Leahey M. May 2004. Lemonidou C. B-56 . and the use of nursing resources for cardiac surgery patients. 1925. Avoiding culture clash. Bernard TE.1895. Nov 2004. Mills-Senn P. Nov 10 1997.41(4):355-367. Laurenzano C. Grindel CG. Learning from errors in nursing practice. Med Care. Nurs Res. 1928. Prog Cardiovasc Nurs. Meltzer LS. No association tested.14(1):14-17. 38-40. Closson T. Miller D. Br J Nurs. Nurs Manage. Restraints: friend or foe? Ky Hosp Mag. Underwood J. 1900. Dimens Crit Care Nurs. Lincks J. Miller BK. Jul 1999. 1899. Nurs Diagn. Mitchell GJ. and their nurses. In answer to hospital shortages. Minton JA. I'm trying to heal.23(12):40-43. 1921. Mitchell D. Not eligible exposure. Comment. Lemonidou C. 1920. Van Berkel C. Apr 1992(15-2465):137-156. Not eligible exposure. 1917. Review.. Huckabay LM. 1924. Evaluation of admission nursing diagnoses. Gafni A. 1916. Walter S. 1903. As the number of foreign-born nurses climbs. Comment. 1898. The restraint match-up.

Comment. 1951. Sep 2004. Jpn Hosp. Reclaiming the night. Fleischmann R. Mar 1993. and annoyance in a pediatric intensive care unit. Morrison AL. Jun 29Jul 5 1994. Questions concerning medical care provided in hospitals.33(2):223235. 1941. Nurs N Z. Nurs Times. Aug 2001. 1938. The effect of staffing levels on the use of seclusion. Adachi I. Beckmann U. Morrissey J. Moait S. Jackson D. Noise. NT/3M National Nursing Awards.1929. Morrison M. Aust Crit Care.42(1):1-3. Lynn MR. Comment. Comment. Morrow KL. Morrison P. 5. Helsen G. Not eligible target population. A study of the official records of seclusion. 1948. Nov-Dec 2004. Moran J. 1940. Haas EC.54(42):suppl 1-2. a wave of the future? Hawaii Nurse (Honol). Comput Inform Nurs. Smithee LM. 1958. 1939. Carless R. 1931. May 1994. Monet SS. quantity. Not eligible association presentation. Morrison WE. Nov 2003. Oct 30 2000. Mar-Apr 1992. 1956. Morita T. Jan 2003. and preferences. Nolan SP. stress. Molzahn AE. Shima Y. Not relevant. Durie M. Feb 2000. Molloy P. Electronic health records documentation in nursing: nurses' perceptions. Mylle G. Palliat Med. Sep 1998. Jan 2004. DeRose C. Hospital provider satisfaction with a new documentation system.14(3):116-121.29(6):48-54. Adachi I. Not eligible target population. 1932. Not eligible target population. Robison DA.and nurse-reported effects of intravenous hydration therapy on symptoms of terminally ill patients with cancer. Morath J. Mar 1998. B-57 . Not eligible exposure. Morton HR. 1949. Miyashita M. nurses.2(6):365-366. Quality vs. and physicians. Nurs Manage.28(6):48-49.34(11):9. Morley B. Comment. 1947. 1995. 1961.7(5):683-693. Not eligible exposure. Sewell LV. 1996. May 1996. 1937 Moody L. Emotional burden of nurses in palliative sedation therapy. IOM report: hospitals must cut back workload and hours of nurses to maintain patient safety. Mongeau C. Nursing staff in intensive care in Europe: the mismatch between planning and practice. Ryals B. Comment. Himes JK. Miyashita M. Garrett ES. Oct 2004. Phillips C. Anna J. 1942. Family favourite. Nurs Manage. Morgan SP. Not eligible target population. Robinson SP. 1957.90(26):54-55. Lamp. Not eligible target population. Nguyen D. Nurses indicted . Not eligible exposure. 1935. Comment. The Foreign Nurse Program: an innovative NCLEX review.15(1):59-66. Jun 2004. Burnard P. McMillen BJ. Moens G. Qld Nurse. attitudes. J Psychiatr Ment Health Nurs.. J Adv Nurs.34(2):93-100. Med Health. Feb 2004. Imbrie JZ. Dec 29-2000 Jan 5 1999. Crutcher JM. Analysing and interpreting routinely collected data on sharps injuries in assessing preventative actions. Not eligible target population.13(1):24-31. The Netherlands.4(4):1. Voices from Colorado. Jul-Aug 1997. Interventions to reduce decibel levels on patient care units. Slocumb E. Comment. Reis Miranda D. Perspect Psychiatr Care. Spotnitz W. Boggs G..24(3):325-333.54(4):245-249. J Nurs Adm. Comment. Am Surg. Moore K. 1944. Shima Y.25(5):78-80. The effects of nursing staff inexperience (NSI) on the occurrence of adverse patient experiences in ICUs. 1954. Snyder PE.18(6):550-557. A prolonged outbreak of Pseudomonas aeruginosa in a neonatal intensive care unit: did staff fingernails play a role in disease transmission? Infect Control Hosp Epidemiol. 1962. Moody LE. Moskowitz DB. 11. Evans S. Moolenaar RL. Why hospitals' staffing woes today are unlike previous nurse shortages. Lehane M. NovDec 1994. Finally. News. Lehane M. the 38-hour week. Morita T.41(3):7. Morrison P. Specialized home care for patients with AIDS: an experiment in Rotterdam. The paradigm shift from traditional obstetrics to single room maternity care. Comment.11:1-9. Van Hoof R. Improving operating room coordination: communication pattern assessment. 1934. Not eligible target population.1(7):13-15. Nurse staffing: a structural proxy for hospital quality? Med Care. Johannik K. Gillies DM. Moons M. J Adv Nurs. Jul 1992. Shaffner DH. 1952. 1955. Comment.13(6):6-8. Chest.23(2):81-82. Not eligible target population.21(2):80-85. Fackler JC. 1959. Stevens B. Morrison P. J Nurs Adm. 1960. Nurs Times. Jun 1994. Not eligible target population.31(1):113-119. 1936. J Contin Educ Nurs. J Palliat Med. J Psychiatr Ment Health Nurs. Case Reports.19(6):1132-1140. Physician. Moss J. Quality of life of individuals with end stage renal disease: perceptions of patients. 1930. Crit Care Med. 1946. Hutwagner LC. Fla Nurse. Not eligible exposure. Jarvis WR. Not eligible exposure.95(50):34-35. San Joaquin VH. 1945. 1990. Jun 1999. Comment. 1933. Jan 1990. Northcott HC.64(9):894-899. Aug 1995. Moore MM. Lang NM. discussion 334-325. Kimura R. 10 hr night duty win. Mod Healthc. Int J Nurs Stud. Not eligible target population.22(6):337-344. Using staffing and scheduling information to support change. Nov 10 2003. A multidimensional scalogram analysis of the use of seclusion in acute psychiatric settings. Not eligible exposure. Mitchell PH. Staff and patient satisfaction in a forensic unit. Nursing Economics Jan-Feb 1995.33(45):8. Carson LA.113(3):752-758. Reduce workload intensity with PCTs. Biewenga T. Morrison P. A missing consideration: the psychiatric patient classification for scheduling-staffing systems. Nursing. Occup Med (Lond). Not eligible exposure. Not eligible exposure. 1953. Moreno R. Legal Cases. Xiao Y. Apr 1996. Implementation of the ANA report card. Promoting night shift.25(3-4):40-47. 1950. Jun 1997. Kerkstra A. Berg B. Morohashi Y. Mobberley T. Dossetor JB. Marketplace.53(4):10-12. Kimura R. Jun 1998.3(1):67-69. 1943.

Nahalla CK. J Adv Nurs. Shatto BJ. Nakagawa J. Stout WA. 1982. Comment. Jul-Aug 1999. Naumanen-Tuomela P. 1984. Mar 11-17 1992. 1976.. Comment. Ann Emerg Med. Feb 1995. Finnish occupational health nurses' work and expertise: the clients' perspective. Klar R. Comment. Health Expect. 1972. Not eligible exposure. Belgrade M. Ouk S. J Nurs Care Qual. Abderhalden C. Sep 1995. Jan 1995. 1981 Napholz L.6(2):7-8. Apr 1991. Not eligible target population. Third Annual Nursing Administration Recognition Program. 1979. Int J Nurs Stud. 1967.63(10):609-618. Navarro VB. J Neurosci Nurs. Halfens RJ. Nurs Econ. Nephrol Nurs J. Riede D. Apr 1995. Schwesig R. Review. Balancing act. Not eligible target population. Quantifying nursing care in barbiturate-induced coma with the therapeutic intervention scoring system. Interobserver agreement in emergency department triage. B-58 . Nikoletti S. Nov 1994. Miller EH. Haug HJ.3(3):28-29. Jul 1991. Perry AG.92(9):28-30. 1966. Chest.41(2):191-195. Dassen T. 1978.19(3):276-279. McLaws ML. Int J Nurs Pract. 1970. Nelson J. 1980.4(4):111-115.5(25):46. Orthop Nurs. Ouwendyk M. Feb 28-Mar 5 1996. May 2001. Compagnoni ML.27(1):35-42. Boone EB. Malkoff MD. Pen power--doctors under scrutiny. Oct 2001. Nardini J. Mrayyan MT. Working parents: primary or secondary? Nurs Stand. Not eligible exposure. Winter 1998. Insight. Dec 2001.9(3):131-139. No association tested. Not eligible outcomes.. Wallace L. Not eligible exposure. Jul-Sep 2004. Part-time working.34(4):538-544. Nazarko L. The perception of aggression by nurses: psychometric scale testing and derivation of a short instrument. Jun 1999. Nash MG. Who coordinates infection control programs in Australia? Am J Infect Control. Improving patient satisfaction through the consistent use of scripting by the nursing staff. 1974. Nurs Stand. When staff are assaulted. Editorial. 1964. Health care for women international Jul-Sep 1992. 1993. Nurs Manag (Harrow).11(1):36-42. Dassen T. Managing expectations between patient and nurse. Nurs Times.4(4):205-208. Everett LN. 1965.13(3):303-12. 1992. Helferty M. Mustard LW. 1983. Okress J.5(3):59-61. Allocation of nursing care hours in a combined ophthalmic nursing unit. Perceptions of jordanian head nurses of variables that influence the quality of nursing care. Blackwood D. Revolution. Fischer JE. Jun 1997. The effect of a training course in aggression management on mental health nurses' perceptions of aggression: a cluster randomised controlled trial.111(6):1631-1638. The NHS--a patient's perspective. Gesundheitswesen. Fall risk assessment: a prospective investigation of nurses' clinical judgement and risk assessment tools in predicting patient falls. Not eligible target population. Nava S. J Cannt. The impact of regular hospitalization of children living with thalassaemia on their parents in Sri Lanka: a phenomenological study. Jun 2000. Working parents: turning against rotation. ScottKillmade MC. 1973. Leuchte S. Myers M. McKay J. Aug 2005. Nocturnal hemodialysis (NHD) adapted to the incentre setting--a pilot study. Schwartz B. 1971. Not relevant.20(1):14-16. 1969. Patient-focused care: what managers should know. 1991. Int J Nurs Pract.a randomised trial of nurses with back pain].24(11):49-55.21(4):17-18. Review.16(4):180188. Not eligible outcomes.31(4):423-431. Lewis E. Nazarko L.1963. Naish J. Miller G. Not eligible target population. JONAS Healthc Law Ethics Regul. Nazarko L. Case Reports. FitzGerald M. Myers H.5(3):6872.42(6):649655. 1985. Feb 2003. J Nurs Adm. Nurs Stand. Murray MG. Not eligible exposure. Jul-Aug 1998. 1968. Nash MG. Murphy F. No association tested. 1995. Improving pain management after total joint replacement surgery. Naish J.27(3):291-295. Faber-Bermudez I. Trauma coordinator: full-time or part-time? J Trauma Nurs. 1977. JONAS Healthc Law Ethics Regul. Muller K. Not eligible target population. Visit at your peril. Evangelisti I. 1990.29(7):24-29. Sex role typology as a function of age among registered nurses. 3rd. 1987. Tolley FM. Recruitment crisis returns. Not eligible target population.6(25):53-54. Honorable Mention. Myles GL. Napthine R. Arnold imitates art. Not eligible target population. Shepherd MF. Abderhalden C. Dec 2002. Comment. 1975. The culture of patient safety. Neitzel JJ. Feb 2004. Not eligible target population. 64. Myers SM. Jul-Sep 1998. Rampulla C. 1986. Stress among nephrology nurses in Northern Ireland. Tannas C. Schriger DL. Medical errors--is the system "ill?" Nephrol Nurs J. Myers L. Fischer JE. Mudge B. A nursing consultation support service. Nader R. Not eligible target population. Jul-Aug 2004. MacInnis K.1(8):6-7. J Nurs Adm. Working mothers: short shrift for long. Sep 2003. Comment. Not eligible target population. Nalon K.9(3):158-165. 1988. Jun 2003. Mustard LW. Jun 2003. Not eligible target population. J Psychiatr Ment Health Nurs. Jr. Murphy CL. [Coordinative treatment and quality of life . Richer S. Needham I. Snyder JC. Libcke J. Jun 10-16 1992. Mar 13-19 1991.Economic model for a hospital-based supplemental staffing program.18(4):37-45. Not eligible target population. 1989. Mar-Apr 2005.6(38):44. Aust Nurs J. 1994.. Needham I. Fracchia C. Rubini F. No association tested.8(1):30-31. J Psychosoc Nurs Ment Health Serv. Not eligible target population. Haug HJ. Not eligible target population. Human and financial costs of noninvasive mechanical ventilation in patients affected by COPD and acute respiratory failure.27(3):272-273.

6(2):32. Nurses' time management in intensive care. Nugent J. Neuhs HP. 525-508. 2000. O'Brien RL. Niederstadt JA. Niedhammer I. Mar 1995. Comment. 2004.81(3):508-509. Nurs Stand. Shamian J. 2023. 2024. Realistic rostering. 1998. Nyqvist KH. J Am Med Inform Assoc. Mar 1997. Status of infection surveillance and control programs in the United States. 1992-1996. Norton A. Serbin MF. Comment. Contemp Nurse. Am J Nurs.12(1):1. Utilization of nursing personnel from supplemental staffing agencies by health care facilities in Minnesota. 2025. Comment. Availability of scheduling options important. O'Brien SP. et al. Alksnis C. Not eligible outcomes. Comment. SinkowitzCochran RL. Jayson DW. 1999. 36. Hauge M. 2021. Nerdahl P. Comment. Mar 2005. 2005. and length of stay. A study pre and post unit dose conversion in a pediatric hospital. Nelson NC. Simms LM. Jul-Aug 2005. Bruce S. Jan 29-Feb 4 1992. Nelson S. News. You're not one of us. Nicholls DJ. 513-522. When discrimination based on national origin becomes a problem. Sep 1998. Duplaga EA. Feb 15-22 1995.6(19):54. 1997. The nursing shortage: crisis as opportunity. J Nurs Care Qual. J Nurs Adm. Ewald U. new answers: pediatric nurse practitioners and the care of adolescents. Staff mix and public safety. Noak J. Grady MS.20(6):511-516. Mar 2000. Northcott N. Not peer reviewed. Pronovost PJ. Journal of Pediatric Health Care Jul-Aug 1999. American Journal of Infection Control Dec 2000. Nelson MS.91(7):29-31. discussion 89S.13(4):183-90. Berglund D. Nurs BC. Not eligible target population. Not eligible outcomes. Not eligible exposure. Nurses' attitudes about floating.2(3):121-125. Wind S. J Nurs Adm. 2019. Snowdon SL. Can J Hosp Pharm. Mar 1996. J Nurs Adm. 2014. Psychol Med. Jan 2001. Ravenscroft E. Aorn J.44(3A Suppl):78S-88S. A triage-based emergency department patient classification system. Nguyen BQ. Norrie P. Do we need another model for mental health care? Nurs Stand. Computer use for work accomplishment. Stuart L. Nevidjon B. Staffing.131(2):153-159.15(1-2):110-113.101(1):77. Oct 2004. Influenza vaccination of healthcare workers. Not relevant.28(6):392-400. Not eligible exposure. O'Brien JA. complications.21(78):46. Development of the Preterm Infant Breastfeeding Behavior Scale (PIBBS): a study of nurse-mother agreement. Ray J. 2026. Meyer LM. Jun 1995. 2009. May-Jun 1997. 2022. 2008.49(9):755-758. 2029.36(4):352-357. Samore MH. mandatory overtime is a necessary evil.26(3):47-55. Graves E. Maier RV. 2001. Gardner RM. Failure of pain relief after surgery. Kerstein MD. Twelve-hour shifts: helpful or hazardous to patients? Nurs Times. B-59 . Nicholson D. Not eligible exposure. Thomson D. 2028. Comment. Shift patterns: a hard day's night. Nelson J. Nicklin W. 2015. Ngin PM. Arch Surg. Newman KM. 2004. Mar 1998. Nurs Manage. 49. Nov 7-13 2001.16(8):33-35. Editorial. Not eligible target population. Nguyen GT. 2006. 2011. Editorial. A comparison between nurse managers and staff nurses. Koehoorn M. Norton A. Johnson E.18(1):9-13. Spring 2005. Nurs Stand. Work-related disability in Canadian nurses. New challenges.12(2):23-27.19(1):34-38. Ostomy Wound Manage. 2016.27(1):56-58. Mar 2005. 2018. Not eligible target population. Nurs Leadersh Forum. Not eligible target population. Mar 5-11 2003. 2017. Frequency and timing of activated clotting time levels for sheath removal. Dec 1994. Jul-Aug 1991. Burn unit ensures expert. Due to the nursing shortage.18(3):189-194. Johantgen M. 2010. Winter 2001. 2002. Newhouse RP. 37-38. Comment. 2013. Jan-Mar 2004. Rappaport P. Feb 1991. Shifting the emphasis. Nesbitt-Johnson M. Rubertsson C. ratios and skill mix--is there an Australian story? Nurs Inq. Heine C. Nursing and patient outcomes: it's time for healthcare leadership to respond. Facey S. Nurs Manage. Proctor SE.25(2):329-338. Nurs N Z. Not eligible target population. Attitudes of ward staff and patients to postoperative analgesia. Marne MJ. Healthc Manage Forum. specialized staffing. Not eligible exposure. et al. Not eligible target population. 40-15.12(4):390-397. Aug 2003. Sep 1996. 50. Detection and prevention of medication errors using real-time bedside nurse charting. J Emerg Nurs. Infect Control Hosp Epidemiol. 2007. J Hum Lact. Perioperative nurses and patient outcomes-mortality. Not relevant. Mar 1991. Nurs Crit Care. van Rijswijk L. Are nurses respecting and upholding the human rights of children and young people in their care? Paediatr Nurs.1(5):12. 2003.1996. Bearinger LH. J Nurs Scholarsh. Review. Sequential biannual prevalence studies of pressure ulcers at Allegheny-Hahnemann University Hospital. Nichol KL. Not eligible target population. Improvement in the organ donation rate at a large urban trauma center. Lert F.44(1):5-15.17(25):16-17. 2027. Nov 1994. Not eligible target population. 2012. O'Brodovich M. Evans RS.36(4):5. Noyes J. Not eligible exposure. Feb 1996.2(10):11. Sjoden PO. Psychotropic drug use and shift work among French nurses (1980-1990). Comment. Anaesthesia. Kerr M. Not eligible exposure. O'Brien KD.21(3):5. Sep 1994.12(3):207-219. Letter. Nurs N Z. O'Connor R. 2020. Not eligible target population. Oates JD. The NurseLink model of care. Jan 1996. Not eligible exposure. Minnesota nursing accent Jan 1991.29(9):40F. Getting them over there. O'Brien-Pallas L.63(1):16-7.

Mar 2002. Meeting the challenge of nursing and the nation's health. Harris CB. Not eligible exposure. 2036.86(4):896-906. Aug 2-8 2005. Health Care Superv. Not eligible exposure. Bistodeau JA. Edo State. Knowledge. Jama. Jul 1994. Hayes JS. Tarantello C. B-60 . Not relevant. Okojie OH. Staffing levels cause concern. Revolution. Violence and aggression in psychiatric units. Not eligible exposure. Owen L. Okolo SN. Apr 1999. Nurs Times.96(42):10-11. Scotland. J Oncol Manag..56(5):438-441. May-Jun 2003. Mar 2004. Workplace violence. 2045.49(11):1452-1457. Not eligible target population. Ratner PA. Tennant C. Impact of an instructional program on nurses' accuracy in capillary blood glucose monitoring. Not eligible target population. Not eligible exposure. Comment. Ostomy Wound Manage. Anesth Analg. 2060. Aug 1997. Healthcare changes bring increased liability risk for nurses.2030.117(5):333338. 2031. Nov 1992. 2034. Nov 1999.5(10):11. News. Nurs N Z. Prof Nurse. Not eligible exposure. Harvey SC. O'Neil E. Jul 2004.7(1):18-20. 2065. Sep 1992. Shippey F. Mo Nurse. N Z Nurs J. Park I. O'Dowd A. Nurses' perceptions: when is it a medication error? J Nurs Adm. Ogbonna C. Apr 1998.65(3):7.47(1):25-32. Nov 1998. Not eligible outcomes. Yassi A. Comment.85(10):20-21. Not eligible target population. Ross-Kerr JC. Dunagan WC. Asuzu MC. Not eligible target population. Fishman RL. Not eligible exposure. 2033. An evaluation of single-room maternity care. News.32(3):727-733. Quality of life in long-stay institutions in England: nurse and resident perceptions. Am J Crit Care.1(6):18-19. 2037. 1997. 2049. Clin Nurs Res. Ostry AS.288(16):2040-2041. Prentice D.96(29):12-13. 12 hour shifts begin in Dunedin. Crit Care Med. Nurs N Z. Not eligible target population. London trust in a royal mess. Editorial. An ergonomic approach to reducing back/shoulder stress in hospital nursing personnel: a five year follow up. Gallagher T. Call for police officer in every A&E. Seago JA. Williamson J. Keene K. Attitudes of patients toward smoking by health professionals. Campbell KE. Owen BD. Weighing up nurse-to-patient ratios. 2059. Stud Health Technol Inform. Ohrn KE. Letter. Sep 2003.13(2):129-46. 2042. Jul 13-19 2000.12(3):24-26. Tiffen J. Coutts P. Not eligible exposure. Turn up the volume. 2044. 2054. Ofili AN.100(14):12-13. 2039. Nurs Times. Ballard JA.6(10):16-17. Comment. Oldenkamp JH. Are minimum staff ratios needed? Nurs Times. 2047. Park IH.29(4):33-38. Simons JL. Eur J Cancer Care (Engl). Public Health Rep. Heesen C. Heading C. Not eligible target population. O'Connor T. 2056. Keast DH. 2043. 2057. O'Neill TR.8(2):166-178. Tomlin KM. The named nurse: patient and nurse expectations. Fridlund B. Oct 19-25 2000.310(6993):1536-1537. Errors in administration of intravenous drugs. Oct 2001. Mar 2002. Nurs N Z. Can J Nurs Res.36(1):142-157. Choosing a model of care for patients in alternate level care: caregiver perspectives with respect to staff injury. Successful strategies for improving operating room efficiency at academic institutions. Soaring violence against nurses. Oleson M. Not eligible outcomes. Ornstein H. Dying in an acute-care setting. O'Dowd A.101(31):20-22. 2058. Shields MD. O'Hare MC. O'Sullivan J. Not eligible target population. Not eligible target population. O'Neill KL. Johansson P. Olive KE. 2053. Am J Ind Med. 2062. Kollef MH. Wahlin YB. Kidd C. Work organization and patient care staff injuries: the impact of different care models for "alternate level of care" patients. Jun 10 1995.20(1):23-32. Jul 20-26 2000. O'Connor T. Oral care in cancer nursing. Cvitkovich Y. Nov 2000.11(1):43-49.12(11):769-771. 2051. 2052. News. Oct 23-30 2002. Comment. Mar 2004. Overdyk FJ. Tate R. Osborne J. Ratner PA. Nursing care at night: an evaluation using the Night Nursing Care Instrument. 2050.107(3):335-339. Nurs Times. O'Leary J. 2048. 2041. Hospital workers' opinions on the predisposing factors to blood-related work accidents in Central Hospital. Legal Cases. Statistics show sick system. 2063.1(2):81-90. Psychiatr Serv. 2061. Can Nurse. Yassi A. Public Health.. Mar 2000. Ostry AS. Olson S. Sterling W. Owen C. Fraser VJ. Shadick KM. Bmj. Suburban hospital nurses fight for safe staffing. 2055.43 Pt A:64-68. No association tested.88(9):20-22. O'Connor T. Apr 6-12 2004. Tate RB. May-Jun 1992. Int J Nurs Stud. 2046. Meeting the challanges in today's outpatient oncology setting: a case study. O'Dowd A. Chronic wound caring . J Adv Nurs. Olson ME. Blais K. Oehler JM. Oct 2003. Not eligible target population. Eur J Clin Nutr. Job stress and burnout in acute and nonacute pediatric nurses. 2032. O'Reilly M. 2038. 2035. Application of telematics for improving multiple schedules.96(28):5. Tannenbaum RJ. May 2002.47(10):26-36. Benin City. Oct 1992. Osmon S. Jul 1995. Ostrowski M. Orsted HL. May 1999.39(3):295-302. Jones M.44(4):392399.64(5):4. Nigeria. Sep-Oct 1995. O'Dowd A. Smith MJ. Sep 1992. Not eligible target population. The floating dilemma. O'Hern-Martin P. Nurs Times. Rn. 2040. Case Reports.9(1):2229. 2064. a long journey toward healing. Sjoden PO. Comment. Davidson MG. Bradley AM. Recommending a minimum English proficiency standard for entry-level nursing. Spring 1997. Not eligible target population. Not eligible exposure. attitude and practice of health workers in Keffi local government hospitals regarding Baby-Friendly Hospital Initiative (BFHI) practices. Oleni M. Comment. Journal of nursing measurement Fall 2005. J Adv Nurs. O'Dowd A. Reporting of medical errors: an intensive care unit experience.

Service assistants threaten nursing. 2096.20(29):4. News. Review. Not eligible exposure. Parse RR. 2075. Not eligible target population. Bryant JB. Not eligible target population.40(3):285-296. Nov 1-7 2000. 2094. Mod Healthc. Aug 2000. Park EK. Diabetes Educ. Muzquiz M. Nurs J India. Chung PM. 2069. How ORs manage on-call varies by local market. No association tested. Park JH. Parish C. Parsons LC.3(2):79-101. Paredes SD. Ingram M. Nurs Sci Q. Pape TM. Review. Synergy: a framework for leadership development and transformation. Feb 2005.20(48):6. Padmam R. News. Feb 19 1997.21(3):243-248. Jul 2000. Sep 1991. Hosp Health Netw. Payne D. Sep 1999. An integrated nurse scheduling model. J Adv Nurs. Staffing the recovery areas an art as well as a science. Pressure area care: an exploration of Greek nurses' knowledge and practice. Palmer J.94(22):15. 2074.13(3):187. Extroversion. quiz 94. Paramedics--above & beyond. Pallarito K. May-Jun 1996. Paterson I. 19-22. Vail A. Mar 1995. 2001. Crit Care Nurs Clin North Am.8(2):91-92. Nurs N Z. Bishop D. Oct 2001. Nurs Stand. Jul 3-9 2002. Song M. 2078. Using the Roper. Interactions between nurses during handovers in elderly care. Not eligible target population. Building RN confidence for delegation decision-making skills in practice. Development of a computerized patient classification and staffing system. Impact of training on empathic communication skills and tendency of nurses. Feb 2002. Comment. 2076. Editorial. Nov-Dec 1999.3(4):32-33. Apr 1998. Coleman P. 2067. 2098. 2086. J Contin Educ Nurs. McCourt C.21(6):541-545. Logan and Tierney model after discharge. 2100. 2088. 2093. J Nurs Adm. Not eligible exposure. Labor proposes rules governing foreign nurses.17(2):113-119. Caring for dying children: a comparative study of nurses' experiences in Greece and Hong Kong. 2092. Oct 1990. Nov-Dec 1995. Vincent PA. Oz F. Scaltrito S. Nurse/parent role perceptions in care of neonatal intensive care unit infants: implications for the advanced practice nurse. PACU staffing. Not eligible target population. Nurs Stand. Comment. Nurs Times. 2085. 2090. Not eligible target population.2066.32(2):277-285. May-Jun 2005. Eight.86(3):65-68.11(22):39-42. Patrician PA. Language: words reflect and cocreate meaning. Pallarito K. 2101. Parsons ML. Hewison J. 2083. Applying airline safety practices to medication administration. Jan 2005. Comment. Oct 17-23 2001. Mich Nurse. quiz 141-102. Innovative approaches to reducing nurses' distractions during medication administration. 2089. OR Manager. Stonestreet J. Night fever. Not eligible target population. Paget-Wilkes M.16(42):12-13. Page L. Not eligible exposure. Feb 2000. 1991. The impact of an educational program on improving diabetes knowledge and changing behaviors of nurses in long-term care facilities. Parsons ML. Not eligible exposure. Staff nurse retention.27(3):131-140. Payne S. 2097. Communication barriers perceived by older patients and nurses. Leggett-Frazier N. Pearce L. 2072. Jul 23 1990. Clinical interventions and outcomes of One-to-One midwifery practice. Comment. Not eligible exposure.42(2):159-166. No association tested. Pape TM. Not eligible target population. Res Nurs Health. Your hospital needs you. Padilla-Harris C. Not eligible exposure. 2071.15(7):14-15. No association tested. Laying the groundwork by listening. Patterson P. No association tested. Not eligible target population.12(2):77-93. No association tested. Page B. Frank DI. OR Manager.15(6):263-269. Int J Nurs Stud. Vondle DP. neuroticism and job satisfaction: a comparative study of staff nurses and students. 2102. 2099. Clin Excell Nurse Pract. 2084.46:508-511. Pederson C. Self-rostering on a neonatal intensive care unit.25(1):76-84.22(9):42-44. 2073. Sharp J. Parker MT. Schranner B. 2095. 2079. Not eligible target population. 2077. Kerr SM. Spring 2004. Beake S.and 12-hour shifts: comparing nurses' behavior patterns. Nov 2002.74(3):30.35(1):7. Stud Health Technol Inform. Martinson IM. J Adv Nurs. Dec 3 1990. ix. Carreno E. 2070. Rule delay leaves foreign nurses in limbo. Pacini CM. J Nurses Staff Dev. Tailoring nursing models to clients' needs. Feb 1995. Nonpharmacologic interventions to manage children's pain: immediate and short-term effects of a continuing education program. 2082. Patterson P. Page M. Papadatou D. Comment.16(2):1. Multiple imputation for missing data. Nurs Manage. 2081. Mar 2000. Medsurg Nurs. J Contin Educ Nurs. Comment. Alcala A. B-61 . Nurs Stand. Clin Excell Nurse Pract. May 1998.4(5):294-301. News. Nurse staffing and outcomes: differentiating care delivery by education preparation. Page JS. Not eligible target population. J Soc Health Syst.10(5):284-288. 2091. Jun 2005.36(3):108-116. 16. Sep 2000. Editorial. J Public Health Med. Welker J. Time for judgement.16(5):23. Not eligible target population. Patterson B. Safe patient care legislation addresses growing national problem. Where have all the nurses gone? Can Oncol Nurs J. Hardey M. 2080. A program to manage nurse staffing costs. Nurs Stand.8(3):107-113. Ozkarahan I.14(4):1. Panagiotopoulou K. Page D. 8-11. Mod Healthc. Park HA. 2087. Minimum effort. Cancer Nurs. Aug 2004:5. 1997. Nurs Manage. Prof Nurse. Jun 3-9 1998. Swanson MS. May 1997.5(1):44-51.21(10):42-44. Nurs Leadersh Forum. Comment. Apr 2003. Guerra DM.24(5):402-412.

Not eligible exposure. Mattern JC.25(2):185-186. J Eval Clin Pract. Coleman J. Mattern M. Time to try travel nurses? Nurs Manage. Bohle P. Dec 2002. No association tested. Feb 1999. Experience of being a shift co-ordinator. Not eligible exposure. Outcomesbased trial of an inpatient nurse practitioner service for general medical patients.7(4):6472. Phillips CY. 2130. 96LL. The nursing assignment pattern study in clinical practice. 2126. Comment. Kim U. Not relevant. Self scheduling helps nurses balance their personal & professional lives. Perlow M. Bowman HM. Penticuff JH. 2104. Am J Health Syst Pharm. 2108. Bohle P. Effects of supervisor support and coping on shiftwork tolerance. Comment. Jarjoura D. Support grows for Massachusetts RN staffing bill.92(9):75-80. Scand J Work Environ Health. Pirret AM. Pink GH. ECT in the PACU? It's possible. discussion 756-758. Feb 2002. Feb 15 1995. Nurs Manage. No association tested. J Perinat Neonatal Nurs. Pepper GA. 28. Watkins CW. 2118. Feb 2001. Comment. 295-296. Assessing the impact of reengineering on nursing.29(5):57-64. 96NN.43(2):22-26. Rudolth LG. Apr 1994. Apr-Jun 2005. Leatt P. Intensive Crit Care Nurs. Daly B. 2116. Not eligible outcomes. Surgery. Arheart KL. 143. 2123. Critical care nurses' knowledge of pressure ulcer prevention. AWHONN Lifelines. Volume 2. Postdischarge follow-up care: effect on patient outcomes. Nov 2000.30(2):39-40.30(1-2):363-368. 2121. Canadian-trained nurses in North Carolina. Fortinsky RH. Pisarski A. Aitken R. Not eligible target population. Parsons V. News. Wade KJ. Anna J. J Hum Ergol (Tokyo). May 1991. Jan 1995. Telemedicine in the neonatal intensive care unit. Not eligible target population. Mar-Apr 1999. Phillips H. Revolution. Alternative staffing strategies for community hospital-based diabetes education programs. No association tested. 2120. Herrick LM. Not eligible exposure. Comment.3(5):227-236. Could a process improvement program improve your quality assurance. Parker J. Payoffs from investments: improving. Number 2):2-11.2103. Apr 1998. Not eligible exposure. Kentucky nurse Oct-Dec 1995. Min Y. Not eligible exposure. Not eligible exposure. Brunke L. Burgess J. Registered nurse perceptions of nursing practice. Persuhn PG.3(1):33-37. Screening swallowing function of patients with acute stroke. 2109. 2117. Pellico L. Murray KP. implementation and initial evaluation of a screening tool for use by nurses. Perry K. Perras ST. The problem-free assignment. Utilizing TISS to differentiate between intensive care and high-dependency patients and to identify nursing skill requirements. Not eligible exposure. 1998. Oct-Nov 2003.28(6):86-87. Peters N. Mar-Apr 2000. Jul-Aug 1992. 2129. 30-21. Jul 2001. Errors in drug administration by nurses. Clinical pathway implementation improves outcomes for complex biliary surgery.18(1):19-26. Cohen J. 2122. No association tested. transforming.71(7):13. Effectiveness of an intervention to improve parent-professional collaboration in neonatal intensive care. Pitt HA. Pioro MH. Australia: a telephone survey of hospital and agency managers. social support and work-nonwork conflict on shift worker's health. hospitals. 2135. Cox J. No association tested. staging and description. Comment. Effects of coping strategies.11(2):78-81.126(4):751-756. 2124.18(4):293. Cameron JL. Pereira LJ. B-62 . Ostomy Wound Manage. Yeo CJ. Family-centered care: do we practice what we preach? J Obstet Gynecol Neonatal Nurs. Not eligible target population.4(5):5.36(1):49-65. Nurs Crit Care.7(3): Longwoods Review. Pillar B. J Clin Nurs. Mar 1997. Doulas: exploring their roles with parents.2(2):54-55. 189. Petersen MF. Gordon TA. J Hosp Infect. Piloian BB. 2125. 2110. An evaluation of five protocols for surgical handwashing in relation to skin condition and microbial counts. Honghong W.7(1):21-33. Not eligible target population. Nurs Econ. Jun 1998. Nurs Manage. Jul-Aug 1990. 2134. Am J Infect Control. May 1999. 2132. Manias E. An exploration of family-centred care in Neuman's model with regard to the care of the critically ill adult in an accident and emergency setting. Nursing. Part one: Identification.22(5):96HH. Lillemoe KD. Guoping H. 2115. Sep-Oct 2002. Oct 1999. 2106. Jul 1993. 2113. RNABC News. Case Manager.21(2):129-136. Wong K. 2105. J Nurs Adm. Lee GM.43(4):28-9. J Adv Nurs. Callan VJ. Am J Nurs. Perez PG. Not eligible target population. Piltz-Kirkby M.33(4):421-427. Rosenthal GE. Perry L. Perry K. Picton CE. Peerson A. Pinkerton S. Risk of medical sharps injuries among Chinese nurses. Diabetes Educ. Job sharing: two who made it work. Agency nursing in Melbourne. Pieper B. Not eligible outcomes. 2107. Phipps W. 2128. Aug 1996. Not eligible target population.31(11):42-44. 2114. Perkins L. 248. Jul-Aug 2004.10(4):463-473.52(4):390-395. Sep-Oct 1998. and building skills. J Nurs Care Qual. 2111.19(2):187-202. Pediatr Nurs. 2131.20(5):244. Hall LM. Not eligible target population. Comment. Petroff J. Dec 2001.30(5):277-282. A practical approach to TQI. Pisarski A.24 Suppl 3:141-145. Healthcare Quarterly 2004. Accid Emerg Nurs.40(5):504-512.22(4):15-16. 2119. Petty DS. 2133. & nurses. Phillips M. 2112. Brennan PF. Not eligible exposure. May 1997. Registered nurses: do you have a right to overtime pay? Ohio Nurses Rev. Williams A. Not peer reviewed. Pinnock D. Sep 1992. 2127. Not eligible outcomes. Landefeld CS. Not eligible target population. Aug 2002.

Pronovost P. 4. Am J Nurs. Potter P. Pope BB. Jan 21 1993. Part II: Developing and testing PINAC. Am J Nurs. Katostaras T. Pownall M. Sep 1993. 2159. 2169. Mar 2004. Pratt R. Mar-May 1993. Medication error--nurses indicated. Vehvilainen-Julkunen K. Three Denver nurses may face prison in a case that bodes ill for the profession. 2137. Scott G. Oct 31-Nov 6 1990. Nurs Crit Care. No association tested. Place B. Apr 2002. Aug 2001. 2152. Critical timing.39(1):31-46.12(3):255-269. Journal of Nursing Administration JulAug 2005.103(5336):27. Hosp Health Serv Adm. Todaro M. Nurs Manage. Not eligible target population. Auditing quality of nursing care.93(26):26-28. Pringle D.33(5):38-41.27(7):34-35. Soeken KL. 116. Nurs Econ. Health Serv J. Chaovisitsaree S. Proctor M. Ohio Nurses Rev. Poissonnet CM. J Nurs Adm. Lanara VA.87(4):405-409. Am J Nurs. What do nursing and the law have in common: retention. Dec 2001. Not eligible target population. Blizard P. Plowright C.76(7):1. Plum SD. Jul 1997. Powers JL. United actions push mandatory overtime. Casey K. Sep 1989.101(7):63-65.10(3):143149. Meeting the staffing challenge: development of a voluntary on-call system.14(2):86-91. Apr 1990. Not eligible target population. Potter P. Sribanditmongkol N. Barriers to assertive skills in nurses. Mar-Apr 1996. Bishop CE. Comment. alcohol. 2171. The effects of All-RN and RN-EN staffing on the quality and cost of patient care.8(3):143-148. 2165. Measuring nursing intensity in ambulatory care. Editorial. Mitchell-Pedersen L. J Crit Care.30(1-2):387-391. 2142. Not eligible year. Surviving the night shift. 2168. Collard AF. A cross-sectional study of the health effects of work schedules on 3212 hospital workers in France: implications for the new French work schedules policy. 2138. 2170. Pongsatha S. 2167. Proehl JA. Christie M. Intensive Crit Care Nurs. 2141. Powers J. 2164. Rauscher C. Prescott PA. 2139.6(3):53-61. J Med Assoc Thai. Morakote N. Shifting ground. Morlock L. Not eligible exposure. Sep 1992. Powell C. J Gerontol Nurs.31(1):31-37.102(4):23. May 2004. B-63 . Dec 2000. The perception of ward-based nurses seconded into an Outreach Service. ACE--Alliance for Clinical Enhancement: a collaborative model. Not eligible exposure. Can Nurse. Mission with a margin. Jun 25-Jul 1 1997. 2149. Nonpharmacological methods in relieving children's postoperative pain: a survey on hospital nurses in Finland. Fall 1993. Case Reports. 2158. 1994. Dec 1995. Iwatsubo Y. Not eligible target population. Medication administered through the wrong access line. Understanding the cognitive work of nursing in the acute care environment. Comment. 2162. Pope M. Revolution. Dorman T. Nursingconnections. Pronger L. Nurs Times. Measuring patient intensity.9(3-4):263264. 2163. Plati C. Not relevant. Nursing absenteeism--one determining factor for the staffing plan. Recruiting and employing foreign nurse graduates in a large public hospital system. 2150. Sep-Dec 2000. Wu AW. Ryan JW.86(44):19. It all depends. 2145. Can J Nurs Leadersh.17(1):1-2. Not eligible exposure. Not eligible outcomes. Nurs Manage. vii. Poquette MC. James SM. 2143. et al. Comment. inadequate staffing to forefront. 68. Burr G. 2147. New contract ensures safe hours. Stress.100(12):75-76. Comment. Nurs Times. Wolf L. 67-68.35(5):suppl 1-7. Jan 2005. Feb 2004. Critical care nursing quarterly Nov 1992. Not eligible target population. J Adv Nurs. Jun 2002. Platte J. 2146. Pizer CM.4(3):113-123.17(2):78-85. Comment. Granger M. 2166. Nursing. Walker J. 2144. 2148. Pronitis-Ruotolo D. The Synergy match-up. Case Reports. Boxerman S. Symptoms of estrogen deficiency in nursing personnel in Maharaj Nakorn Chiang Mai Hospital. Prescott PA. Case Reports. Victory for Youngstown nurses.37(1):89-96. Porter-O'Grady T.17(9):1057-1067. Nurs Manage. Plant MA. 2156.24(9):64-66. Cornock M. Procter S. 2151. Boxerman S. Evanoff B. Comment. Mar 2002.91(11):28-32. Aust J Adv Nurs. Summer 1997. Sledge J. Plant ML.15(3):29-36.11(6):354-359. Caillard JF. Daniels D. Building safety into ICU care. Not eligible target population. Accepting and refusing assignments. Powers BA. Leelarthaepin B. O'Riordan B. J Adv Nurs. Turning points: implementing kinetic therapy in the ICU. Wolf L. Nurs Manage. Apr 2004. Poroch D. 2154.2136. J Adv Nurs. Cosquer M. A mix-up of tubes. Marshall J. A reliability study. Walsh S. Prater M. Mantas J. Not eligible exposure. Not relevant 2155. Aust N Z J Ment Health Nurs. 2161. Not eligible target population. Soeken KL. May 2001.7(2):11-12. Case Reports. Nurs Clin North Am.34(4):483-492. safe staffing and quality patient care for RNs. The unexpected relocation of elderly inpatients in response to a threatened strike. Everyday ethics in assisted living facilitites: a framework for assessing resident-focused issues. Floating: sink or swim. Veron M. Spring 1994. Foster J. 2153.34(2):101-109. Medicalisation of life: are nurses involved? Contemp Nurse. Bonaparte B. 2157. quiz 8. Price C. Plowright C. Not eligible target population. Scand J Caring Sci. Dec 1995. Mapping the nursing process: a new approach for understanding the work of nursing.10(3):27-39. Grayson D.31(6):8. Pietila AM. Quera Salva MA. Eval Health Prof. Developing emergency nursing competence. May-Jun 2005. McIntosh W. Editorial. Case Reports.15(4):423-429. Not eligible exposure. Jun 2000. Comment. Not eligible exposure. Poirrier GP. May 2002. Plum SD. 2160. Polkki T. A national uprising. Not eligible target population. No association tested. tobacco and illicit drug use amongst nurses: a Scottish study.35(7/8):327-35. J Hum Ergol (Tokyo). Sep 1995. 2140. Jul 2001. Review.

One year on: Part 2. Res Nurs Health. Fielding B. 2182.2(1):15-23. Kishen M. 2174.17(1):43-45.8(4):414-421. Ream KA. 2177. SepOct 2003. Rawlinson D. Rapala K. Nixon R. Nursing and medical staffing in neonatal units. Quality of nursing care perceived by patients and their nurses: an application of the critical incident technique. Prof Nurse. 2188. Quality of nursing care perceived by patients and their nurses: an application of the critical incident technique. Jun 15 1995.13(1):41-44.11(3):5-10. Oct 2003. Education as a determinant of career retention and job satisfaction among registered nurses. Ray CE. 2195. Ramritu P. Du Plessis E. B-64 . How effectively do we use double staff time? Aust J Adv Nurs. Morgan D.29(3):245-253.6(4):229-244. Ramudu L. Mar-May 1994. RCM Midwives. Crit Care Med. Discharging older people from hospital to care homes: implications for nursing. Jul 1999. Factors explaining variability among caregivers in the intent to restrict life-support interventions in a pediatric intensive care unit. 'Patient satisfaction': knowledge for ruling hospital reform--an institutional ethnography. Restricted versus open ICUs. Clinical governance. Not eligible exposure. McIntosh B. Not eligible outcomes. Not eligible exposure. 2173. Eur J Anaesthesiol. Nurs Manage.4(6):33-34. Cathelyn J. Finlayson K. Fla Nurse.37(2):185-192. J Nurs Manag. Not eligible exposure. 2178.7(7):312. Sheehy S. Not eligible exposure. Pract Midwife. J Emerg Nurs. Experiences of the generalist nurse caring for adolescents with mental health problems. 2176. Rawnsley MM. training. Harris A. Randolph AG. Not eligible target population. Comment. Sep 1993. Harris A. Goucher E.17(6):402-407. 2199. J Adv Nurs. 2179. Courtney M. Not eligible exposure. Response to Kim's human living concept as a unifying perspective for nursing.4(4):171175. Medication-management component of a point-of-care information system. Aug 28-Sep 3 1991. and qualification. J Nurs Scholarsh. Not eligible target population.45(4):351-359. Hosp J. Ratio bill gains support. 12. patient-classification systems. 2190. Dec 2000. Pullenayegum S. Feb 1998. Am J Health Syst Pharm. J Obstet Gynaecol. Apr 1999. Guidelines. Jagim M. Not eligible target population. Not eligible target population. Mar 2003. Sandman PO. Rauhala A.10(1):57-65. 2185. Reinier K. 2192. Accuracy of emergency nurses in assessment of patients' pain. Not eligible target population. 2183. Gallagher G. 2191. Jan 1994. 2186. Crit Care Nurs Clin North Am.47(2):34. J Clin Nurs. Pumford S. Determining optimal nursing intensity: the RAFAELA method. News. Rae CP. Part 2. Dec 2002. Audit of nutritional practice and knowledge. Not eligible target population.14(14):778-784. Comment. 2189. Not eligible target population. 2201. Mentoring staff members as patient safety leaders: the Clarian Safe Passage Program. Nurses' work in a hospice and in an oncological unit in Sweden. Peate I. King I. The value of the role of the rehabilitation assistant. J Child Health Care. Raines DA. N J Nurse. Mar 1997. 2194. Quigley P. 2193. An audit of patient perception compared with medical and nursing staff estimation of pain during burn dressing changes.17(2):121-126. Feb 2005. Puckett F. Nurs Sci Q. Smith R. Not eligible target population. Jun 2005. Reed J. McKay JI. Norman I. Assessment of contraceptive services in a maternity unit of a district general hospital in the UK. Gugliotta B. 2180.13(5):291-294. Not eligible target population. A survey of emergency department triage in 185 hospitals: physical facilities. Redshaw ME. J Emerg Nurs. Dec 1991. 2197. Not eligible exposure. Rayens MK. 2202. Not eligible target population. J Clin Nurs.52(12):1305-1309. Not eligible target population.8(4):407-413. J Nurs Manag. News. waiting times. Dec 2003. Purnell LD. Svavarsdottir EK. Jan 2000. Pain Manag Nurs. Jan 2000. Glenn LL. Ramsey P. Rankin JM. Fagerstrom L. Nurse staffing and patient outcomes from one acute care setting within the Department of Veterans' Affairs. 2200. Kinsella J. Norman I. Quinn S. Jun 2003. J Emerg Nurs. Part 1. Jun 2001. Rawal N. Nursing skill mix in neonatal care. Br J Nurs. Rainer SR. Feb 1996. Watson S. 2000. Not Eligible Exposure.87(35):31-33.25(3):435-439. 2187. 2196. Ingram JC. and skills of triage personnel. Jun 1999. Agnew J. 2181. Yeh TS. Pettigrew C.33(7):1. Nurs Times. Higgs J. Redshaw ME. Rambur B. No association tested.2172. Stanley T.25(2):179-181. J Adv Nurs. California to mandate nurse-patient staffing ratio. Palumbo MV.26(5):409-419. Revising routines. Redfern S. Janzen SK. Rasmussen BH. Not eligible target population.15(1):17-25. 2005.1(5):221-228. Choices of neonatal nurses in ambiguous clinical situations. ENA's new guidelines for determining emergency department nurse staffing. Making a nonsense of training. fast-track systems. partner. Feb 2004. 2175. Not eligible target population. Bellet B. Zollo MB. and interaction effect model for family outcomes.26(6):29A. 2198. Puntillo K. ix. Wigton RS. Not eligible target population. Neonatal Netw. Jan 2000. Redfern S.31(1):42-44.29(4):819-825. Das G. No association tested. Ralston R. A new methodological approach in nursing research: an actor. Jul 2004. 2184. Comment. O'Neil N. Not eligible target population. Nurs Inq. Sargent J. Latimer C. Neighbor M. Jul 28-Aug 10 2005.15(1):53-75. Jul 1999.

33(13):20-24. Richardson JR.8(3):465-480. Devaney F. Work well campaign. Kim HM. Transfer of a patient with a ventricular assist device to a non-critical care area. Robinson G. Nurs Manage. Reid C. Iapichino G.19(5):938-946. Twelve-hour shift on ITU: a nursing evaluation. Moody R. Tobacco cessation intervention in a nurse practitioner managed clinic. 2225. Comment. Larson PA. J Adv Nurs. Preimplementation financial evaluation of a structural work change: cost analysis of an innovative staffing schedule. Todd C.12(5):163-9. Bmj. Carthey J. Reilly P. Render ML. Mar 2002. Reilly P. Reid N. Feb 2005. 2231.24(3):479-487.28(5):62-69. Not eligible exposure. Spring 1994.9(1):28-33.28(1):47-54. Richardson T. 2213. educational programs. Feb 23 2004. J Adv Nurs. Importing controversy. de Leval MR. 2227. Cohen GA. Revolution. 2229. Multidisciplinary assessment at triage: a new way forward. Lyne M. 2230. No association tested. 1991. Comment. Hofer TP. 2219. Mod Healthc. Not eligible target population. Nurs Crit Care. Daley J. 2210.31(6):1638-1646. 2208. Comment. Calabro K.36(2):18. May 1999. Manual handling activities and injuries among nurses: an Australian hospital study. 2207. Not eligible exposure. Dabner N.8(3):103-108. Timmons S. The Sutter Memorial experience. Plug into success with centralized flex staffing. Case Reports. Not eligible exposure. 2217. Spring 1996.320(7241):1031-1034. Ricketts T. Not eligible target population. Apr 2000. Goldman AP. AdamsMcNeill J. Clin Radiol. J Nurs Adm.32(43):14. Mod Healthc. Intensive Care Med. Reilly P. Review. Not eligible target population. Nov 24 2003.36(5):14-5. Thomsen C. Crit Care Clin. Rich K. Smith P. In need of nurses. Developing a tissue viability nursing assistant role. Journal of the American Academy of Nurse Practitioners May 2000. Jan-Feb 1993. Not eligible target population. Richardson A. Reid N. Not eligible target population. Johnston J. Feb 2004. Burnand V. Not eligible target population.. Curtis S. Nurs Manage.18(3):68-73. Sep 2004. Case Reports. Mod Healthc. 2205. foundations. 2224.27(10):38. Reilly P. Not eligible exposure. Crit Care Med. Reed P. Nurs Stand.11(13-15):45-47. A suitable case for treatment.1(4):31. Inhospital cardiac arrest: pre-event variables and nursing response. Blegen MA. Healthc Leadersh Manag Rep. 2221. 2206. Nurs Ethics. 2232. News. Reedy JE. Bradding A. 2228. Automated intensive care unit risk adjustment: results from a National Veterans Affairs study. Welsh DE. May 1994. Nurs Crit Care. Heart Lung. Int J Nurs Stud. 2216. B-65 . Yeoh MJ. Oct 28 2002. 2226. 2218. Promoting the dignity of the child in hospital.31(4):875-883. Reynolds M. Coulter C. Peeler C. Not peer reviewed. Lehane M. 2211. Wagner D. Mod Healthc. "Coopetition. Reisdorfer JT. Mandatory overtime: whose right is right? Revolution. Black L. Jr. U. Foreign certification. 2214. Regan S.33(47):S19-20. Ricci M. Nurs Adm Q.2203.57(12):1067-1069. Emerg Med Australas.10(1):67-76. Not eligible target population.10(3):1-9." perks and price tags: stakes grow higher as the workforce crisis worsens. The nuts and bolts of organizing and initiating a pediatric transport team. Clin Nurse Spec. Reis Miranda D. 2234. J Adv Nurs. MayJun 2003. Richie K. recruitment. Connors AF. Not eligible target population. Not eligible target population. Oct 1996. 2222. JAMA study: chance of dying increases with more patients under nurse's care. Jul-Aug 2000. Apr 15 2000. Retsas A. Witnessing violence to staff: a study of nurses' experiences. Not eligible target population. Comment.6(1):35-38. Dec 2002. Patient focused care: consultants. 40.23(7):760-765.S. Goode CS. Nurs Stand. No association tested. May 1998. Jul 1997. Nine equivalents of nursing manpower use score (NEMS). Building a patient-focused care unit.18(32):68-72. Ward nurses' evaluation of critical care outreach. Renaud M. Todd C. Pitfalls of adverse event reporting in paediatric cardiac intensive care. Richardson A. Riddell AM. Dec 18 1996. Illinois hospital makes name for itself through RN retention. Not eligible target population. Pinikahana J. A survey of current practice in out of hours percutaneous nephrostomy insertion in the United Kingdom. Colley H. hospitals' recruitment of foreign nurses stirs debate as poorer countries struggle with staffing shortages of their own. AHA seeks delay on regs for immigrant nurses. Fletcher M. Moreno R. Reed JL. 2212. Not eligible target population. Educational activities on wards under 12 hour shifts. Rees C. Nurs Times. 2215. Robinson G. 2223. General satisfaction and satisfaction with nursing communication on an adult psychiatric ward. 2220. Hui S.91(24):28-30.16(1):4146. No association tested.13(3):147-153. Reeder L. The 12-hour shift: the views of nurse educators and students. Not relevant. 2204. 2233. Apr 21-27 2004.22(1):71-76. Jan-Feb 2004. Arch Dis Child. Jun 2003. Sep 1996.89(9):856-859. A case for more nurses. 2209. 42 passim. Reeve K. Braitberg G. Not eligible target population. Jun 14-20 1995. Nursing BC Dec 2004. Charig MJ. Fewer graduates able to find full-time employment.34(8):17. quiz 154-146. News. Jan 2003. Review. Mar 31 2003. Reichelt PA. Adverse patient occurrences as a measure of nursing care quality. Inpatient care of mentally ill people in prison: results of a year's programme of semistructured inspections. Jul 1992. Reed L. Reid T.

Oct 2000.14(3):223-228. Dresden GM. Not relevant. Ramon JM. Robinson J.34(4):167-169. Keim J.13(3):142. Molyneux EM. Lampat LR.14(3):223-8. Jun 1991. Review. Dodek P. Recruitment and retention. Edtna Erca J. 2269. Registered nurse hours worked per patient day: the key to assessing staffing effectiveness and ensuring patient safety. 2243. 2236. 2254. Guyatt G. Apr 1995. Oromi J. Not eligible target population. Sep 2003. Robinson S. Crit Care Med. Not eligible outcomes. Qual Health Care.86(38):31-33. Rollins D. Flentje JR.85(3):208-213. Nurse burnout: work related and demographic factors as culprits. Cost of intensive therapy. Street A. Think pink. Sep 2001. Riley J. A description of methodology and initial results. Not eligible exposure. Fall 1997. Haig N. Dec 1998. Duran MM. Ridge KW. Smith NA. 2255. Ringerman ES. Not eligible target population. Not eligible exposure.51(3):810-811. Barber ND. The Beverly Allitt case. Triage in the developing world--can it be done? Arch Dis Child. Risk for occupational transmission of HIV infection among health care workers. Journal of Nursing Administration Nov 2004. 2261. Jan-Feb 1992. Robertson MS. Patient and provider attitudes toward commercial television film crews in the emergency department. Romea S. Robinson SE. 2259. Aiken LH. 2251. May 2004. Not eligible exposure. et al.1(4):10-11. Eur J Epidemiol. Dec 1995. Health Care Manage Rev. 2252. Feb 23-Mar 1 1994. Rivers FM. Nurs Times. 2262. Not eligible exposure. Etard JF. 2268.2235. Can prescription of sip-feed supplements increase energy intake in hospitalised older people with medical problems? Br J Nutr. Nurs Staff Dev Insid. 2247.23(4):202-212. 2258.91(42):46-47. Levy M. Sep 19-25 1990.30(1):27-30. Rollins G. Roth SL. Mussol LR.8(22):21-22. Helicobacter pylori infection in intensive care: increased prevalence and a new nosocomial infection. News. 2266. Comment. Young JC. 2253. 2240. Alkiza ME. Comment. B-66 . Ronsmans C. Dangerous liaison.8(10):940-948. McColl J. Health Aff (Millwood). Ridley S. Hassan M.79(4):30. Sjokvist P. Robb EA. Keim J. Robinson A. Rocker G. Florence of Arabia.32(5):1149-1154. Robinson CA. Dinges DF. Planning shift patterns. J Emerg Nurs. Nurse burnout: work related and demographic factors as culprits. 813. Rogers AE. Qualified in caring? Nurs Stand. Maternal mortality and access to obstetric services in West Africa. Jun 1990. 12-hour shifts. 2263. Rogers R. Torrent AM. Comment. Ritter-Teitel J. Nurs Manage. No vacancies. Robertson MA.31(10):42-46.29(3):199200. Roberts G. Jul 1999. Self-scheduling: satisfaction guaranteed? Nurs Manage. Reilly J. Aug 2001. Mar 1990. Not eligible target population. 2264.46(7):523-530. Who's exempt? New overtime rules still getting scrutiny from nurse unions and lawmakers.34(7):16-18.90(2):425-429. Not eligible outcomes. passes bill to end mandatory overtime. Jan-Mar 2004. Jun 2003. Cross-training: maximizing staffing flexibility. Dowd SB.27(7):1276-1280. Hwang WT. Not eligible outcomes. Evaluation of a bed utilization system in a surgical nursing section. Anaesthesia. Jun 2004.94(45):30-31. Not eligible target population. Medication errors during hospital drug rounds. Nov 14-20 1990. McDonald E. Weaver B. News. Riley V. Kirby A. No association tested. Medsurg Nurs. Research in nursing & health Jun 1991. Robinson K. The effects of work breaks on staff nurse performance. Robertson RH. 7. Evaluation of relationships between haemodialysis unit professionals. Finfer S. Shift work. Nurs Times. Jul 2001. Not eligible target population. Nursing's perfect storm--staff shortages and patient ratios. 2237. The working hours of hospital staff nurses and patient safety. Res Nurs Health. Jenkins DB. 2238. Not eligible target population.163(12):839843. Nurs Manage. Roberts D.4(4):240-243. Editorial.13(17):16. 2245. Marshall J. de Bernis L. Robinson SE. 2265.21(6):48I-48J. Case Reports. Ritz DA. Competence increases comfort for float nurses. News. May 2004.11(2):225-229. Apr 2004. Jan 13-19 1999.12(3):411-423. Rohland P. Gatius JR. Acad Emerg Med. Roberts M. Cade JF. Hoj L. Not eligible target population. Noyce PR. Revolution. Comment. Roscoe J. Determan AC. Navarrete IG. 2256. Scherbring MJ. Bashor K. Jul 2003. 815. Not eligible exposure. Nurs Stand. Improving networks between acute care nurses and an aged care assessment team.34(11):512-9. Stone P. Nichols D. Potter J. Scott LD. Education. Levenson M. Walraven G. Clinician predictions of intensive care unit mortality. Apr 2005. Kodio B. Not relevant. Trop Med Int Health. 2257. 2267. Nurs Times.22(4):61-71. Ventura S. No association tested. Heyland D. Aorn J. Lavallee SM. Workforce.8(7):740-745. Hwang W. Solano M. Study in a Spanish hospital. Nov 11-17 1998. Cook D. Rodriguez L. No association tested. Aug 2003. 2249. Magnet nursing services recognition: transforming the critical care environment. Jul-Aug 2004. Slifka RM.5(8):43. 2260. Rodriguez RM. Biggam M. Oct 1824 1995.1(1):4.J. An outcomes approach to skill mix change in critical care. 2250. Nurs Stand. Jul-Aug 2000. Jul 1991. Roth SL. Mil Med. J Clin Nurs. Pueyo CG. 2239. 2242. No association tested. Clancy RL. Rogers AE. Not eligible target population.34(9):10. Rivares AV. Fielding P. No association tested. Dumont A. 2244.13(4):486-496. Oct 2003. Scott LD. Nurs Manage. Hosp Health Netw. Comment. A scheduling alternative for ORs. Study side notes. 2246. Skill-specific staffing intensity and the cost of hospital care. Not eligible exposure. Nenninger KM. 2248. 2241. Crit Care Med. AACN Clin Issues. N. J Nurs Adm. Dugan MF. Four ways to make a difference.

Ryrie I. Sep 1995. 2293. Rosenstein AH. A randomized controlled trial of a nursery ritual: wearing cover gowns to care for healthy newborns. Lindenauer PK. Hills B. Nurs Leadersh Forum. Implementing a patientfocused care delivery model. Rosenthal VD. 2277. Kaufman K. 2286.12(26):23.5(3):101-106. Reducing readmissions to the intensive care unit. 2276. Rothrock JC. May 2003. Feb 1999. Feb 2-8 1994. The effect of a structured neonatal resuscitation program on delivery room practices. Ryan T.8(9):1-6. State-by-state numbers and initiatives. Rose DN. Study links disruptive behavior to negative patient outcomes. 2289. J Clin Nurs. Not eligible target population. 2294.21(3):39-40.12(4):208-212.9(6):583-598. Benchmarking patient outcomes. Dec 1998. Matlack R.5(11):18-19. Raymond R. Children's participation in the decision-making process during hospitalization: an observational study.18(1):25-30. 2001. Not eligible target population. 2273. A prospective two-month audit of the lack of provision of a high-dependency unit and its impact on intensive care.28(5):365-372. Comment. Sep 1996. Russell S. Jingree M. Comment. A randomised controlled trial of weaning from mechanical ventilation in paediatric intensive care (PIC). Davidson LJ. Reynolds TM.11(1):73-81. Nadzan L. Aug 2005. Review. Ruflin P. J Psychiatr Ment Health Nurs. Ryan CA. Sorbello S. Elander G.21(3):1. Heart Lung. Comment. Not eligible target population. Harrington C. Rusch LM. Recruit Retent Restruct Rep. 2297. Runy LA.33(4):196198. Not eligible target population. Malone A. Roseman C. Hospital care for elderly. Nurs Stand. Russell D. Ravn IH. Closed-unit staffing speaks volumes.17(1):25-30. Mar 18-24 1998. Designing a nursing model for dermatology. 2282. 2295. 2291. CRNA vacancy rates in US hospitals. 2285. Not eligible outcomes. 2271. Holy C.43(8):785-791. Sadaba JR. Todays Surg Nurse. Not eligible exposure. Sep 2004. 2287.44(4):226-230. A buddy program for international nurses. 2275. Legal cases. Ryan M. Patients' perceptions of nurse uniforms. Mar 1997.5(2):137-142. Rowe J. B-67 . Jun 2003. Thomas K. Rothman LW.52(3):265-270. J Tissue Viability. Improving nurse-to-patient staffing ratios as a costeffective safety intervention. No association tested. Ruane-Morris M.76(8):41-46. OR Manager. Review. Hosp Health Netw. Usefulness and effects on costs and staff management of a nursing resource management information system. Not eligible exposure. Effect of education and performance feedback on rates of catheter-associated urinary tract infection in intensive care units in Argentina. Not eligible target population. Rosen LF. Winter 2004. Comment. Workload and environmental factors in hospital medication errors. Routh BA. 2272. Prof Nurse. 2298. J Psychiatr Ment Health Nurs. The changing face of staffing--UAPs. Rowen L.11(2):67. Journal of nursing management May 2003. author reply 1131-1132.33(6):350-352. Russell LJ. 2281. 2278. Weldon OG. May-Jun 1999. JulAug 1996. J Nurs Adm. How accurate are pressure ulcer grades? An image-based survey of nurse performance. Comment. O'Daniel M. Staff perceptions of substance use among acute psychiatry inpatients. Comment.11(3):208-15. Jun 1999. Lawton S. Safdar N.8(19):32-36. Apr 2005. 22. Aspens Advis Nurse Exec. Nurse anesthesia Jun 1990. On the record. J Nurs Adm.25(1):47-50. Am J Nurs. Nurs N Z. Rowland W.1(2):61-70. 70-65. 2284. Dec-2000 Jan 1999. No association tested. 2296. Rudy EB. Selecting the perioperative patient focused model. Booker JM. 3-6.30(6):37-39. Eur J Cardiothorac Surg. 2279. The health care workforce. 20. Hermeren G. Ryan M. Jul-Aug 1995. Med Care. Mar 2005. Nurs Res.71(5):10301034. The effect of music listening on acute confusion and delirium in elders undergoing elective hip and knee surgery. Guzman S. Sions J. Nurse staffing levels and budgeted expenditure in acute mental health wards: a benchmarking study. Not eligible target population.103(5):115. Not eligible exposure. Not eligible exposure. Supporting clinical nursing leadership and professional practice at the unit level. Apr 2003. 2288. Bayly PJ. Rushforth K. Anaesthesia. Stafford R. Implementing patient-focused care: success indicators for measuring satisfaction. Birth. Smith DA. Locsin R. Hallstrom I. Clark LM. No association tested. Changing public health nursing practice. J Nurs Scholarsh. Not eligible exposure.21(2):7686. Not eligible outcomes. Selden T. Rosenfeld P. 2280. Wheatley GH.33(2):185-189. 2290.25(6):1130-1131. Ryan DW. Rothberg MB. Nov 2002. Comment. News. 2299. Nurs Stand. Whitman GR. Not eligible target population. Apr 1998. The patient care delivery mode at Mercy Medical Center: a licensed caregiver model. 2292. Comment.9(2):61-66. Jan 2004. Feb 2004. 2300. 2303. 2283. Methodological and practical issues. Not eligible exposure. Jun 2004. Not eligible target population. Runeson I.13(6B):91-96. Making oneself at home? Examining the nurse-parent relationship. Nurs Manage. quiz 40. 2301. Aorn J. 1036-1037. Not relevant. Contemp Nurse. No association tested. Infect Control Hosp Epidemiol. Rush J. Mar 1990. Rosenbach ML. May 2000. 2302. Lucke JF.14(3):1. Ruland CM. Sep-Oct 1999. Webb L. Not relevant. Rudy S. Fiorino-Chiovitti R. Neonatal Netw.2270. Abraham I. McGowan J. Mitchell A. Nurs Ethics. Ruth M. 2274.10(9):565-566. Surgical assistants and working time directives. J Nurs Staff Dev. Apr 2001. Jun 1995. Thompson G. Floating: managing a recruitment and retention issue. Ahmed S. Intensive Crit Care Nurs. Aug 2002.

White PF. Br J Nurs. Comment. J Adv Nurs. 2332. King DJ. Burrows E. let's support each other more. continuity and control: changing midwifery. Decreasing companion usage without negatively affecting patient outcomes: a performance improvement project. A review of risk factors for catheter-related bloodstream infection caused by percutaneously inserted. 2318. Jawad AF. Midwifery. 2313. 2307. Jun 24-Jul 7 2004.2304. Clancy M. Drug administration and professional accountability. Not eligible target population. More than just a resident issue? Gastroenterol Nurs. Scarbrough ML. Not eligible exposure. Mulhim KA.11(4):201-209. Hoult L. The law. Nov 1992. Aquila A. J Nurs Adm.21(8):723744. Implementation of the Ottawa Ankle Rules by nurses working in an accident and emergency department. MayJun 2000. Not eligible exposure. Impact of dedicated space. J Nurs Adm. Med Princ Pract. Sanz C. Aug 3-9 2004. 2311.13(12):690. Ludwig-Beymer P. J Pain Symptom Manage. 2316. Stress in perioperative nursing: sources. J Perianesth Nurs. Not eligible target population. 'I call it the rock and roll of nursing'.15(2):141-144. 2315. 2327. Nurse sabbatical: reflections on professionalism. 2320. May 1995. Muzynski J. Jul 1998. 2330. Prof Nurse. Clin Nurse Spec. Not eligible exposure. Nurs Spectr (Wash D C).20(1):109-118. Comment. Issues Ment Health Nurs. Mar 1997. Dec 1995. Comment.91(11):39-40. Comment. Santamaria N. 2305. J Nurs Adm. Kluger DM. Iversen R. Not eligible exposure. Oct 2000. Not eligible target population. MEDSURG Nursing Aug 2003. Sunol R. Nurs Times.12(4):230-7. Sanderson D. Goes J. Saxena AK. Design and results of the nursing quality assurance program in Hospital de la Santa Creu i Sant Pau: an integrated effort.22(3):10-15. Not eligible target population.12(4):153-167. 2331. Sundaram DS. Sandall J. The relationship between nurses' personality and stress levels reported when caring for interpersonally difficult patients.33(9):478-485. Sales A. Scharer K. Panhotra BR. Aust J Adv Nurs. Salt P. 2317. 2328.16(2):109-111. Naguib M. Not eligible target population. Scharer K. Morrison B. Schaffner M. Apr 2001.100(31):28-29. Moscovice I. Dailey T. J Accid Emerg Med. The relationship between nurse staffing and patient outcomes. Salyer J. A quantitative study of nursing staff interactions in psychiatric wards. frequency and correlations to personality factors. Sep 2003. Jun 2 1999. Heyman R. Legal cases. Nursing.32(4):913-921. Dec 2000. Venkateshappa CK. Fisher S. Freed H. towards a sociological perspective.81(1):46-51. Saxena AK. Differences in preferences for neonatal outcomes among health care professionals. Not eligible exposure. Abello C. Review. J Healthc Qual. 2306. Sartain SA. Not eligible exposure. 2319. Safdar N. nurses and coffee breaks. 2324. J Child Adolesc Psychiatr Nurs. 2323. 2314. Sep 1993. 2325. Not eligible exposure.7(8):443-453. Dec 1995. 2333. Nurse-parent relationship building in child psychiatric units. Hearing the voices of children with chronic illness. Sawaki Y. 2308. Furlong W. Aug 11 1997. and adolescents. Sanchez-Sweatman L. Uzzaman W. Aug 1997.31(1):26-33.81(6):466-479. Blanc A. Propotnik T. Not eligible target population.26(2):82-83. O'Sullivan S. Apr 1995. Not eligible target population. Not eligible target population. Lurie N. The impact of nurse understaffing on the transmission of hepatitis C virus in a hospital-based hemodialysis unit. Nursing gets an "A".21(5):219-225. Admission: a crucial point in relationship building between parents and staff in child psychiatric units. Mar-Apr 2003. Feeny D. Nov 2002. Not eligible target population.281(21):1991-1997. A pilot study for the development of a hospital-based immunization program.5(3):267273. Nov 1997. Lennon M. Sasichay-Akkadechanunt T. Sandford DA.25(4):12-20. 2322. Nurs Manage. 2326. No need for pain.11(2):70-75. Costa L. Comment. Sandlin D. Choice. Rosenbaum PL. B-68 . Developing a patient care model for an integrated delivery system. Salamon L. 2321. Mar 1997. Sep 1999. 2329.7(16):3. Collegian. Is quality in the eye of the beholder? Jt Comm J Qual Improv. Sanford K. Sandiford R. Nurses. Landis SE. 2309. Stoskopf BL. Take a bite out of high employee turnover. 2310. Fighting fatigue. Not eligible target population. noncuffed central venous catheters: implications for preventive strategies. and nursing staff on the transmission of hepatitis C virus in a hemodialysis unit of the middle east. Schaffner JW.23(9):118.12(11):827. Panhotra BR. Can Nurse.13(3):129-135. Jan 1990. Am J Emerg Med.18(2):20-26. Salvage D. Peters T. Sayers M. 2312.29(9):43-50. Am J Infect Control. Alleman S. Dec-2001 Feb 2000. Not eligible exposure. Attitude of emergency department patients toward HIV-infected health care workers. Oct-Dec 1999. Schaffner A. Impact on nurse performance. Not eligible exposure. Elzinga RH. Jan 1990. Acta Psychiatr Scand. Environmental turbulence. Qual Assur Health Care. Salluzzo RF. Jama. Graber M.14(6):363-365. Marando R. 2334. Clarke CL. Editorial. Not relevant.5(3):10-15. Feb 2003. Review. Santamaria N. Maki DG. Patient and nurse evaluation of patient-controlled analgesia delivery systems for postoperative pain management. Not eligible exposure. Medicine (Baltimore). Parker RK. Sep 1992. May-Jun 2004. Pacura LJ. Scalzi CC. parents. Saigal S. Research shows nursing agencies in a positive light. Not eligible exposure. Bartfield JM. Saver C. dialysis equipment.

Caley L. Apr 15 1995. 2360. 2339. Br J Nurs. Friedman LH. unlicensed assistive personnel. Scott CA. May 2002. Review. 2348. Not eligible outcomes. and physicians' perceptions of nurses' caring behaviors. Journal of Nursing Administration Feb 2006. Scharf L. Am J Health Syst Pharm. Am J Emerg Med. Haughey BP. and work performance among hospital staff nurses. Not eligible outcomes. Spring 1993. 2346.26(6):1033-1042. J N Y State Nurses Assoc. 2351. 2357. Schmidt CE.20(6):641-643.14(2):51-53. News. Not eligible target population. 2362. Not eligible exposure. Not relevant.95(48):21. Correlation between triage nurse and physician ordering of ED tests. adverse events. Jan-Feb 2004. B-69 . J Emerg Nurs. Clin Nurse Spec. 2363. Allen PJ. Scholz JA. and organizational culture in hospitals. Nurs Stand.5(1):8-9. Nursingconnections. nurses'. Bottoni T. Interview by Marietta Lee. The closing down of a hospital is deeply traumatic for patients and staff. and contributing factors. Schumacher KL. J Nurs Adm. Issue: how do you tell your patients that you are short-staffed? Ohio Nurses Rev. Schmieder RA.23(3):10-15. P. Documentation in the pediatric emergency department: a review of resuscitation cases. 2366. 2337. Not eligible outcomes. Scholz DA. News. Jul-Sep 1982. Versatility-consequence of changing from mixed to all registered nurse staffing on a surgical ward. Wu YW. Patients'. 2365. 291. Schnelle JF. Scherer YK. Farrell M. Not eligible year. Scheerle PK. Scott LD. Not eligible outcomes. K.73(5):16. Revolution. Perspect Psychiatr Care. Right to nurse.80(3):21-24. Massachusetts safe staffing: time runs out for bill this year but final hurdle on horizon. Cotting J. Jul 1994.4(2):71-74. 2361. Lindstrom I. Jan 1998. Seago JA.20(4):178-182. Nurs Econ. Jul-Aug 2004. 2358.24(2):51-54. Sefton G. Seaberg DC. Baker MD. Editorial. Registered nurses.10(2):128-40. Jacob M. Not relevant. 2352. Feb 1990. Not eligible exposure. Lundgren S. 2345. Feb 2001. MacLeod BA.29(1):12-16.39(2):225-50. Hosp Top. Brockton nurses end 103-day strike. Relationship of nursing home staffing to quality of care. Not eligible target population. and overall satisfaction with the hospital experience. 2341. 2336. Ruelo V. Pay special: a bit excessive. Not eligible target population. Schildmeier D. 2350. Nursing home. 2340. Hwang W. Establishing and monitoring an endemic medication error rate.2(5):5. Evaluation of nurses' errors associated in the preparation and administration of medication in a pediatric intensive care unit. Comment. Feb 1997. Scott J. Moderating effects of social support in shiftworking and non-shiftworking nurses. Reconceptualizing family caregiving: family-based illness care during chemotherapy. Schmidt LA. J Nurs Manag.36(2):86-95. Administrative decision making: staff-patient ratios (a patient classification system for a psychiatric setting).20(3):111-123. 2353. Comment. et al. Revolution. Work & Stress Apr-Jun 1996.72(2):16.94(7):38-40. A longitudinal study of nurses' attitudes toward caring for patients with AIDS in Erie County. Not eligible target population. Feb 2003. 2356. Seago JA. Not eligible exposure. Scholz JA. The perceived learning needs of paediatric intensive care nurses caring for children requiring haemofiltration. Not eligible target population. severity.17(1):40-50. Contract includes staffing/mandatory OT protections.19(4):261-271. Scott RA. Brodowy BA. 2342. Not eligible outcomes.6(4):223-230. Aug 1996. Chemotherapy medication errors: descriptions. Oncol Nurs Forum. 2355. Res Nurs Health.30(5):278-286. Patients' perceptions of nurse staffing. Jul 1998.52(8):823-828. 2354. Implementing practice innovations to improve nurse-client relationships. 2344. Epilepsia. Pannatier A. Sep 9-22 2004. Jul 1999.41 Suppl 5:S3-8. Schwarz HO. Improving medication safety and patient care in the emergency department. Falero Y. May 1998. Putting patient-centred care at the heart of nursing. Implementation and evaluation of an automated dispensing system.13(16):937. Rehabil Nurs. 2343. Smith CS. May 2000. 2000. Collective bargaining in the nursing profession: salient issues and recent developments in healthcare reform. Scott H. Fish TR. Comment. Schraeder M. Sciabarra C. Seccombe I. MNA blows whistle on hospitals using paramedics in RN roles. Issue: what guidelines does the Joint Commission on Accreditation of Healthcare Organizations use to determine if a hospital has adequate staffing for patient care? Ohio Nurses Rev. Intensive Crit Care Nurs. Schildmeier D. Schildmeier D. Harrington C. Interview. Sep 1992. Nurs Times. Quigley PA. Health services research Apr 2004. Revolution. Pharm World Sci. Summer 2002.22(6):295-306. Schroder PJ. Simmons SF. Ann Emerg Med.2335. Dec 1-7 1999. Mar-Apr 1999. Am J Nurs. A comparison of two patient classification instruments in an acute care hospital. Jun 1991. Schoenfeld PS. Segesten K. Not eligible exposure. J Nurs Qual Assur. Mar 2000. 2349. Not eligible exposure. 2347. Mar 8-14 1995. Design of an intensive epilepsy monitoring unit.32(5):243-249. Nov-Dec 2004.16(1):8-11. Rogers AE. 2338. Noyes J. News. Kronawetter N. stress. 2359. Miller CM. Aug 1998. J Nurs Adm. Sep-Oct 2001. Schneider MP. The impact of multiple care giving roles on fatigue. 2364. Not eligible target population. nursing care. Schulmeister L. Washington WP. Review.5(4):9.6(1):3-12. Scheerle. Not eligible exposure.9(24):45. Not eligible exposure. Multi-site coverage gives new meaning to "beyond the walls".

Soc Sci Med. Meeting psychosocial needs of medical patients in the acute care setting. Hollinger-Smith L. Not eligible target population. Nurse bait: strategies hospitalized patients use to entice nurses within the context of the interpersonal relationship. Fein JA. 2371. Not eligible target population. Not eligible target population. Sellick KJ. Nov-Dec 1996. 2392. Not eligible exposure. Nov 1997. Comment. B-70 .97(11):3543. Comment. 2379. Shields L. No association tested.21(5):460-464.26(2):511. Nurs Clin North Am. Comment. Shaha SH. Ohio Nurses Rev. Selbst SM. 2383. 2390. Kinnunen J. Pediatr Nurs. Jan 16 1992.14(6):346-356. Hofdijk J. The WISECARE Project and the impact of information technology on nursing knowledge. Jul 2003. Long-Middleton E.26(2):205-223. Seo Y. Russell S. Sheward L.102(5285):20-21. 2370. Hoy D. 2376. Dormann A. May-Jun 2004. Sharma T. Issues Ment Health Nurs. Shamian J. Primary nursing: an evaluation of its effects on patient perception of care and staff satisfaction. Patient care. J Pediatr Nurs. Shattell M. Not eligible exposure. Mar 2004. Skill mix and clinical outcomes. Patient voices. Aug 20 1993. Not eligible target population. Tsai PJ.30(1):77-86. Shinkman R. Stud Health Technol Inform. Hall J. Tansley J.41(4):437-446. The determinants of job satisfaction among hospital nurses: a model estimation in Korea.12(1):10-11. Mar 1995. Seigerst EG. Gau ML.15(1):1-4. Hosp Health Netw. Int J Geriatr Psychiatry. Shields L. The state of the health care workforce. Tanner A. Cheng Y. Qualitative analysis of the care of children in hospital in four countries-Part 2. Pediatr Emerg Care. Not eligible target population. Not eligible target population. Liao YC. The effect of an educational intervention package about aggressive behaviour directed at the nursing staff on a continuing care psychogeriatric ward. Not eligible target population. Hosp Health Netw.13(1):35-40. Pilot study of a tool to investigate perceptions of family-centered care in different care settings. De T. King S.11(11):1. Commentary. No association tested. J Nurs Manag. 2384. Int J Nurs Stud. Macleod M. Shindul-Rothschild J. News. Nurs Econ. Am J Nurs. Oct 2003. 2373. Next steps for nursing. No association tested. J Nurs Adm. Aug 2000. Comment. Ohio Nurses Rev. 2385. MacLeod JA.11(12):790-792. Ko J. Nov 2004. Feb-Mar 2005. J Occup Health. Shader K. Perlia MA. Prof Nurse.31(4):210-216. Beckmann JL. Eur J Clin Nutr. Nurs Forum. West ME.16(2):36-41. Jan 2005. Not eligible outcomes.16(3):206-213. Not eligible exposure.12(6):385-387. Jun 2001. Not eligible target population. Feb 2000. Broome ME. Nov 2003. 2393.8(1):9-33. Seigerst EG.75(8):41. Hunter J. 265-273. Not eligible outcomes. 20.75(7):15. 1991. Not eligible target population. Pediatr Nurs. Shahinpour N. Apr 2001. Nursing perceptions of using physical restraints on hospitalized children. Sep 1996. Guo YL. Delesie L. Selvam A. Shindul-Rothschild J. Jun 1998. Can Oper Room Nurs J. Shinkman R. Sermeus W. Ball J. Structure and organisation of 47 nutrition support teams in Germany: a prospective investigation in 2000 German hospitals in 1999. Hagen S. 2378. 711. Not eligible exposure. Sep-Oct 1995. Calif.47(3):218-225. 2375. Sharu D. Shah A. Selekman J. Nursing skill mix and staffing. Mantas J. Shuldham CM. The impact of the 9-21 earthquake experiences of Taiwanese nurses as rescuers. discussion 553-544. How good is it where you work? Am J Nurs. Shang E. 1997. Hasta la vista for Calif.30(3):189-197. Broome CD. Carson J. 2388. Medication errors in a pediatric emergency department.96(3):22-24. Fixing acuity: a professional approach to patient classification and staffing. Not eligible target population.13(1):51-60. Not eligible target population. J Child Health Care. Int J Nurs Stud. May 2005. J Nurs Manag. 48.55(4):659-672. International Journal of Nursing Studies (1983). Shen HC.57(10):1311-1316. The relationship between UK hospital nurse staffing and emotional exhaustion and job dissatisfaction. Bush C. 2368. Jodrell N. hospitals move to comply with nurse ratios despite litigation. One year later: evaluating a changing delivery system. 2394. Duh BR. Senkal M. Not eligible target population. 43-46. Aug 2002. 2369. News. Sherer JL. 2366. The medical-psychiatric consultation liaison nurse. Berry C. Nash M. 2367. nursing ratios? Healthc Leadersh Manag Rep. Not eligible target population. Feb 1999. Gypen T.46:176-181. 2372. Berry D.40(5):545-551.75(2):12. Aug 2001. Lee SH. 10 keys to quality care. 2386. Health Serv J.2365. East Liverpool City Hospital nurses make sweeping improvements. Price JL. Factors influencing satisfaction and anticipated turnover for nurses in an academic medical center. 2391. Mar 1996. Suchner U. Osterhoudt K. 2387. Shih FJ. Jan 1998. Not eligible exposure. Hyslop A. Snyder B. Not eligible target population. Chan SM.67(16):26-28. 2381. Attribution of blame for a child's disability. 2382. Parents' and staff's perceptions of parental needs during a child's admission to hospital: an English perspective. 2380. Hunt J. 2374. May 2004. Occupational stress in nurses in psychiatric institutions in Taiwan. Geneva negotiations. 13. Ho W. Sella S. 2377. Shields L. Healthc Leadersh Rep. Jan 2004. 2389.

Norback D. Not eligible target population. J Adv Nurs. Survey of carer satisfaction with the quality of care delivered to inpatients suffering from dementia. Getting an early start on early discharge. and trust. satisfaction. IT. Nurs Stand. 46-8.14(3):242-244. Jul 1991. Simons JM.15(4):409-417. Health Care Manage Rev. Not eligible outcomes. Poor communication and knowledge deficits: obstacles to effective management of children's postoperative pain. Not eligible exposure.33(2):68-75. 2399. Dec 2004. Bair N. Jan-Feb 2000. 2407. Arch Intern Med.155(5):502-510. Oct 2002. Sibbald B. Not eligible exposure. Jul 1992.71(3):38-40. Jebb P. controlled trial of an attending staff service in general internal medicine. Jun 25Jul 1 2003. Balas-Stevens S. Nov 2000. Slomka J. Comput Nurs. Implementation of a patient falls riskmanagement strategy. Hospital and patient characteristics associated with death after surgery. Beyond outrage. Not eligible outcomes. 2414. B-71 . 2406. Vincent M. Feb 2003. 2408. Psychiatric nurses' satisfaction with a patient classification system for staffing. 2426. Slota MC.22(3):517-527. Can Nurse.314(7089):1225-1228. Increasing clinical. Nov 2001. Apr-May 2002. Ahlen C. Relationships between indoor environments and nasal inflammation in nursing personnel. Kippenbrock TA. 1991:136-140. Mion LC. Newcomb CS. Eustress at work: the relationship between hope and health in hospital nurses. AWHONN Lifelines. Hoffman-Hogg L. and hospital reimbursement for liver transplant patients. IT takes a village. Mishra V. Comment. Bobek MB. Not eligible exposure. Not eligible target population. Prof Nurse. Not eligible exposure. 2402. Revolution. Simmons M.93(3):18. In direct proportion: ratios.23(7):104. Nerenz DR. Wright J. Influence of clinicians' values and perceptions on use of clinical practice guidelines for sedation and neuromuscular blockade in patients receiving mechanical ventilation. Jun 1990. 2397. Arch Environ Health.8(6):51-56. How immigration laws affect hospitals. Proc Annu Symp Comput Appl Med Care. 2424. Simmons BL. 2413. Issues Ment Health Nurs. Revolution. Stevenson T. Schwartz JS.17(41):33-37. Slaughter J. Mar 13 1995. Nov 2004. Daily R. Hosp Top. Simon HK. "Fast tracking" patients in an urban pediatric emergency department. Sklar J. Review. Roberson E.40(1):78-86. Krakauer H. win 'slam-dunk'. An initial evaluation. 2400. Simpson RL. 2415. Potokar J.36(2):14-16. Not eligible target population. Sinclair K. Transpl Int. Drug misuse by patients in an inner-city hospital. A study of adverse occurrence and failure to rescue.57(2):155-161. Unimed S.1(3):5.30(7):615629. Cooper C. Comment. Shullanberger G. 2401. A randomized. Oct 2002.18(3):124-32.32(3):525-535. Scullion J. Silvestro R. Bmj. Harris E. Med Care. Simons J.2395. Not eligible target population. Not eligible exposure. Sincox AK. Sep 25-Oct 1 2002. Apr 26 1997. 16. Not eligible target population. 2403. Not eligible exposure. Benfer DW. 2398. Aug 2004:4. Nilsen AM. Monitoring nursing productivity: a unique approach integrating an on-line kardex with workload measurement. Not eligible target population. J Adv Nurs. Tuma P.8(4):264-278. Comment. 2418. Up against a giant. Arroliga AC.27(2):180-183. Not eligible target population. Nurse staffing decisions: an integrative review of the literature. Coggon D. Comment. Siviter B.1(1):28-35.6(2):91-92. Shusterman C. Not eligible exposure. Lanese C. Slaughter J. Jul-Aug 1994. J Adv Nurs. Skeie B. Prospective cohort study of predictors of incident low back pain in nurses. A comparison of actual cost. Comment. 2423. An evaluation of nurse rostering practices in the National Health Service. Mich Nurse. 2420. Smedbold HT. News.17(3):168-171. Nelson DL. Nurs Adm Q. Rutt WM. Simpson RG. McLario D. Scothern G. Not eligible outcomes. Macdonald LM.29(7 Suppl):JS31-40. Mich Nurse. 2417. May-Jun 2000. Feb 2005. Sims CE. Safe patient care: a crisis in nursing. Not eligible target population. J Child Health Care. Silvestro C.15(9-10):439-445. Simpson RL. Editorial. Am J Crit Care. Summer 1993. Integrative review. 2419. 2396. Implementation of the patient self-determination act in a hospital setting. Mar 1997. Sims L. Amlie E. Comment. Humm C. Increasing patient satisfaction and nursing productivity through implementation of an automated nursing discharge summary. Aderholdt B. 2421. Safety in numbers? Nurs Stand. Mandatory overtime can hurt a hospital's financial status. Nursing Economics May-Jun 2000. Nurs Manage. Silva N. Williams SV. Not eligible target population. 2416. 2405. 2412. Jul 1992.77(9):9. Improving health care in the 21st century. Silverman HJ. Nov-Dec 1992. Implementing and evaluating a change to 12-hour shifts. Comment. Siders AM. Med Care. 2422. May 1996. 2411. 2409. and financial performance through nurse-driven process improvement. Nurs Manage. Peterson M. Hilt B. J Nurs Adm. Collins D. Castillo J. Sincox AK.17(2):22. 2425. Apr-Jun 2003.26(4):718. Vaaler S. Am J Emerg Med. Mandatory staffing ratios: a dilemma.9(6):412-418. 2410. Comment. Smedley J. Sep 2000. Pain-less floating. Not eligible target population.10(6):232-234. Mar-Apr 2002. 2404. Simmer TL. Pain assessment tools: children's nurses' views. Bissonnette T. Singh B. Egger P. Silber JH. Schaeffer MH. Sep 1995. Neonatal Netw. Sinclair BP. Fall 2001. DRG-based cost. Nurses quash Tenet's demand for 16-hour shifts.

23(22):2422-2426. Jan 1994. Smith MK.16(1):99-108. Mayo Clin Proc. Comment. Specht J. JulSep 2004. May-Jun 1995. 2428. Nurs Manage.16(3):113-116. Cooper C. Medication errors and difficulty in first patient assignments of newly licensed nurses. Inskip H. 2456. Boulter T. Buckwalter KC. J Med Syst. Fall 2001.26(1):11-22. Kalma S. Smith AP. Revolution. 2460. Smedley J. Smedley J.20(9):3-5. Impact of ergonomic intervention on back pain among nurses. Not eligible target population. Case Reports. 2449. Not eligible target population. Not eligible target population. 2445. 2452. Aug 1997.21(5):427-433. Not eligible exposure. Saving nurses. Buckle P. A revised role for the hospital cardiac arrest team? Resuscitation. 2440. Apr 2003.2427. Smith SA. Uphoff ME. Oct 1997. Nov 15 1998. Dignity in situations of ethical difficulty in intensive care. Mills JV. Oct 5-11 2004. Jan 2005. Smith DR. Humphrey CK. Not relevant. Pediatric nurses may misjudge parent communication preferences. J Healthc Educ Train. Coggon D. Not eligible target population. Heart Lung. Gamroth LM. Sneed NV. 2438. 1993. Not eligible target population. 2451. Mar 2001. Unique considerations in caring for a pediatric burn patient: a developmental approach. Coggon D.38(3):145-149. Sobo EJ. Smith P. Smith K. B-72 . Buckle P. 2444. 2431. Smith DM. Sep 8-14 2004. May 2003.8(2):73-80.5(3):147-152. Hixon AK. Improving resource utilization through patient dependency systems.61(7):37-38. Not eligible target population. Intensive Crit Care Nurs. Smith M.13(3):135-144. 2442. Geriatr Nurs. Jul 1998.21(5):291-302. 2441.32(3):528-532. Epidemiological differences between back pain of sudden and gradual onset. Cooper C. The Chicago plan: innovative strategies to change nurses' work patterns. Smith J. saving patients: responses to the labor crisis. Estabrooks CA. Jun 1998. Too few to care. Mar 2001. Not peer reviewed. Soliman F.21(1):3-11. Not eligible target population. Psychometric evaluation of pharmacology calculation test for hospital staff nurses. J Clin Ethics. SmithBattle L. Gilje F. Ortiguera SA.22(5):357-370. Sep 1999. 2453. Risk factors for incident neck and shoulder pain in hospital nurses. Adams D.36(3):131-145. Not eligible outcomes. Cooper C. Sochalski J. Not eligible exposure. Accuracy of heart rate assessment in atrial fibrillation. 2436.76(3):275-284. Review. Smith F. Geropsychiatric inpatient care: what is state of the art? Issues Ment Health Nurs. Schaefer S. Not eligible target population. Saudi Arabia: land of adventure & opportunity. Nov 2003. J Nurs Adm. 2432. Smith LW. Yamagata Z.12(3):231-238. Smith M. Soderberg A. Spring 1995.29(2):117-123. 2443. 2454. Valentine F. Not eligible target population. Personal Construct Theory: a strategy for the study of multidimensional phenomena in nursing.31(3):103-104. A longitudinal study in nurses. Patient Dependency Knowledge-Based Systems. 2446. Sep 1998.5(1):39-42. Uncharted terrain: dilemmas born in the NICU grow up in the PICU. Jun 1997. Inskip H. Dec 1999. Ohmura K. Can J Nurs Res. JONAS Healthc Law Ethics Regul. A preliminary analysis of psychophysiological variables and nursing performance in situations of increasing criticality. Not eligible exposure. Jan-Feb 2004. Coggon D. 2439. Mar 2005. The resident: the heart of it. 2435. Comment.19(4):193-197. Snow T. Case Reports. Occup Environ Med. Gaines KA. J Qual Clin Pract. Doctor M.11(7):9-10. Inskip H. RNs and UAPs: not much difference? Rn.19(3):253-262. Coggon D. Nurse staffing and patient outcomes: evolution of an international study.31(3):69-88. Crawford L. Soliman F. 2433. Lesson from Colorado.5(3):6567. part 1. McKay U. Soar J. Not eligible target population. Understanding the experience of training for overseas nurses. Sep-Oct 1992. Hartman AD. Jun 1999. Not eligible target population. Smith P. Mar 2004. Snowdon AW. Smedley J. Mullenbach DM. J Nurs Care Qual. 2429. Nurs Times. Bersante S.18(52):12-13. Not eligible exposure. Norberg A.13(3):157-161. 2459. Towards excellence in quality patient care: a clinical pathway for myocardial infarction. Planning for patient care redesign: success through continuous quality improvement. Comment. Smedley J. Editorial. Review.60(11):864-869. 2457. Oct 1998. 2448. Smith S. Prevalence and correlates of hand dermatitis among nurses in a Japanese teaching hospital. Trevelyan F. Sep 2004. Smith GB. Not eligible target population. No association tested. 2455. J Nurs Adm. Case reports. J Med Pract Manage. Natural history of low back pain. Janzen SK. Legal Cases. Nurs Stand. Cooper C. Inskip H. Larson DR. Not eligible target population. Crit Care Nurs Clin North Am. 2447. J Med Syst. 2437. Laskowski ER. Beyond blaming individuals. Paediatr Nurs. Getting your feet wet: becoming a public health nurse. Smith J. Smetzer JL. Hollerbach AD. J Epidemiol. Shifts in attitudes about self-esteem in the recovering chemically dependent nurse. Buckle P.5(2):60-3.19(2):103-105. Value added decisions. Sep 2003. Not eligible target population. Addictions Nursing Network Summer 1993. Spine. Can J Nurs Res. Leander S.100(40):40-42. Letter. The effectiveness of a preceptorship model in postgraduate education for rural nurses. 2458. Administrative support for addressing staff nurses' ethical concerns regarding staffing.29(6):49-51. Smith SP. Fisher W. Public Health Nursing Jan-Feb 2004. Sep 1990. Nurses on the move.7(2):1-6. Aust J Rural Health. Diekemper M. J Nurs Care Qual. 2434. 2450. Smeltzer CH. Gow P. Trevelyan F. Smith AM. Case Reports. Scand J Work Environ Health. 2430. J Rheumatol.

Cole M. Adams S. Journal of continuing education in nursing Sep-Oct 2002. Bumpy junction may lie between supplies and nursing models. Inadequate data presentation. Robays H. Ermini-Funfschilling D. Nurses' narratives of outcomes after delegation to unlicensed assistive personnel. Stelling J. Souhrada L. Stamouli MA. Heart Lung. Somers A. Addressing the educational needs of shiftworkers: should shift be a consideration? J Contin Educ Nurs. Stearley HE. Mar-Apr 1995. Not eligible exposure. Steinbrook R. Soltani H. 2489.10(Pt 1):759-763.24(3):253-258. Spiegel T. But is it nursing? Nurs Que. Stanford D. Staff time required to manage disruptions. Mantas J. Nov 20 1996.2461. 2463. van der Merwe AE. Bogaert M. What makes the ideal dialysis setting? Nephrol News Issues. 2490. Petrovic M. Nov 1992. 2462. Spangler Z. Being a good dance partner.11(9):14.1(3):37-44.50(5):6-7. Mater Manag Health Care. Spetz J. Sourial R. Pa Nurse. and staff burden. Inglis TJ. Mar-Apr 1994. No association tested. Transcultural care values and nursing practices of Philippine-American nurses.7(9):27-30. Maddox GL. Stabenow D. Gastroenterol Nurs. The psychosocial functioning of nurses in a burn unit. 2464 Sorrentino EA. 2484. Nurs Stand. Feb 1994. 2474. Not relevant. Development and evaluation of a nursing service management and administration information system at district hospital. Comment. Simunek LA. Agitation in demented patients in an acute care hospital: prevalence. Stead L.35(1):14-16. 2479. 36.25(1):212-218. 2001. Comment. Patient-focused care: what it is-what it is not. Spetz J. The Synergy Model in practice.3(2):28-37. Dec 1999. Spilsbury K. J Am Geriatr Soc. B-73 . A new behavioral assessment scale for geriatric out. Oct 2004. 2477. Sep 2005.12(6):411-418. Meyer J.36(4):6567. Automation of patient dependency systems.11(4):25-30.and inpatients: the NOSGER (Nurses' Observation Scale for Geriatric Patients). Nov-Dec 1995. Speas J. 2476. J Med Syst. (57 ref) (Pamhet #15-2402).19(6):86-87. 2465. Not eligible outcomes. Yarandi HN.29(8):31-36. Spiegel R. Soliman F. 2491. A prescription for addressing Michigan's nursing shortage. Comment. Jan-Feb 2006. Not eligible exposure. Culture care diversity and universality: a theory of nursing National League for Nursing 1991(Leininger MM):119-46. Medinfo. Dickinson F. May 30 2002. Aug 1998. Stannard D. Steele D. Squires A. Disruptive behaviors of older adults in an institutional setting. Mich Nurse.346(22):1757-1766. Hosp J.15(1):35-51.33(5):203-9. Not eligible target population. Practice makes perfect. Culture care of Philippine and AngloAmerican nurses in a hospital context. Job satisfaction among critical care nurses. Public policy and nurse staffing: what approach is best? J Nurs Adm. Journal of Transcultural Nursing Winter 1992. Brunner C. 2466. Health Care Supervisor Apr 1991. Not relevant. 2496. Who is accountable for inadequate staffing? Nurs N Z. Burns. Tulsky JA. Tanner J. A multicentre survey of hand hygiene practice in intensive care units. Not relevant. Shifting patterns. Reporting adverse drug reactions on a geriatric ward: a pilot project. Nov 2004. Oct 1998. 2482. Jun 1995. Predictors of burnout in critical care nurses. Comment. No association tested. Jul-Aug 1991. Jan 2005. 2487. disruptiveness. Eur J Clin Pharmacol. Review.18(6):206209. Holist Nurs Pract.18(5):235-237.22(4):225-236. Int Psychogeriatr. Southard-Ritter M. 2495. Standing T. 2475. Flexible sigmoidoscopy training for nurses. Not eligible target population. Jan-Mar 2001. Nov-Dec 1993. Crit Care Nurse. Nurs Times. Nursing in the crossfire. Person JL.13(2):183-197. Stacchini J. Not eligible target population. Puxty J. Not eligible exposure. Letter. Steele L. Comment. 38. 2472. Spangler Z. Feb 2003. Sep-Oct 2004. 2470. The evolution of volunteerism and professional staff within hospice care in North Carolina. Stechmiller JK. 2473. J Gerontol Nurs. Sep 2001. Case Reports. Stat nursing--alive and well. Not eligible target population. Not eligible target population. 64-29. 2000. O'Sullivan P.5(1):18-23. Not eligible outcomes. Jan 2026 2000. Notter M. Nurses' perceptions of temporary nursing service agencies.12(2):96-99. Aug 2003. Not eligible outcomes. misuse and non-use of health care assistants: understanding the work of health care assistants in a hospital setting. 2471. Staring SL.26(2):137-148. 105. Comment. Hertz JE. Comment. 2492. McCusker J. Steinhauser KE.96(3):41. Tremmel L. Use. Apr 1991.26(2):79-83. 2483. Jul 1-7 1998. Not eligible exposure. A shift in staff relationships. Stahl M. Does your staffing agency have JCAHO's stamp of approval? Nurs Manage.9(3):55-62. Pract Midwife. Not eligible target population.78(7):11. Review. 2494. May 1995. Not eligible target population. Anthony MK. 2481. 2469. Sproat LJ. J Nurs Manag. Not eligible target population. Am J Crit Care. Souder E. Apr 2005. Stechmiller JK. Steenkamp WC. How can employment-based benefits help the nurse shortage? Health Aff (Millwood).12(10):39-40. Outcomes Manag Nurs Pract. 2467.58(10):707-714.39(4):339-347. Nurs Econ. Monsch A. Nurs Stand. J Hosp Infect. 2468.4(6):34. 2486. Comment. Mother country. 2478. Not eligible target population. New graduate orientation in the rural community hospital. 2485. 2488. Yarandi HN. Jun 2001. Abrahamowicz M.22(6):534-541. Comment. Review. Developing a maternity unit visiting policy.12(41):24-25. N Engl J Med. 2493. May 1998. 2480.7(8):4.

75(3):7. Markowitz SM. Oct 1991.34(2):152-156. Jun 7-13 1995. 2511. nurse. Tex Nurs. 2520. Sullivan J. Aug 17-23 1994. Nurs Times. Tabet N. N Z Nurs J. Public policy initiatives and the nursing shortage: a disconnect. Dec 1997. Dunn D.18(3):43-50. Pepper G. Not eligible target population. J Med Ethics. Cuddihy L. Comment. 2509. Reporting of medication errors by pediatric nurses.15(7):654-657. J Nurs Adm. 2500. Jun 7-13 1995. QMC study methodology.24(6):582-589. Goldsmith J. Comment. Sauer J.30(2):32. Howard R. Svenson J. 2507. 2499.26(5):346-352. Puukka P. Suominen T. 2521. Katajisto J. Nosocomial urinary tract infection: nursing-sensitive quality indicator in a Thai hospital. Tabone S. Testing the individualized care model. 2510.21(9 Suppl):S406-407. Dec 1994. Auvert B. Schell M. Selfadministration. 2508. 2525. Stolman CJ. Jun-Jul 2004. Education and accountability.94(32):27. No association tested.2497. Unsung nursing heroes. Levine JL. Stelling J. Truth-telling and patient diagnoses. Staff nurse participation is key. Mar 2004. Breakpoints and continuities: a case study of reactive change. Staff empowerment in Finnish intensive care units. Jun-Jul 1997.17(6):341-347. Ashcroft R. Not eligible target population. Henderson J. Stodart K.35(1):19-22. Nurs Adm Q. Doran DI. Incidence and documentation of patient accidents in hospital. New nursing shortage hits. medical students. Comment.11(3 Suppl):13. Not eligible target population. Sweeney V. 2506. 2505. Not eligible target population. Morgan J. Sutton J. Review. 2529. Suominen T. Nov 1997. Arch Intern Med. Havens DS. Le Gall JR. Intensive Crit Care Nurs. 2523. Laippala P. physician. Blegen MA. Nurs Times.90(33):29-35. Rostering: placing the nurse in the picture.83(6):16-18. Street A. Stotka JL. Not eligible exposure. 2503. Chew S. Not eligible exposure. hospital float pool. Selfadministration. Jan 2005. Not eligible exposure. Dec 2004.2(4):196-202. Review. Comment. Stopfkuchen H. Not eligible target population. Not eligible target population. Am J Emerg Med. Whitaker C. Not eligible target population. Not eligible outcomes.12(52):14. Tex Nurs. Tabone S. Dec 2001. Sep 1993. Serving suggestions. 2514. Swain S. Dutheil M. Sutherland K.71(6):7. Comment. White RM. An educational intervention can prevent delirium on acute medical wards. Leino-Kilpi H. Wallace A. Not eligible exposure. Jun 1998. Nurs Times. Nurs Times. A pressure ulcer toolbox for facilitating hospital-wide quality.78(5):8-10. Contemp Nurse. Bryant C. Evaluation of patient.19(1):6-11. Stapczynski JS. 2498. Estimation of direct cost and resource allocation in intensive care: correlation with Omega system. Semple S. Wilks D. Stuart CG. Merliere Y. Valimaki M. Not eligible exposure. Age Ageing. Standen P. Nurses' role in informing breast cancer patients: a comparison between patients' and nurses' opinions. Tabone S. Critical care of medical and surgical patients in the ED: length of stay and initiation of intensive care procedures. Booth RZ. Mar-Apr 1998.71(2):11. Leleu G. An analysis of blood and body fluid exposures sustained by house officers. Menapace LW. J Nurs Care Qual. Comment. 2524. 2501. Williams DS. J Nurs Adm. Reducing costs and improving processes for the interventional cardiology patient. Aegerter P. 10. Jul 1996. The ward sister's view. 2512. Comment. Morgan J. Guidet B. Jan 1994. 10. Besinger B. Davis LL. Mar 1990. Nursing care quality: comparison of unit-hired. Aug 12-18 1998. Milne-Smith J. Sujijantararat R. Mar 2005. Tex Nurs. Flash point in Nelson. Infect Control Hosp Epidemiol. and family attitudes toward do not resuscitate orders. and agency nurses.11(2):22-36. Stimler C.150(3):653-658. Not eligible target population. Oct 2000. Tex Nurs. Sugrue NM. Wong ES. B-74 . Semple S. Intensive Care Med. J Med Ethics. Yellow card for violent patients. Hudson S. causes complex. 2526. J Cardiovasc Nurs. Staff models for the next millennium. Semin Nurse Manag. Not eligible outcomes. Not eligible association presentation. Buonamico G. Not eligible outcomes. Feb 1997. Sep 16-22 1998. Leino-Kilpi H. Apr 2001. Tex Nurs. 2522. Tabone S. Stewart M. Jun 2001. 2528. J Pediatr Nurs. Mar 2001. 2516. 2513. J Adv Nurs. Campbell AV. Sznajder M. Merja M. Howland-Gradman J. News. J Nurs Care Qual. Spring 1994. May 1999. Gregory JJ. Jan 1997. Tabone S. Sweeney YT.27(3):192-197.91(23):32-33. 2515. Not eligible target population. Not eligible target population. Best D. A comparison of governance types and patient satisfaction outcomes. Impact of national health system financing on quality of care in the intensive care unit: the German experience. 2527. 2504. Not eligible target population. Strzalka A.6(3-4):145-151. Don't get mad--get help.19(6):385-392.18(1):27-36. Stephen H. Adv Wound Care. 2519.10(4):5965. Macdonald A. Nurs Stand.20(2):134-139. Not eligible target population. Nurse fatigue: the human factor. AprJun 2005. Scand J Caring Sci. 2517. Vaughn T. The decision making process regarding the withdrawal or withholding of potential life-saving treatments in a children's hospital.91(23):30-31. Leino-Kilpi H. Suhonen R. Jul 1990. Stumpf LR. Successful change: renaissance without revolution. Crit Care Med.31(4):196-202.73(5):6-7. May-Jun 1998.12(10):583-590. Sullivan RJ. Comment. 2502. Street K. and nursing personnel on acute-care general medical wards: a prospective study. 2518. Stratton KM. Am Nurse. Geladas D. Sutherland K.

Tammelleo AD. Union Memorial Hospital.34(3):4. Takenouchi J. Legal case briefs for nurses. Tammelleo AD. Nurs Law Regan Rep. 2550. Nov 1993.V.34(2):51-52. treatment: proximate cause issue. Lund CH. Inc. Rayne Branch Hosp. Regan Rep Nurs Law. Not eligible target population. 2531. Case Reports. Lippincotts Case Manag.33(10):3. Acad Emerg Med. 2557.33(1):1. Care allegedly provided without proper supervision. Case Reports. Tattam A. Warden A. Yarnold PR.2(5):18-19. and dies. Supr. IL. Mar 1991. 2543. 2539. Case Reports. Am J Crit Care. AL: substance abuse-licence revocation: highly qualified and talented nurse.2530.: the school nurse: a professional engaged in teaching? Regan Rep Nurs Law. Plum Creek Medical P. 2d 948--LA [1992]). Case in point: Godeaux v. Jul 1992. Jul 1992.? Regan Rep Nurs Law. Bay Area Hospital (829 P. 837--NC (1995). 2d 929--CO (1993). IL. Case Reports. Regan Rep Nurs Law. Tammelleo AD. Revolution. OH: "LifeFlight" nurse & pilot to marry: hospital's nepotism policy mandates transfer. Zozula R. Feb 1990. Case in point: Winkleman v. Case in point: Raicevich v. Legal Cases. High risk nursing in Los Angeles.W. (483 N. Nov 1993. NY: working outside of job description: union contract and civil service violations. Comment. When no news isn't good news. Mystery nurse reports child's sexually transmitted disease in error. Tammelleo AD. Tamblyn S. IL: failure to diagnose pt. Tan SG. Regan Rep Nurs Law. OR: nurses state "all sponges .10(3):136-145. Feb 1992. Mar 2004. Case Reports. Legal case briefs for nurses. May 1998. Case in point: Perez v.34(6):4. Legal case briefs for nurses.R.App.35(12):2. Tanner CA. Case Reports. DiBrienza R. Tammelleo AD. 2540.36(4):2. 2535.. Regan Rep Nurs Law. OK: Slip and fall of "medicated" patient: nurse abandons patient in shower. Regan Rep Nurs Law.2(8):21-22. Tammelleo AD. Regan Rep Nurs Law. Dec 1997. Does routine gowning reduce nosocomial infection and mortality rates in a neonatal nursery? A Singapore experience. Case on point: Gerard v. Beloit Memorial Hosp.36(4):3.11(1):59-65. Tammelleo AD. Legal Cases. Feb 1995. 2556.36(4):1. Not eligible exposure. Legal case briefs for nurses. Regan Rep Nurs Law. Essentials of advocacy in case management. Legal Cases.J.1(1):52-58. May 1995. NY: overworked nurse falls asleep at wheel: auto accident-workers' comp. falls in bathroom: "routine nonmedicale care" standard applied.: pharmacy failure to give directions. Jul 1994. Mar 1995. Sep-Oct 2001. Regan Rep Nurs Law. Int J Nurs Pract. Review. 2547. Tammelleo AD. 2555. 918 F. Legal Cases. 2537.33(2):4. Tamburri LM. 2d 700--OR [1992]).34(6):3. Hospital mortality in relation to staff workload: a 4year study in an adult intensive-care unit. job to existing employee upheld. Sumrall By Ritchley 618 So.: spinal meningitis misdiagnosed: "patient dumping" charged. Sep 1995. Regan Rep Nurs Law. 2545. Tammelleo AD. Legal case briefs for nurses. LA: nurse gives I. Tammelleo AD. Regan Rep Nurs Law. Nocturnal care interactions with patients in critical care units. Tammelleo AD.C. Shearer AJ. Regan Rep Nurs Law. Tammelleo AD.: "medication dosage misadventure" triggers libel suit: privileged communication. Death after E. Legal Cases. NY: Failure to diagnose fetal distress: suit for prolongation of distress. Case Reports. IA: unattended pt. Gimbel R. Case Reports. May-Jun 2005. Comment. removed": court rejects "captain of ship" doctrine. Comment. Lim SH. Supp.R. (606 So. Comment. Legal case briefs for nurses. 2548. Tate ET. 2553. 2536. 2558. 2538. Malathi I.32(9):3. Kyriacou DN. Living in the midst of a paradigm shift. 2541. 2551. quiz 114-105. Court upholds nurse's refusal to float. Aust Nurses J. Mar 2002.H.33(12):3. 3/6/2002-NJ. Jun 1992. Regan Rep Nurs Law. Refusal to be party to 'trumped-up' charges--retaliatory termination. Sep 1995. Nurse denied pay differential for unscheduled work. Jul 15 2000. Mar 1993. Legal case briefs for nurses. issue. Regan Rep Nurs Law. Tammelleo AD. Aug 1993. Nurs Manage. Legal Cases.34(12):3.19(7):18-20. Tammelleo AD. The sun the moon & the stars.. A Flex-Ability Nurse (FAN) program. Tammelleo AD. Tammelleo AD. How hospital ties with a newspaper put a story on the spike. Tanabe P. Failure to follow orders: patient arrests--coma results. 2549. Legal Cases.33(9):4. Aust Nurs J. GA: "non-life-threatening" assessment: four hour delay-patient leaves E. Legal Cases. Regan Rep Nurs Law.356(9225):185-189. Regan Rep Nurs Law. Case Reports. Reliability and validity of scores on The Emergency Severity Index version 3. J Nurs Educ. Feb 1993. Redeker NS. Regan Rep Nurs Law.'s TB: attending nurse sues: N. NY: refusal to stay for additional shift: "abandonment" charged--suspension results. May 1993.33(2):2. Camden Cnty.. Sep 1995. 2d 1274--MS (1993). Tammelleo AD. Tarnow-Mordi WO. Rptr. Case in point: Sullivan v. Ctr. Lancet. Adams JG. Tahan HA. N. Editorial. 2533. Case Reports.31(10):3.13(2):102-112. FL: did physician prescribe excess dosage?: did nurse err in administering meds. 2542. Case in point: Romo v. 2d 211--WI [1992]). Jan 2004.M. Tammelleo AD. 2534. Not eligible target population.38(7):3. Failure to follow protocols: hospital vulnerability.42(10):4. 2532. quiz 146-137. Nurse risk manager alleges "retaliatory transfer".Div. Case Reports. B-75 .35(2):3.R.29(5):46. Not eligible exposure. Tammelleo AD. Hau C. Nov 1995. instead of I. 2552. 2546. 2554. Health Srvcs. Arbitrator's award of E. 2544. 878 F. May 1994. Supp. Smart R.

Ory MG. 2583. Collart F. Thomas MB.14(25):3.105(3):715-717. Interview by Lynne Wallis. Nurs Manage. Patient outcomes: are they linked to registered nurse absenteeism. Taunton RL. 2588. Not relevant. Oct 19 1999. Not eligible exposure. Not eligible target population. Can medical error self-reporting be easily implemented? Counterpoint. Taylor JA. Parahoo K. Nov 1998. Attractive force of nursing. J Gerontol Nurs.31(3):956959. Aust Health Rev. 2566. Not eligible exposure. MCN Am J Matern Child Nurs. Taxis K. Thompson CR.12(6):899-911.326(7391):684. Nurs Stand. 2576.18(4):244-248. Wolf GA. Holmes D. Review.24(1):49-53. Not eligible target population. Ann Intern Med. Teahan B. Grathwohl K. Healing is who we are . Taylor CB. 2574. Review. 2585. Emerg Med J. 2586. Cancelled operations. The Magnetic pull. Nurs Stand. Discrepant attitudes about teamwork among critical care nurses and physicians. Melby V.9(6):431-433. 2584. Mar 1998. Nurs Stand. An appropriate nursing skill mix: survey of acuity systems in rehabilitation hospitals. After the volcano. Don't scapegoat temporary nurses. 2591. Klein EJ.6(1):5-8. Edtna Erca J. Terris J. 2590. Sexton JB. Taylor C. Bmj. Thompson K. Spear SJ. Thomas LH. 2578. Editorial. Brownstein D. Identification of factors contributing to increased length of stay in two diagnosis related groups. Athan D. Not eligible target population. separation. Comment.21(5):537-541. Shafii J. Jul-Aug 1993. Thompson S. Taylor ME. Ter Maat M. Humphreys WG. Sep 1999. No association tested. Nurs Leadersh Forum. Thanasa G.24(4):81-90. Lowe E. Not eligible target population. Habner M. Nurs Econ. Thompson W.59(11):815-817. 2001. Not eligible target population. Thompson TM. Implementation of a self-scheduling system: a solution to more than just schedules! J Nurs Manag.35(1):38-44. Smoking cessation after acute myocardial infarction: effects of a nurse-managed intervention. Rorive G. Cmaj.28(4):241248. Not eligible exposure. Mar 8-14 2000. Belgian peer review experience on the Achille's Heel in haemodialysis care: vascular access. Thomson PJ. Study examines working hours and feelings of fatigue by reported nurses. Taking on the student role: how can we improve the experience of registered nurses returning to study? Aust Crit Care.. English R. Strandjord TP. Crit Care Med.28(1):9. Jun 1994. SWAT team: aggressive approach to the '90s.28(4):164-166.114(3):729-735. Interview. Not eligible outcomes. Eur J Clin Pharmacol. 2589. Barber N. 2570. 2572. Rehabil Nurs.171(8):244-245. Int J Nurs Stud. Helmreich RL. J Clin Nurs. 2561. 2565. Thompson J. Thomson D.33(11):585-595. B-76 . Nurs Stand. Olivieri D. Sep 8-14 2004. 2569. Not eligible exposure.18(52):20-21. 2571.113(2):118-123. Insulin adjustment by a diabetes nurse educator improves glucose control in insulin-requiring diabetic patients: a randomized trial. patient outcomes. The patient with diabetic nephropathy in the hospital.24(4S): Suppl):4855. Comment. Jul 15 1990. Mar 29 2003. Teresi JA. Taxis K. Jan 15 1997. Houston-Miller N. Not eligible exposure. Jan 1998.31(3):231-244. 2580. Gardner B. Thompson DN. Wood R. Not eligible exposure. Nov-Dec 1991. 2577. Not eligible exposure. 2568. Kleinbeck SVM. 2560. News. Misuse of metered-dose inhalers in hospitalized patients. Thompson DG.7(28):37-39. Staffing in traditional and special dementia care units. et al. Irvine T. Killen JD. Oct-Dec 2002. Oct-Dec 2004. 2575. Not eligible target population. Oct-Dec 1999. A current problem in oral and maxillofacial surgery. Stafford R. Thomas L. Nov 2003. Not eligible exposure. 2573. 2581. Not eligible outcomes. Blackburn S.. Outcomes of hospital staffing research project: a preliminary report. Taylor NT. Jan 2004. Kozak SE. 2587. 2564.12(3):98-102.98(3):40-41. Comment. Taylor M. Thompson DM. Pediatrics. Nov 2003.19(1):29-32. team and functional nursing wards. Barber N.11(17):16. Information provided to patients undergoing gastroscopy procedures. Texas Board of Nursing Bulletin Oct 2005. Mar 1994. Dennis M. Taylor C. 2579. Heslop L. Feb 1999. Incidence and severity of intravenous drug errors in a German hospital. Grant LA. Jan 2004. When your patient doesn't want to leave. Not eligible target population. DeBusk RF.25(4):28-31. Not eligible target population. Thomas N. Thomas EJ. Not eligible target population. A comparison of the verbal interactions of qualified nurses and nursing auxiliaries in primary.6(6):361-368. Br Dent J. Driving improvement in patient care: lessons from Toyota. Roth B. Mar 31-Apr 6 1993. Sheps S. Critical pathways in the intensive care & intermediate care nurseries. Chest. 2562. Leman P. Krzesinski JM. Not eligible target population. Not eligible target population. Not peer reviewed. J Nurs Adm. Making an IMPACT on emergency department flow: improving patient processing assisted by consultant at triage. Preliminary findings from the National Institute on Aging Collaborative Studies. and who are we? Nurs Adm Q. Mar 2003. Sep 2004. or work load? Journal of Nursing Administration Apr 1994. Fall 2001. Use of incident reports by physicians and nurses to document medical errors in pediatric patients. Am J Nurs.2559. Christakis DA. Pain control: patient and staff perceptions of PCA. Theelen B. Ogle KR. Keighron K. Oct 19 1991.161(8):959962. Ridley T.36(4):2-3. 2582. Edtna Erca J. Jan-Feb 1994. Ethnographic study of incidence and severity of intravenous drug errors. Afthentopoulos IE. O'Connor N. Concern. 2567. Sep 2004.

B-77 . Apr 2005. Not eligible exposure. 2623. J Accid Emerg Med. Interview by Iris C. Thyer GL. 2622. Mod Healthc. Salyer J. 2615. J Clin Nurs. Tippett J. No association tested. Ferguson L. Tierney AJ. News. Calif Hosp. Mod Healthc.32(20):20-21. The Model of Whole-Person Caring: creating and sustaining a healing environment. 2603. Care 2000--a patient-focused care model.1(5):215-220. Not eligible target population. The nursing shortage--a Washington Post columnist's perspective. Government eases up on foreign nurses. Identification of nurse-family intervention sites to decrease health-related family boundary ambiguity in PICU. Titone NJ. Accid Emerg Nurs. Tonges MC. Timmons S. Winbolt M. Tigert JA. Field S. 2612. Thornton L. Tierney MJ. 2617. 2609. Intended and unintended effects on satisfaction and well-being. Toyry E. nurse attitudes and contextual factors in the bone marrow transplant unit. Mar 1996.27(11):15-22. 2611. Tieman J. Apr 8 2002. Robinson G. Percutaneous endoscopic gastrostomy (PEG): the role and perspective of nurses. magnet hospital traits and mental health.30(6):495497. Amid push for nurse ratio laws. Nurs Econ. Mutka R.78(1):24. Giles L. May 20 2002. Sep 1993. 2613. Dynamics.11(2):73-79. 2618.13(4):212-217. Todd C. Scott J. Tightening ratios. News. Savolainen P. From rituals to reason: creating an environment that allows nurses to nurse. Laschinger HK. Pediatr Nurs. Amplifying nursing's voice through a staff-management partnership. Information needs of myocardial infarction patients. Tieman J.32(14):3032. Cincinnati-area hospitals get serious--and a little silly--to cut nurse vacancy rate. Feb 2005. Tonges MC. Thrall TH. Kaliszer M. 2619. Environmental turbulence: staff nurse perspectives.12(1):39-46. Lavelle M. Not eligible target population. As feds collaborate. 2614.3(1):1123. Tanner J. study finds. 2599. J Adv Nurs. 2604. Tieman J. Constant observation in medical-surgical settings: a multihospital study. Not eligible exposure. Nov 2004. skill mix and staff supervision. News. Jul-Aug 1997. J Nurs Adm. Thurston J. Tomczyk B. Nurs Case Manag. Not eligible target population. Murdoch IA. An investigation into modification of personality hardiness in staff nurses. quiz 24-15. Eur J Cardiovasc Nurs. Timmins F. Apr 2005. Tornabeni J. the nation's hospitals also face new JCAHO requirements for measuring staffing effectiveness. Mar 2004. Not eligible target population. Int J Nurs Pract. 26. Aug 2001. Verhoef M.5(3):228-235. Nov-Dec 2004. Seppanen M. Taking family-centered care to a higher level on the heart and kidney unit. Not eligible target population. Not eligible exposure. Nurses' knowledge of traditional Chinese postpartum customs. Interview. 2601. 2607. Not eligible target population. 2602. Nurs Ethics. Durward A. 2597. Mar 2003. Jan 2004. Correa-West J.30(6):1160-1166. Taylor J. 2616. 2593. Intensive Care Med.8(4):12-13.2(3):246-252. 22. Job design for nurse case managers. Tomlinson PS. Not eligible exposure. Comment. Trafford A. Mod Healthc. J Nurs Staff Dev. Martin G. White P. 2610. McAllister M. Research in practice: an 'experiment' in researcher-practitioner collaboration. Hosp Health Netw.34(3):134-139. Am J Crit Care. But national nursing groups disagree over ratio laws and how best to recruit and retain quality nurses. Todd V. Duregon K. Dobal MT. Not eligible exposure. Tourangeau AE. J Nurs Manag. Ethics in health care management: developing an instrument to assess humane caring. Atzori M.22(1):27-47. Jun 3 2002. Mod Healthc. Tibby SM. Tokarski C. Should accident and emergency nurses request radiographs? Results of a multicentre evaluation. Van Rosendaal G. Nursing the nurse shortage.32(22):10-11. J Nurs Adm. Thrall TH. May-Jun 2005. Can J Nurs Leadersh. Holist Nurs Pract. Not eligible exposure. maternal responses.27(4):391-393. Jun 2004. May 1998. May 1991. The relationship of child acuity.19(3):106-115. Not eligible target population. 2596. 2621. Winter 2004. Tien SF. Tonuma M.6(4):214-218. News. May 1993.2592.78(4):140-145. 2620. Hosp Health Netw. Apr 2003. Jan 2004. Sileo M. Peterson J.15(4):19-23. Adverse events in a paediatric intensive care unit: relationship to workload. Creative recruiting in southern Ohio. Mark BA.79(4):20. Cross R. Kirschbaum M. Not eligible target population. Workforce. Torkelson DJ. Not eligible target population. Thurtle V.20(49):2. Swiggum P. Harbaugh BL.16(5):506-510. Not eligible exposure. Apr 2005. 2608. Frank.12(2):4-20.17(3):149-155. Int J Nurs Pract. 2598. Not eligible target population. News. 2594. Why do nurses enter community and public health practice? Community Pract. J Emerg Nurs. states and localities act on own. Double standards. Jan-Feb 1998. Nov 1997. Dare to be different: transformational leadership may hold the key to reducing the nursing shortage. 2600. Reid N. Dec 10 1990. Aug 2000. Jul-Aug 1994. J Nurs Manag. Evaluation of a partnership model of care delivery involving registered nurses and unlicensed assistive personnel. Jan-Mar 1999. Registered nurses key to good patient outcomes.26(7):722-732. May-Jun 1999. Herve R. 2605. Not eligible target population. Critical care nurses' perceptions of workplace empowerment. Workforce. Nurses' acquisition and retention of knowledge after trauma training. Not eligible exposure. May-Jun 1999. Baloga-Altieri B. 2606. West J Nurs Res. Tillman HJ. Not eligible exposure.2(1):57-65. Review.13(2):8689. Not eligible exposure. Issues Compr Pediatr Nurs. Tomlinson PS. Operating theatre nurses: emotional labour and the hostess role. Corley MC. 12-hour shifts: job satisfaction of nurses.14(2):187-194.11(2):85-91. Review. 2595. Not eligible outcomes.

GRASPing infection: a workload measurement tool for infection control nurses. will travel? Nurs Manage. Doong JL. Jul-Sep 2003. 3-4. Nov 2001. 2625.10(8):12-13.93(7):27. The Solcotrans Plus versus the Stryker-CBC ConstaVAC.88(4):196-198. ANA. Comment. Lee V. Comment. Lochhaus-Gerlach J. Farrington M. Comment. 2629. Hagey R. Sep-Oct 2003. de Haan RJ. 2648. Parents' experiences of ambulatory care. 89. Working 'round the clock. access to. Not eligible exposure. Dec 1995. Cash in the bank.18(3):226-240. support of and use of research in the acute care setting. Comment. Shiftwork strategies. Triage: how long does it take? how long should it take? J Emerg Nurs. Redpath CK.5(2):164-168. Comment.41(2):191-198. 2636. Hudson K. Tsai WW. Guruge S. Comment. Not eligible exposure. Dec 1992. Jan-Feb 2002. Nurs Health Sci. Development of the 'Euro Rota' in A & E. Turk M. 87. Trossman S. MayJun 2004. 12. Turner M. more errors. J Gerontol Nurs. J Nurs Care Qual. Accid Emerg Nurs. Nurs Manage. Patient volume. Can J Nurs Leadersh. 2633.46:275-278. Paediatr Nurs.91(11):41-42. Apr 1995.31(5):1-2. Oct 2004. Jun 1999. Haines N. Fighting the clock: nurses take on mandatory overtime. 2001:40-43. 2642. 2627. Jun 2001. Trossman S. Takatanic Y. AprJun 2004. Not eligible target population. Jan 12 2002. 2637.27(3):8-18.31(2):1. Knowledge. 2634. The geriatric resource nurse model. 2644. No association tested. Not eligible target population. 2641. Am Nurse. Review.2624. Dirico L. The effect of individual characteristics on perceptions of collaboration in the work environment. Comment. A "transfer fair" approach to staffing. Closed-wound drainage systems. Tuttas CA.31(1):1-2. Not eligible target population. Not eligible exposure. J Hosp Infect.11(4):2224. 2649. 16. Geriatr Nurs. Interpreting family-centred care within neonatal nursing. Shindob S. Staffing smart: a difficult proposition. 2657.. attitude and safe behaviour of nurses handling cytotoxic anticancer drugs in Ege University Hospital. Nov 2001. Not eligible target population. Int J Nurs Stud. Mar 2002. and getting harder! State Health Care Am. 2640. Jul 1993. Feb 12-18 1997. B-78 . Medsurg Nurs. Macdonald AJ. Comment. Managing costly Medicare patients in the hospital. Review. Stud Health Technol Inform. 2635. 2653. 2656.36(3):1. News. Trossman S.13(5):312318.34 Suppl 4:15-16. Tsuru S. Turnbull GB. Sung WH.20(6):536-542. Limburg M. Paediatr Nurs. Feb 2004. Jul-Aug 2004. 2646. Tucker J.35(3):1-2. Turner JT. Jul 2003. Not eligible target population. Tselikis P. Turrill S. Trossman S. Trossman S. MNA support Dana-Farber nurses facing disciplinary action. Lam M. Comment. Brueckmann FR. Am J Nurs. Not eligible exposure. Comment. Tuttle DM. 2643. Mar 2001. Tsai SL.48(12):12-13. Oct 1998. Am Nurse.25(3):238240. Decreasing nurse staffing costs in a hospital setting: development and support of core staff stability. 10. 2647. Treloar AJ. Barton D. Tranmer JE. Trundle CM. Turley S. Validity in action research: a discussion on theoretical and practice issues encountered whilst using observation to collect data.49(3):215-221. Mar-Apr 1999. The effect of staff nurse participation in a clinical nursing research project on attitude towards.24(5):294-297. Fisher D. Travers D. Am Nurse.3(2):69-71. 2639.18(7):1101-1105. Fletcher K. Evaluation of computer-assisted multimedia instruction in intravenous injection. Not eligible target population. 2654 Turrittin J. Not eligible target population. Move over eBay? A potential trend involving bidding for shifts online. J Adv Nurs. Not eligible target population. J Adv Nurs. Tselebis A.39(6):655-67. Dec 2002. Trossman S. 1997. Nurs Times. Seod A. Am Nurse. 2630. Trossman S. The experiences of professional nurses who have migrated to Canada: cosmopolitan citizenship or democratic racism? International journal of nursing studies Aug 2002. The global reach of the nursing shortage. and workload in relation to risk-adjusted outcomes in a random stratified sample of UK neonatal intensive care units: a prospective evaluation. Have RN. Trossman S. Burnout versus depression and sense of coherence: study of Greek nursing staff. Turner G. 2645. Mercan T. Jun 1991.36(3):471-477. Am Nurse. Not eligible target population. Number of nursing staff and falls: a case-control study on falls by stroke patients in acute-care settings. Not eligible exposure. Not eligible target population. May 1999. Lancet. Oct 1997. Recognition of cognitive impairment by day and night nursing staff among acute geriatric patients. Measuring quality of care with an inpatient elderly population. Anderson L. Ilias I. J R Soc Med. Am Nurse. Ostomy Wound Manage. Tutuarima JA.23(12):72-74. Orthop Rev. Travis M. May-Jun 2003. Asian Pac J Cancer Prev. Am Nurse. 2652. Tucker D. 12. Turnock C. Not eligible target population.36(4):1. Ciceklioglu M. 2638. A conception of a support system for optimising the organisation of nursing staff from the viewpoint of the nursing care needs structure. Davas A. Not eligible target population. Sacaklioglu F.. Increased hours. May-Jun 1998. staffing. 2628. Tschannen D. Can Nurse. Gibson V. Not eligible target population. Chai SK. Jan-Feb 1999. 12. 2650. Office of Inspector General (OIG) issues draft compliance program for pharmaceutical manufacturers. 2626. 2655. Fung CP. It's a hard knocks life for providers .359(9301):99-107. 2632. Not relevant.30(3):1. 8.5(4):178-180. Moulou A. 2631. Trammell TR.15(1):1826. Trossman S.102(3):85. Sep-Oct 1999. Nurses' Rx for medication errors. 2651. Not eligible exposure. et al.

Parlevliet GA. Mar 2004. Review. 2670.12(4):509-518. Not eligible target population. Ketefian S. Van Furth AM. Uchal M. Not eligible exposure. Not eligible target population. Upenieks VV. job satisfaction. quiz 10. J Nurs Adm. 2664.26(1):1827. Nurs Health Care.33(9):456-467. van Servellen G. Housos E. Best JD. Tzeng HM. Tytgat GN. Sarkodie S. Sep 9 1996. Not eligible exposure.21(1): Crit Care Manage Ed):64A. The fake patient: a research experiment in a Ghanaian hospital. Ambaum B. Wright J. Jan 2002.47(9):1373-1381.6(19):6-7. J Nurs Adm.47(1):41-45. Uitterhoeve R. How RNs view the work environment: results of a national survey of registered nurses.25(4):165-166. Valouxis C. Sep-Oct 2002. Van Der Zwet WC. 34. Not eligible target population. Sep 2005. Norman L. 2673. 2661. Rieder KA. Qiu X. Jul 2003. Not eligible target population. Comment. Not eligible target population. Not eligible target population. Buerhaus PI. Comment. Grigg LE. Ulrich BT.5(2):11-9. & Nursing Practice Aug 2005. Not relevant. Not eligible target population. Nov 2000.39(1):79-84. What constitutes effective leadership? Perceptions of magnet and nonmagnet nurse leaders. van der Ende A. 2685. Demand and supply for nursing competencies in Taiwan's hospital industry. Gastroenterol Nurs. 2667. 2672. Upenieks VV. Demystifying the influence of hospital characteristics on inpatient mortality rates. J Adv Nurs.55(2):155-158. Int J Nurs Stud. 2682. 18. van der Voort PH. Jul-Aug 2002. J Nurs Adm. Oct 1996. Not eligible target population. Unruh LY. Int J STD AIDS. Not eligible target population. Feb 2003. Apr 1999. 32. Outbreak of Bacillus cereus infections in a neonatal intensive care unit traced to balloons used in manual ventilation. Tzeng HM. Dec 822 2003. Demand for nursing competencies: an exploratory study in Taiwan's hospital system.8(5):289-293. Vincke J. Not eligible target population. Newman RW. Kesecioglu J. 2674. Fottler. Tyson PD. J Healthc Qual. 2680. Vail JD.21(3):130-139. Adverse drug events in hospitalized patients. Nurses' self-assessment of their nursing competencies. Hare DL. Savelkoul PH.163(22):2775-2783. 2666. van den Bemt PM. Geraedts AA. Nurs Manage. Nov 2002. Nurs Spectr (Wash D C). Morton DA. May-Jun 2003. Nurs Econ. Not eligible exposure. 2659. Unruh L. Workload management system highlights staffing needs. Sep 2003. Nurses' attitudes and concerns to HIV/AIDS: a focus group approach. Simons KA.2(3):185-187. Van der Geest S. Dart AM. van Wissen K. 2675. F-G.35(9):389-396. 2662. van Servellen G. Trends in adverse events in hospitalized patients. Hepatitis C among risk groups for HIV and hepatitis B. Ho BP.32(11):564-576. Nov 1998. Dittus R. J Nurs Adm. Projections and trends in RN supply: what do they tell us about the nursing shortage? Policy. May 1987. 2681. Donelan K.20(6):1141-1147. Apr 1999.189(6):753-757. Vale MJ. Urden LD. Stoof J. Comment. van Achterberg T. J Hosp Infect. job demands and job performance in the Taiwan hospital system.24(5):4-10.22(5):30. B-79 . Van Slyck A. Duijnhouwer E. Not eligible exposure. Martinsen E. 2669. Cancer Nurs. J Nurs Adm. Soc Sci Med. Legislative protection against mandatory overtime. nurses and patients as sources of reports. A model for outcomes evaluation. Woodman K. Not relevant. Not eligible target population. 2677.20(2):155-175.26(10):15-21. Management during the off-shifts. Not eligible target population. Ketefian S. Ugrovics A. Redman RW. 2665. Mak R. Tzeng HM. The impact of sleep deprivation on product quality and procedure effectiveness in a laparoscopic physical simulator: a randomized controlled trial. and patient satisfaction with nursing care. Am J Surg. van der Hulst RW.29(4):39-47. Leufkens HG. Vanderschueren S. 12-hour shifts: does fatigue undermine ICU nursing judgments? Nursing management Jan 1990. Eur J Clin Pharmacol. Jul 2004. Int J Nurs Stud. Umansky PW. J Clin Microbiol. Oct 2000. Leake B. Bergamaschi R. Van Renterghem L. Egberts AC. Not eligible exposure. Jan 2001. Development of a nurse executive decision support database. 2676. Lenderink AW. Five-year follow-up study of stress among nurses in public and private hospitals in Thailand. Not eligible year. 2683. Tjugum J. 2660. 2668. 2663. Not eligible exposure. Emotional exhaustion and distress among nurses: how important are AIDS-care specific factors? Journal of the Association of Nurses in AIDS Care Mar-Apr 1994. Verzijl JM. 2684. Jun 2005. Int J Nurs Stud. May 1991. A systems approach to the management of nursing services. Pongruengphant R. 2679. No association tested. VandenbrouckeGrauls CM. Relationship of nurses' assessment of organizational culture. A comparison of doctors. Verhofstede C. McNeil JJ. Dec 1994. Jelinek MV. Artif Intell Med.6(3):171-82. Tzeng HM.41(3):247-254. Assessing differences in job satisfaction of nurses in magnet and nonmagnet hospitals. Politics. Hybrid optimization techniques for the workshift and rest assignment of nursing personnel. van der Pol WS. Kaiser AM. Turning toward the psychosocial domain of oncology nursing: a main problem analysis in the Netherlands. Gut decontamination of critically ill patients reduces Helicobacter pylori acquisition by intensive care nurses. 2671. J Clin Nurs.38(11):4131-4136. Ullmer D. Zandstra DF. Not eligible target population.41(5):487-496. Schultz MA. May-Jun 1991. Inadequate data presentation. Arch Intern Med. 2678. Part III: Staffing system. Coaching patients On Achieving Cardiovascular Health (COACH): a multicenter randomized trial in patients with coronary heart disease. Plum J.2658.

Jul 1996.18(3):171-180. Jun 1996. 2690. Not eligible target population. J Adv Nurs. The perceived function of health care assistants in intensive care: nurses views. 2712. 2703. Not eligible target population.71(6):10-11. Fletcher AM. Enhancing verbal communication skills and promoting effective socialization of newly hired Spanish-speaking registered nurses. Res Nurs Health. Understanding why medication administration errors may not be reported. Not eligible exposure.2686. Prior-Willeard PF. 2705. Wakefield DS. discussion 499-502. 2696. Comment. 2709. Preliminary results on nursing workload in a dedicated weaning center. 2687. Nov-Dec 1991.1(3):123-125. 2711. Jul 2003. No association tested. 1992. Ohio Nurses Rev. Comment. Nurs Manage. Jul-Aug 2001. Jul-Aug 1996. Uden-Holman T. Am J Nurs. J Occup Health. A strategic nursing assistance program--SNAP. J Pain Palliat Care Pharmacother. Vore AL. Int J Nurs Stud. Best Pract Benchmarking Healthc. Nov 2000.26(6):796-799. 2693. Vyas A. Perceived importance of caring behaviors to Swedish psychiatric inpatients and staff. von Essen L. International Journal of Nursing Studies (1991). Sjoden PO. 2710. 2695. 2697. Patient-controlled analgesia in children. Not eligible target population.28(3):267-281. von Essen L. Not eligible outcomes. The importance of nurse caring behaviors as perceived by Swedish hospital patients and nursing staff. Vicca AF. Blegen MA. 2003. Wakefield DS. Uden-Holman T. Velianoff GD. NovDec 1990.14(2):81-88. Ting D. Borders T. J Psychiatr Ment Health Nurs. Blegen M. 2692. Feb 1998. Caught short-staffed. 2689. 2706. Wakefield BJ. Not eligible target population. Fiori M. Mar-Apr 1997. Bonfiglioli R. Comment. Not eligible target population. von Essen L. Francis HC. Am J Med Qual. Staffing ratios are the answer. J Hosp Infect. 2698.43(2):109-113. 2704. Nurs Econ. Garagnani G. The importance of nurse caring behaviors as perceived by Swedish hospital patients and nursing staff. Not eligible target population.16(4):128-134. Rigorously assessing whether the data backs the back school. Chrischilles E. Poxon I. J Nurs Staff Dev. Palliat Med. Nursing staff workload as a determinant of methicillin-resistant Staphylococcus aureus spread in an adult intensive therapy unit. 6253. Addington-Hall JM. Blegen MA. Intensive Care Med. Waid EO. Medsurg Nurs. Not eligible exposure. Not eligible exposure. Comment.5(4):291-298. 2702. Not eligible exposure. Am J Med Qual. Mattioli S. Phelps CL. Winter B. Mar 2004. Uden-Holman T. Patient and staff perceptions of caring: review and replication. Not eligible target population. Not eligible target population. Vaughn T. 2699. 2707. and immunology and their relation to glutaraldehyde and other occupational exposures among endoscopy nursing staff. Sjoden PO.7(1):39-44. Perceived occurrence and importance of caring behaviours among patients and staff in psychiatric. Veyckemans F. Immediate management of the airway during cardiopulmonary resuscitation in a hospital without a resident anaesthesiologist. Nov 1991. Vejlgaard T. 2708. Borders T. Blegen MA. Clini E. Visina CE. J Adv Nurs. Wakefield BJ.43(1):57-61. Vanderslott J. Sjoden PO. Ambrosino N.46(2):100-108. Understanding and comparing differences in reported medication administration error rates. Gerthoffer TD. Not eligible target population. Not eligible target population. von Essen L.22(9):36-38.2(2):59. Oct 1999. Risi A. Vaughn T. Survey of symptoms. Jun 2000. Jordan C. 1991.7(6):286-289. 2701. Not eligible target population. Oldham LA. Johnson CW.8(6):426-427. 2703. Intensive Crit Care Nurs. Viney C. A study of incidents of violence towards staff by patients in an NHS Trust hospital. Wakefield BJ. Wakefield BJ. Mar 2005. 28. Vinh DT. AMIA Annu Symp Proc. Perceived barriers in reporting medication administration errors. Wakefield DS. Vonfrolio LG. Acta Anaesthesiol Belg. Am J Med Qual. Merrett T. 2694. Vaughan CA. 267-281. Mar-Apr 1999. Vitacca M. Reeds LB. 2688.57(11):752-759. Not eligible target population. Wakefield BJ. Int J Nurs Stud.16(11):1363-1374. Uden-Holman T. Aug 1993. Sjoden PO. Blegen M. Not eligible outcomes (medication error reporting perception). Organizational culture. Occup Environ Med. respiratory function. Niven RM. Not eligible target population. Associations of psychosocial and individual factors with three different categories of back disorder among nursing staff. Vieira AM. Not eligible target population. 2003:1041. Establishing a 10-hour schedule. and medication administration error reporting. Wainwright TA.21(2):266-276. Percifull D. 2700. Community hospital physician and nurse attitudes about pain management.67(6):80. Fiorentini C. Biggs R.1(4):191-197. with comparisons to somatically-ill samples. Nurses' perceptions of why medication administration errors occur. No association tested. Wakefield DS. Attitudes of Danish doctors and nurses to palliative and terminal care.19(2):119-127. Violante FS. Does the APACHE II scoring system equate with the Nottingham Patient Dependency System? Can these systems be used to determine nursing workload and skill mix? Nurs Crit Care. Pickering CA.14(2):73-80. B-80 . Sjoden PO. Chen J. Not eligible target population. von Essen L.40(5):487-497. medical and surgical care. continuous quality improvement. Not eligible exposure. 2691. Vaughn T. Job sharing meets nurses' needs.96(6):63. Jun 2002. Verghese C. Sep 1994. Aug 1998. Sep 1991. Wakefield DS. UdenHolman T.16(4):293-303.17(2):51-62. Baskett PJ. Porta R. Jun 2004. Feb 1995. Eur J Emerg Med. Rn. Mar-Apr 1999.

Ward KG.21(5):42-52. Not eligible target population. Case reports. Not eligible target population. Jun 17 1996. STAR Day: one hospital's solution to educational challenges.48(6):690-696. It's all in the mix. 2716. and quality of care. Karlsson S. Harris M. Walrath JM. J Nurses Staff Dev. Not eligible target population. Int J Nurs Stud. Fatigue and critical thinking on eightand twelve-hour shifts.7(12):suppl 8p. benefits. 2721. Supplemental staffing. 2740. Walters JA.9(4):189-192. Johansson A.15(2):80-84. Not eligible target population. Patient perceptions of hospital care: building confidence. Kamikawa C. Int J Nurs Pract. Crit Care Med. 2729. 2714. Infection control: reducing the psychological effects of isolation. Yamauchi SS. 2717. Nurs Econ. Warminger P. Walker SB. Walker AC. 2724. Walker EK. Int J Nurs Pract. Sheron L. 2744. Waldenstrom U. J Nurs Manag.18(6):293-296. Inadequate data presentation. The Queen's Medical Center Honolulu. Lowe MJ. Nursing Economics Sep-Oct 1990. 2723. Feb 2002. Jonasson U. Sep-Oct 2002. Jul 2000. Not eligible exposure. Cox MJ. faith and trust. Mar 2003. Not eligible target population. Multicentre study of validity and interrater reliability of the modified Nursing Care Recording System (NCR11) for assessment of workload in the ICU. 2715.22(2):71-74. 2730. Warren DK. Rozell BR.1(1):23-30. Nurses' perceptions of reportable medication errors and factors that contribute to their occurrence. Lancon M. Romand JA. Comment. Acta Anaesthesiol Scand. Walker JK. Arching the flood: how to bridge the gap between nursing schools and hospitals. Effects of guidelines implementation in a surgical intensive care unit to control nighttime light and noise levels. Ward D. Bennett J. Feb 2001.40(3):307-319.38(1):25-35. Nov 1999.4(2):97-102. Not eligible target population. Evaluation of outcomes: the effects of continuous lateral rotational therapy. 2742. Oncol Nurs Forum. Walker J. Many American nurses are having trouble finding jobs. 2735. Nursing management Sep 1991. Dec 1994. Nov-Dec 2002. May 1992. J Nurs Care Qual. Nov 1994. Not eligible target population.6(4):193-200.F-H. Archer S. Staff and patient communications-trends and technologies. Warren IB. Walsh B. Feb 1999. Walters AJ. 2741.13(41):12-13. Macnee CL. 2738. McInerny J. Byrne PO. Prof Nurse. Appl Nurs Res. Waters A. 2734. An educational intervention to prevent catheterassociated bloodstream infections in a nonteaching. Francioli D. A hermeneutic study of the concept of 'focusing' in critical care nursing practice. 55. Fraser VJ. 2720. Haisfield ME. Nurs Stand.19(1):33-65. 2731. 2718. Walsh C. Walther SM. Health Estate J. Not eligible outcomes. Hawaii. Int J Nurs Stud. Beezley A. An observational study of hand washing and infection control practices by healthcare workers. Not eligible target population. Washington GT. 2719. Mathews BP.62(2):47-49. 2743. Walker DD. Walker CA. Health Aff (Millwood). Midwifery. Jones SL. Jun 1998. Waters A. Jul-Sep 2005. May 1994. Knowing and approaching hope as human experience: implications for the medical-surgical nurse.2713. Maguire JM.21(4):710-715.44(6):2-8. Berkowitz B. Nurses' views on reporting medication incidents. Not eligible outcomes. Not eligible exposure. PerezAvila CA. McGuire DB. 2737. 2728. Lanier J. Stages of stroke: a model for stroke rehabilitation. Review. Feb 10-23 2000. Warr J. Nurse manager views of costs.14(4):207-213. B-81 .28(7):2242-2247. Continuity of carer and satisfaction. Not eligible target population.25(6):51-57. Brooksby A. 2726. Not relevant. Mar 1994. Not eligible target population. Nurs Stand. Weaver J. Wang CE.22(9): Crit Care Manage Ed):80A. Jul 1990. 2733. Jun 1995. Walczak JR. Nurse managers making a difference: creating a healing place. A TEAM approach to NICU care. 2727. Not eligible exposure. Not eligible outcomes. Not eligible exposure. J Accid Emerg Med. Nurs Adm Q. Taylor A. A survey of research-related activities and perceived barriers to research utilization among professional oncology nurses. Use of a pro forma for head injuries in the accident and emergency department--the way forward. Wallace SA. Gullan RW. Jun 25-Jul 8 1998. Not eligible exposure. Mar-Apr 2004. 2739. Infection Control and Hospital Epidemiology Nov 1998. Walker R. 2725. Nurs Inq. News. Br J Nurs.8(5):314-8. Walder B. Pickering R. Watanakunakorn C. Staffing accommodations to hospital unit admissions. Not eligible target population. Aug 2000. 2722. Medsurg Nurs. Adam J. Zack JE. Emergency department: improving patient satisfaction. J Nurs Adm. Quinn DA. Not relevant. No association tested. Dec 1998. Malstam J. Fall 1994. Hazy J.9(3):162-170. Rn. Jun 30-Jul 6 1999.17(23):14-17. Feb 19-25 2003. Br J Nurs. A measurable framework for improving quality. A matter of life and death. Tomallo-Bowman R. Nordlund P. Jul 2003. Changing time in an operating suite. Steiner A.31(7):1959-1963. 2736.11(1):33-42. Irvine N. Lima C. Semin Nurse Manag. et al. Nurs Spectr (Wash D C).20(3):273282. Wang C.5(2):86-88. Safety and comfort work of nurses glimpsed through patient narratives. Ward D. Crit Care Med. community medical center.8(1):42-48. Not eligible exposure. Jul 2004. Jul 1998.2(4):234-238. Not eligible target population. Review. Not eligible target population. Comment. Meyer JJ. Nurse-led inpatient care: opening the 'black box'. 2732. Washburn M.6(13):5. Cohen MM. Watson LD.19(11):858-60.

Patients first when budgeting.97(36):3435. 2751. Weber S. Weltman AC. 2774. Jun 1996. The essence of professional practice. Not eligible exposure. 2766. 2749. Brenner PS. Recognizing excellence.22(9):54-56. quiz 170-152. Caring Professionals. Nurs Times. 2763. Apr 2003. Comment. Wheeler J. 2771. Tour C. The nurse manager's role in creating a healthy work environment.10(1):1621. Soloshy DE. Comment. Apr 2005. Westera D. Rodriguez M. Clin Nurse Spec. Wells N. 2764. 2761. Patient satisfaction with information received after a diagnosis of angina. Not eligible target population. Weinberg AD. Webb D. Review. but hardly improved.28(1):31-40. Harrison Memorial in Bremerton. A profile of part-time faculty in Canadian university nursing programmes.95(41):49. Comment. Nov 2003. Weisman CS. Not eligible exposure. The use of medication modules for medication administration problems. St Clair V. Gafni A. Satisfaction with nursing care: a comparison of patients with HIV/AIDS. Clin Nurse Spec. Todays OR Nurse. Werab B. Salyer S. Aug 1994. Differentiated practice in Colorado--what's happening? Colo Nurse. Enhancing nurse-physician collaboration: a staffing innovation. Not eligible exposure. Not eligible exposure.8(2):39-46. B-82 .23(3):11-16. Webb AA. Not eligible exposure. Not relevant. The effects of unit self-management on hospital nurses' work process. J Nurs Adm.26(2):28-33. et al. 2775. J Healthc Risk Manag. Gordon DL. Nov 1996. 2760. Aug 1994. New. Stewart L. 2756. Martinez R. MarApr 1997. Falco J. Spring 1999. 2753. Lesene AJ. Strateg Healthc Excell. May 1993. Giving your AWE. Nurs Times. Feb 2002. Med Care. Quality care indicators and staffing levels in a nursing facility subacute unit. Night shifts: light-headed night staff. Arch Psychiatr Nurs.17(4):51-53.22(6):412-426. Mar-Apr 1993. Easton S.2745. Macfarlane R. Wheaton M. Comment. Whelchel C. Disposal-related sharps injuries at a New York City Teaching Hospital. Washington records satisfaction all around from 2year-old "private practice" unit nursing experiment. AACN Clin Issues. Jan-Feb 1999. 2768. Whiley K. 2759. Antonova S.6(46):44-45. Goryunova M.19(3):150-153. Fall 1997. competence. Comment. Bergner M. May 1995.8(4):254-261. Valuing authority/responsibility relationships. 2757. 2746. Comment. Aug 2001. Hansen v. and caring. Nurs Manage. 2765. Dec 1996.23(2):77-81.31(5):381-393. Not eligible exposure. Webster DC. Miller M. Not eligible exposure. Wells B. Not eligible exposure. Health Care Manage Rev. Johnson R. 2776. Glenn R. Agency not liable for actions of nurse supplied by agency.5(12):1-10. Browne G. Nurs Adm Q. Cassard SD. Not eligible outcomes. Feb 1996. Weinstein SM.96(4):17-18.12(3):356-365. J Clin Nurs. Not eligible exposure.14(4):159-169. Not eligible exposure. Perl TM.33(4):193-195. Wong R.28(11):90-92. J Nurs Adm. 2762. Jan-Feb 1994.12(4):161168. Not eligible outcomes. Are daily bed linen changes necessary? Nurs Manage. The efficacy and effectiveness of process consultation in improving staff morale and absenteeism. 2747. Jul 1998. Weetch RM. Comment. 2750.35(4):334-353. Weir R. 2769. Seymour L. Not eligible target population. Webster J. 2773. An outbreak of Staphylococcus aureus in a pediatric cardiothoracic surgery unit. Webber S. Pressure-relieving equipment: promoting its correct use amongst nurses via differing modes of educational delivery. Gill S. Price SA. Richards CL.14(4):473-478.24(4):47-59. West JC. An innovative professional nursing practice model. Nurs Stand. Summer 1990. Cross-training: meeting staffing needs in the ICU. J Assoc Nurses AIDS Care. Nov 1997. Sep 6-12 2001. Using the nurse practitioner in the acute care setting. How to delegate your way to a better working life. and retention. Short LJ. Wermers MA. Not eligible exposure. Aug 5-11 1992. Not eligible target population. Sep 1992. Not eligible exposure. Infect Control Hosp Epidemiol. 2772. 2748.30(1):16-17. Bower DA. Scott D. Not eligible exposure. 2755. Dec 1992. Review. Aspens Advis Nurse Exec.3(1):1-4. Not eligible exposure. Gosney M. 2770. Weiss JP. Jan-Feb 1998. Vaudaux P. Heart Lung. Westfall NL. Nurs BC. Oct 13-19 1999. Dagnillo R. J Nurs Adm.27(11):32B. Wenzel K. Herwaldt LA. Wheeler EC. non-HIV/AIDS infectious diseases. Not eligible exposure. Vaughn K. Roberts J. Welford M. Interdisciplinary collaboration.16(5):268-274. J Nurs Staff Dev. The work attitudes of full-time and part-time registered nurses. Wehby D. Wester F. McNutt LA. Mar 2004. Rhomberg P. Hurt R. 2777. Not relevant. Wetzel K.35(3):16. and medical diagnoses. Med Care. Pfaller MA. Taking charge of your practice. Western H. Weber DO.15(2):5-7. Jul 2000.15(3):79-85. Not eligible exposure. 2758. Jt Comm J Qual Improv. Nurs Manage. Brunt B. Alexander C. van Kammen DP. Prof Nurse. Planning and assessing a crosstraining initiative with multi-skilled employees. The CNS's impact on process and outcome of patients with total knee replacement. Cowart P. Inc. 2752. Gallagher DG. Infect Control Hosp Epidemiol. Mendelson MH. Cluster staffing: cooperation. work satisfaction. No association tested. Coeling HE. Journal of the American Medical Directors Association Jan-Feb 2002. Canadian Journal of Nursing Research Winter 1992. Burrow CM. 2754. Lilienfeld DE. Wedge C. 2767. Webb SS. Perceived learning needs of patients with heart failure. Apr 1997. Introducing solution-focused approaches to staff in inpatient psychiatric settings.9(11):4-6.

Not eligible target population. education and engineering. Not eligible exposure. Williams AM. Wild D.10(1):63-69. Arch Intern Med. Nurse-led intermediate care: patients' perceptions. Wild D.23(1):32-39. Williams R. Walsh B.46(6):262-267.177(8):418-422. Enhancing the therapeutic potential of hospital environments by increasing the personal control and emotional comfort of hospitalized patients.. Br J Nurs. Kim Y. Scullion J. Revolution.98(25):24-25. Jurczyk W. Comment. Nov-Dec 1998. Review. Williams R. Apr 1999. Not eligible target population. Not eligible target population. Wang SL. News. 2789. Williams AM. Jan 2005.1(4):9. Review. 2802. quiz 159-160. Jt Comm J Qual Patient Saf. Sep 2003. Bradley EH. Irurita VF. Katz DL. Taeger K. 2809.74(1):16-20. Nurs Stand. Not eligible exposure. 2795. Wiles R. McGowan S. Widmark-Petersson V.17(23):21. Not eligible exposure. 2787. 2788. Sjoden PO. Hollow-bore needlestick injuries in a tertiary teaching hospital: epidemiology. Whelan A. Wiesner G. Appl Nurs Res. Not eligible target population. Wichowski HC. Feb 1994. No association tested.10(4):227-233. Oct 2004. Doctor's orders. Wilkinson CL. Scand J Caring Sci. Nurs Stand. Williams C. Williams J. Aust J Adv Nurs. Kubsch SM. 2792. Measuring nurse-sensitive patient outcomes across specialty units. Steiner A. 1996. Missing RN would threaten safety in OR. A framework for patient assessment. White CL. Happy together. Pique practice. George L.36(4):205-10. 2801. 2786. 2810. rostered day off option.19(2):219-225.31(1):13-20. Absenteeism and the impact of a 38-hour week. Mar 22 1993. et al. Jacob SR. Stotts RC. Szulc R.8(4):155158. Not eligible target population.17(3):293-300.14(31):12-13. Safe practice: machine age killers. Dec 1-7 1999. May 1993. Nurse leaders' perceptions of quality nursing: an analysis from academe. Nurs Stand.8(38):29-33. Ladwig J. 2800. Nursing staff requirements for neonatal intensive care. Sobczynski P. Nurs Times. 2804. 2780. 2803. Staff shortages would be a thing of the past with a return to ward-based training. Jul 1996. J Gerontol Nurs. Inactive nurses: a source for alleviating the nursing shortage? Journal of Nursing Administration Apr 2006. Wykes T. J Clin Nurs.68(5 Spec No):534538. Weindling AM. Not eligible exposure. J Clin Nurs.7(2):2. Torres C.6(4):152-158. Clin Nurse Spec. 2807. Williams S. Comment. Jul 1999. Whittington R.153(6):708-712. Cooke RW.2778. May-Jun 1995. B-83 .13(4):166-172. Davidson LJ. 2782. Jr. Nurs Stand. Postle K. Nawaz H. An evaluation of staff training in psychological techniques for the management of patient aggression. Hobbhahn J.25(4):6-11. Perceptions of caring among patients with cancer and their staff. 2799. Hoerauf KH. Feb 19-25 2003. White C. Jul-Aug 1992. Not eligible target population. J Public Health Manag Pract. 2806. Aug 23-29 2000.6(43):44-45. Shame reactions after suicide attempt. Asberg M. Professional autonomy: a pilot study to determine the effects of a professional development program on nurses' attitudes. Irurita VF. 2785. Jan 2001. Arch Dis Child. 2779. Violence in psychiatric hospitals: are certain staff prone to being assaulted? J Adv Nurs. Not eligible exposure. Comment. Nurs Outlook. Feb 2000. Feb 2005. Effects of interdisciplinary rounds on length of stay in a telemetry unit. Not eligible exposure. Wykes T. Comment. White F. Williams KA. Williams AM. Med J Aust. Jan 2003. 2808. Ferguson DA. Scand J Caring Sci. Revolution. 2793.5(4):257-261. Patients' and nurses' perceptions of quality nursing activities. Wilkinson R. Increased prevalence of Helicobacter pylori antibodies among nurses. Williams S. Chan W. von Essen L. Not eligible target population. J Nurs Staff Dev. J Nurs Staff Dev. Editorial. von Essen L. Not relevant.12(19):1122-1129. Int Arch Occup Environ Health. White RJ. 2805. 2797. Samuelsson M. Not eligible target population. Oct-Dec 2002. Nurs Times. Whitman GR. Lindman E. Wiklander M. 2791. Apr 19-25 2000. Buswell C.11(3):150-155. 2798. Therapeutic and nontherapeutic interpersonal interactions: the patient's perspective.95(48):43. Not eligible target population. Kalbfleisch JH. Not eligible exposure. Irurita VF. A follow-up study on occupational exposure to inhaled anaesthetics in Eastern European surgeons and circulating nurses. Orienting foreign nurse graduates through preceptors. Jul 15-21 1992. An evaluation of an educational program on the management of assaultive behaviors. Wilhoite SL. Williams G.40(1):61-71. Oct 21 2002. 2790. Int J Nurs Stud. The gap between nurses and residents in a community hospital's error-reporting system.14(49):18-19. Thomas E. 2794. Not eligible outcomes. Changing pain management practice and impacting on patient outcomes. Sjoden PO. Widmark-Petersson V. Lowry M. 2783. Williams S.16(2):36-44. Jun 15-21 1994. Outcomes Manag.13(7):806-815. Soike DR. Therapeutically conducive relationships between nurses and patients: an important component of quality nursing care. Whitby RM. Not eligible exposure. Dec-1999 Feb 1998.23(4):89-96. Jan-Feb 2004. Differences and disagreements. Not eligible exposure. Whitehead E. Not eligible outcomes. Whittington R. Summer 1997. 2781. Cancer patient and staff perceptions of caring vs clinical care. Oct 23-Nov 12 2003.18(1):22-28. Aust Health Rev. Baldwin M. Jul-Aug 2000. It all adds up. 2000. 2796. Nurs Stand. Slater K. Cancer Nurs. Not eligible target population. Jun 18-24 2002. Cost-cutters eliminate skilled nurses. McLaws ML. Wolf GA. 2784. Harth M. Not eligible target population. Williams RP. Not eligible target population.

2838. Wood D. Nurs Manag (Harrow). Can nurses safely assess the need for endotracheal suction in short-term ventilated patients. Nurs Manage.20(3):259-274. 2829.11(5):15-29. Jun 2001.27(3):215-222. Not eligible exposure.59(1):4.69(3):216-224.9(3):10-14. So CK. Not eligible exposure. Br J Nurs. 2836. Ingham E. Jablonski RA. 2814. Effects of nurse follow-up on emergency room revisits: a randomized controlled trial. May-Jun 2004. Not eligible target population. The erosion of nursing resources: employee withdrawal behaviors. Soc Sci Med. 2839.25(7-8):46-51. Resident-patient interactions: the humanistic qualities of internal medicine residents assessed by patients. 64D. Can I say no? Nurs BC.22(3):165. 2846. Wootten N. Wilson M. Oct 2001. Job satisfaction and the 12-hour shift. Nurs Stand. Not eligible target population. Review. Aug 12-18 1998.9(20):2169-2174. Williams SA. 2844.25(3):134-140. 2816. Not eligible outcomes. Not eligible target population.32(1):43-46. Wilson N. Pa Nurse. Not eligible target population.28(11):84-86. 2825. 2834. J Post Anesth Nurs. Winkleman L. Windsor K. 64F passim.6(2):65. Not eligible target population. Sep 2000. Nurs Econ. Skin tolerance and effectiveness of two hand decontamination procedures in everyday hospital use.6(2):98-101.4(6):460467. Omachonu VK. Accid Emerg Nurs. Developing a successful self-rostering shift system. Patel BP.59(11):2207-2218. 2832. Wood CJ. Development of a women's wellness center in Almaty. Nursing: an ageing population.2811. Kazakhstan. Apr 2002. 2817. Am J Nurs. Aug 1998. Worthington K. Pattrin L. Nurs Manage. 2827. Nurs Manage. Willson B. 2812. Patients' rights to privacy and dignity in the NHS.3(4):219220. Wise LC. Editorial. Not eligible outcomes. Mar 1996. Chang K. Benchmarking working time in health care: the case of Excelcare. Woodhouse AJ. McGoldrick TB. Allgeier PJ. Wintle JM. Nurs Stand. program supervisors.17(3):264-273. Differential impacts of coping strategies on trati the mental health of Chinese nurses in hospitals in Hong Kong. Wood L. Haakenson DA. Reproductive hazards on the job. Not eligible target population. Leung SS.23(8):64A. Client centred approach to community child and family care: a descriptive account of social support services provided by Plunket nurses in the central region. 2831. Woodward W. 2813. Wright B. Witchell L. Medsurg Nurs. Wirt GL. Floating to another worksite. Not eligible outcomes. Woodcraft B. Wolf ZR. Comment. Keech RR. Getting results with integrity. Willis J. Liu J.17(42):40-42. 2822. Mar 1993. Nurs Manage. 2828. 2002. Apr 1998. Letter. Jun 1997. Feb 1995. Nov 1997. Oct 1995. Comment. 2823. Costello A. Woogara J.101(10):104. Not eligible target population. Nurs Prax N Z. Aust Health Rev. Relationship between nurse caring and patient satisfaction.30(2):231239. Comment. 2833. Wood D. Not eligible target population. J Manag Med. Autotransfusion in the postanesthesia care unit.14(41):18-19. Implications of power imbalances. Wilson CK. Clinical care coordination program: a working partnership. Wolf G. Preparing a new workforce. J Nurs Adm. Comment. Comment. B-84 . Bormolini S.143(3):546-550. Swanson DB. instead of using routine techniques? Intensive Crit Care Nurs. and nurses. Grierson-Hill L.6(26):46. Mar-Apr 2001. Apr 1998. 2830. Winnefeld M. Jun 2002. Causes of institutionalism: patient and staff perspectives. Comment. Wortley V. Accid Emerg Nurs.19(18):33-37. AARN News Lett. Gabriel VH. 2840. Oct 1998. Not eligible target population. Jan 2001. Mar 18-24 1992. Winstead-Fry P. Chow S. Wolf ZR. J Nurs Care Qual. 2820. Interview by Debbie Smith. 2815. Gaston-Johansson F. Using simulation to project staffing levels. Wong DF. Not eligible target population. Not eligible target population. Wilson TA. attending physicians. Drancourt M. Richard MA. Dec 1995. Jan-Feb 2004. Not eligible target population. 471. Managing international recruits. Jul 2-8 2003. Nurs Stand. Editorial.26(2):54. Nurses receive bonuses for patient satisfaction. Not eligible exposure. Case Reports.10(3):31-38.v. News. 2842. A late shift in accident and emergency. Wing KT. Interview.14(4):170-178. Int J Nurs Pract. 1996. Evaluation of 12-hour shifts on a cardiology nursing development unit. Case Reports. Medsurg Nurs. When flex comes to shove: staffing and hospital census.49(3):10-11. Retention and work environment. J Obstet Gynecol Neonatal Nurs. Feb 1993. Willis E. Nurs Adm Q.14(1):2-3. 2821. Wolsieffer D. Gassner LA.34(2):23. Nurs Times.16(1):67-75. Jan 12-18 2005. Nurs Stand. Jenkins EL.7(2):99-105. Nov 9-22 2000. Aspens Advis Nurse Exec. Howell JD. Temporary assignments: a new process. Woolliscroft JO.94(32):28-29. Oct 2004. Res Nurs Health. Mar 1994. 2824. Apr 1991. No association tested. 2819. Aug 1992. I can see clearly now. Unpalatable options. 2843. The relationship of patients' perceptions of holistic nurse caring to satisfaction with nursing care. line: a simple but potentially costly procedure for both patient and health unit.7(3):188-198. Acad Med. 2847. Nurses' perceptions of harmful outcomes from medication errors. 2837. Issues Ment Health Nurs. Nursing in Texas--a personal account. Grob JJ. Shift work: benighted existence. Jun 28-Jul 4 2000. 2818. Not eligible target population. Flushing an i. Not eligible outcomes. Jul-Sep 2003. Not eligible target population. 2835. Dec 2004. 2841. 2845. Acting on complaints about mental health services.11(1):12-18. Colahan M. Br J Dermatol. May-Jun 1999. Wotton K. Crutchfield JE. Contemp Nurse. Lee A. 2826. Wong FK. Jul-Aug 1995. Not eligible target population.

Int J Nurs Stud.8(2):62-73. Dec 2001. May 2004. Sauter S. Zeler KM. Am J Crit Care.28(4):337-342. Int J Nurs Stud.17(4):29-34. Oct 3-9 1990. Salivary cortisol levels and work-related stress among emergency department nurses. Baxter PJ. Jenkins J. Manthous CA. Not eligible exposure. Yuska C. 2877. Ziegler E. Not eligible target population.2848. Chiang MC. Young WB. Pust-Marcone J. Intentionality: evolutionary development in healing: a grounded theory study for holistic nursing. Yip Y. Not eligible target population. Not eligible target population. and intent to stay.33(12):20.28(2):95-96. Wynd C. Nov 1994. Intensive Care Med. Changing attitudes towards families of hospitalized children from 1935 to 1975: a case study. Standing up for Pink. Not eligible year. Sep 2003. Not eligible exposure. Schnebel B. Chia SE. 2866. Not eligible exposure. Apr-Jun 2002. McPharlane TJ. Huang CK. Young WB. Not eligible exposure.86(40):18. Samstag DE. J Nurs Res. 2005. Eastern light. 2868. Summer 1991. Failure of a brief educational program to improve interpretation of pulmonary artery occlusion pressure tracings. Can J Nurs Adm. Tate R. Not eligible target population. Jezewski MA. Not eligible target population. Aust J Adv Nurs. 2880. Comment. Editorial.26(6):698-703. Wright S. Leapfrog Group jumps over nursing. Not eligible exposure. 2874. Egypt. Maljanian R. Wright V. Editorial. Edtna Erca J. Not eligible outcomes. Jun-Aug 2000. Journal of Holistic Nursing Mar 2005. B-85 . 2867. Yi M. 2854. 2863. Jul 2004. Patient satisfaction with nursing care in Alexandria. J Emerg Nurs. Br J Perioper Nurs. 2865.43(12):1011-1018.11(1):5-6. Lee LN. 2862. Dec 1992. 2856. Nov 24-30 2004. el-Hadad A. Aaohn J. Coulombe KH. 2869. Not eligible outcomes. Zahourek RP. Dong F. Not eligible exposure. Agard-Henriques B. Relationships between nurse staffing and patient outcomes. Not eligible target population. J Adv Nurs. Not relevant. Nurse caring behaviors and patient satisfaction: improvement after a multifaceted staff intervention. 2870. Not eligible exposure. Not eligible target population. Not eligible target population. Wright B. J Nurs Adm. Deddens J. Aorn J. J Adv Nurs. Marcantonio R. Schaps MT. Zarich S. 1991. J Adv Nurs. Dec 1992.11(3):149158.13(2):141-152.1(2):7075. J Occup Environ Med. Salamonsen RF. patient handling activities and the risk of low back pain among nurses in Hong Kong. 2876. Yeung SS. 2855. Not eligible exposure. Staff nurse weekend program proves cost effective. 2864. The relationship between protective and risk characteristics of acting and experienced workload.36(6):794-804. Trottier J.60(5):796. 2849. Yang Y. 2872. Causes of staff abuse in health care facilities. Lee FC. Berger G. William SG. 2857. 2878. Not eligible target population. Image J Nurs Sch. 2875. Zahr LK. Not relevant. Wu ML. Yeh SH. Patient-centred care in Turkey. Cooper J. 2871. J Nurs Adm. Yassi A. 2859. J Wound Ostomy Continence Nurs. Dec 1993. Jun 2005. J Nurs Res. Bacterial carriage on the fingernails of OR nurses. It just doesn't add up. J Safety Res. Nurs Res. J Adv Nurs. Wynd CA. Wright S. Not eligible target population. Patient classification systems: another perspective. Nurs Manage. Amoateng-Adjepong Y. job satisfaction. Mar 2004. Yang KP. Lapp AM.23(1):89-109. Sep 1992.36(1):85-95.19(6):529-531.59(9):608-612. 2852. Effectiveness of nursing involvement in bedside monitoring and control of coagulation status after cardiac surgery. Occup Environ Med. Terminology used by different health care providers to document skin ulcers: the blind men and the elephant. Zimmermann PG. Yang KP. Comment. Implications of nursing care in the occurrence and consequences of unplanned extubation in adult intensive care units. Jul 2000. Dec 2001. Dec 2002. work stress and sedentary lifestyle. Not eligible target population. Not eligible outcomes.44(5):290-297. Staff nurses' career development relationships and self-reports of professionalism. Canadian Journal of Nursing Research Mar 2002. 2850. Yip VY. 2858. ZborilBenson LR. Smith DL. News. Young J. Not eligible exposure. Sep 2003. Courtney M.19(11):20-21. Sep 2000.26(5):15-20. Minnick AF. Mason HJ. Nurs Manage. White WD. Crabtree-Tonges M. Oct 1998. Why nurses are calling in sick: the impact of heath-care restructuring. Comment.33(4):89-107. 2879. "On call" staffing. Nurs Stand. 2853.46(10):484-491. Nov 2003. 799-805. Sep 2002. Nurs Adm Q. Chan G. Not eligible target population.17(12):1422-1429. Models of nursing care: a comparative study of patient satisfaction on two orthopaedic wards in Brisbane. Jun 2000. Ho TH. The effects of staff nurses' morale on patient satisfaction.33(9):434-436. New low back pain in nurses: work activities. Implications for prevention. Lehrer EL. Zeleznik J. Koh D. Korean nurses' adjustment to hospitals in the United States of America. The effect of education on the practice of nursing. Can you work? Accid Emerg Nurs. Jan-Feb 1998. May 1996. and musculoskeletal disorder cases among nurses.30(6):324-333. Winter 1984.14(7):300. Wrona-Sexton S. Staffing to meet patient care needs.23(2):105-108. Occupational exposure to cytotoxic drugs in two UK oncology wards. Nurs Times. How wide is the gap in defining quality care? Comparison of patient and nurse perceptions of important aspects of patient care.23(12):38-39. Bohannon RW. Yoder LH. Ng V. Wylie DM. A study of work stress.8(3):127. Genaidy A. Sep-Oct 1995. 2851. 2873. Yurugen B.32(3):721-729. Lin LW. 2860.46(4):430-440. Yeakel S.41(3):255-262. 2861.

2883.51(4):767-772. Fiore T. Hadid S. Weiss HM. Piehler S. University Clinic of Regensburg. 2882. Self-scheduling in the emergency department. Feb 1997. Feb 1995. Not eligible target population. Will TL. Pain relief in major trauma patients: an Israeli perspective. Shemer J. Soules DM. Comment.21(1):58-61. Eitan A. Halperin P. Zimmermann PG. Comment. 2884. Zimmermann PG. J Emerg Nurs. Stolero J. Aug 1996. J Cardiovasc Surg (Torino). Avoiding registered nurse layoffs: three hospitals share how it's done. J Emerg Nurs. How to run a heart surgical unit: experiences during the first year of the Department of Cardiothoracic and Vascular Surgery. Zimmermann PG. Zurbrugg HR. Zveibel FR.38(1):53-61. Comment.21(4):335-337. 2886. Zohar Z. B-86 . Oct 2001.2881. Aug 1995.22(4):323-327. J Trauma. Not eligible target population. Use of "stat" nurses in the emergency department. J Emerg Nurs.

D.. F.N. Christine Kovner. Affiliation School of Nursing University of Minnesota Patient Care Services University of Colorado Hospital College of Nursing New York University School of Nursing University of North Carolina at Chapel Hill School of Public Health UCLA Chief Executive Officer American Organization of Nurse Executives Colleen Goode. R. Ph.D.A.N. F. Ph..A. TEP Member Sandra Edwardson. C-1 . Ph.. F.Appendix C: Technical Expert Panel Members and Affiliation Peer reviewer comments on a preliminary draft of this report were considered by the EPC in preparation of this final report. Barbara Mark.A.A.N... Jack Needleman..N.D.S.N. R.A.N. Ph.A..D.N. Pamela Thompson. R.. Ph. Synthesis of the scientific literature presented here does not necessarily represent the views of individual reviewers. R.D. R.N. M.

number of patients/aid Yes If Yes. Data source for nurse staffing variables (define) Nurse to patient ratios: Registered nurse/patient ratio Yes If Yes. 2. Mark Yes/No by assessment in the study. Provide the definition of each variable used in the article. define No No No D-1 . define Aid/patient ratio. define Licensed nurse practitioner/patient ratio Yes If Yes.Appendix D: Sample Abstraction Forms Nurse Staffing in North American Hospitals Staffing Ratios/Patient Outcomes Abstraction Form (Complete for each study) Number of the study First author Year of the publication Journal of the publication Database to identify the study Person to score the study Publication type (check one) Published article Administrative report Dissertation Abstract/Presentation Book/book chapter Purpose/aim of study Design of the study (check one) prospective cohort retrospective cohort cross-sectional descriptive study case-control case-series randomized controlled clinical trial not randomized clinical interventions ecologic Nurse staffing variables (independent variables) 1.

define Registered nurse hours/patient day Yes If Yes. in days_______________ No D-2 . define Aid hours /patient day Yes If Yes. define Proportion of licensed nurses among nursing personnel Yes If Yes. 2. define No No No No No No Patient outcomes variables 1. in days____________ Time of follow up from hospitalization to death . Mark Yes/No by assessment in the study. define Measures of nurse work hours Total hours of care/patient day Yes If Yes. Provide the definition of the variable used in the article. define Licensed nurse hours/patient day Yes If Yes.Proportion of RN among nursing personnel Yes No If Yes. define Data source to measure mortality : Time of follow up from the day of surgery to death. define Licensed nurses/patient ratio Yes If Yes. Mortality Yes If Yes.

Provide the definition of each variable used in the article.Mortality rate in groups with different staffing levels Yes No If yes. days Yes No Data source to measure LOS Data extraction table: Complete cells with values of LOS reported in the article Categories of independent staffing variable Exposure variable LOS in hospital in days Mean STD Median LOS Lower 95%CL Upper 95%CL RR LOS in units in days D-3 . 4. Provide the data source to measure the outcome. Mark how the outcome was reported Variable Assessment in the study Yes No Definition Source to measure Reporting number of events Proportion in % Relative risk Adverse events Other Length of stay. days Yes No Length of stay in the hospital. 3. how reported (mark all applicable): Number of events Proportion in % Relative risk Adverse drug events 1. 2. Mark Yes/No by assessment in the study. Length of stay in the unit.

4. Provide the definition of each variable used in the article. in days __________ days Patient satisfaction scale (define)______________________________ D-4 . Mark Yes/No by assessment in the study. Mark how the outcome was reported Assessment in the study Yes No Reporting scores % of favorable responses Relative risk Variable Satisfaction with nurse care Satisfaction with education Satisfaction with pain management Time from the hospitalization to the measurement of the patient satisfaction. Provide the data source to measure the outcome. Mark Yes/No by assessment in the study. 2. 2. 3.Nurse quality outcomes 1. Mark how the outcome was reported Source to measure Reporting number of events Variable Assessment in the study Yes No Definition Proportion in % Relative risk Falls Injury Pressure ulcers Failure to rescue Patient satisfaction. 1.

4. Mark Yes/No by assessment in the study. Mark how the outcome was reported Source to measure Reporting number of events Variable Assessment in the study Yes No Definition Proportion in % Relative risk Urinary tract infection Postoperative complications Gastrointestinal bleeding Hospital-acquired pneumonia Shock Atelectasis or pulmonal failure Accidental extubation Nosocomial infection Surgical wound infection Post surgical thrombosis Cardio-pulmonary arrest Any complication Any Medical complication Any surgical complication Sepsis Post surgical bleeding Other D-5 .Quality Measures: Patient related: 1. 3. Provide the definition of each variable used in the article. Provide the data source to measure the outcome. 2.

Provide the definition of each variable used in the article.Nurses related: 1. 2. 4. Provide scale to measure the outcome. Mark Yes/No by assessment in the study. 3. Mark Yes/No by assessment in the study. 1. Mark how the outcome was reported Source to measure Reporting number of events Variable Assessment in the study Yes No Definition Proportion in % Relative risk Turnover rate Burnout Vacancy Nurse self-reported. 4. Mark how the outcome was reported Variable Assessment in the study Yes No Definition Scale to measure Reporting scores % favorable responses Relative risk Satisfaction with job Perception of adequacy of staffing Perception of quality care Autonomy of nurses Nurses Governance Stress D-6 . 3. Provide the data source to measure the outcome. Provide the definition of each variable used in the article. 2.

Patient Eligibility criteria Complete the table with definitions used in the article: Inclusion criteria Age Sex Race Insurance Residency Hospitalization Availability of records Diagnosis (ICD code) Comorbidities Severity Acuity Other Exclusion criteria Patients Medical Surgical Adults Pediatric combined % of the sample % of the sample % of the sample % of the sample Sample characteristics: Complete with values reported in the article and with page number in the article where the data was extracted: Page in the article Exposure : # Subjects Mean age Sex % of males Not reported Race (%) White Black Asian Other Not reported Ethnicity(%) Hispanic Not Hispanic Other Exposure categories D-7 .Patient characteristics.

Not reported Socioeconomic status (Scores) Not reported Primary diagnosis % ICD codes Co morbidities (case-mix index) Severity Acuity DRG Nurse characteristics. Nurse eligibility criteria Complete the table with definitions used in the article: Inclusion criteria Exclusion criteria Age License Experience Gender Working status Self-selection Other Nurses sample characteristics: Complete with values reported in the article and with page number in the article where the data was extracted: Page in the article Exposure : Mean age Gender % of males Not reported Race (%) White Black Asian Other Not reported Exposure categories D-8 .

Ethnicity (%) Hispanic Not Hispanic Other Not reported Foreign graduates % Not reported Other nurse characteristics which may impact patients outcomes: 1. Provide the data source to measure the outcome. 2. Nurse education Yes No Data Source Nurse degree Yes Data Source No Nursing degree Associated degree Diploma BSN MS Doctorate Nurse experience in years (in nursing) Yes Data Source No Non nursing degree Proportion of nurses with temporary positions (pool nurses) Yes Data Source No Nursing unions Yes Data Source No D-9 . Mark Yes/No by assessment in the study.

% of the sample non profit. % of the sample private. % of the sample Combined sample Location Size (number of beds) Ownership profit. % of the sample Not teaching.Organization characteristics which may impact patient outcomes. % of the sample public. Hospital eligibility criteria Complete the table with definitions used in the article: Inclusion criteria Data source Location Size Care Teaching status Ownership Availability of information Self-selection Other Exclusion criteria Status of selected hospital(s) Number of eligible hospitals Number of enrolled hospitals Number of analyzed hospitals if more than 1: Teaching. % of the sample Technology index not reported Computerization of communication and records not reported Central hospital support adequacy not reported HMO penetrating not reported Clinical units Intensive care unit Labor and delivery Pre-natal Post-natal Nursery Emergency Trauma Critical care Visits Hospital general Medical Surgical Operating room Pediatric D-10 .

number of patients/aid Number of Patients/Licensed nurses Proportion of RN among total nursing personnel in % Proportion of licensed nurses /total nursing staff in % Hours Total hours of care/patient day Registered nurse hours/patient day Licensed nurse hours/patient day Aid hours /patient day Mean STD 95%CL Median D-11 . /*Complete with values reported in the article with the page number in the articles the data was extracted for a quality control*/ /*Add as many lines for categories as necessary*/ /*Median is calculated when ranges only reported assuming normal distribution*/ /*Increment is analyzed when regression coefficients only reported*/ Staffing variables: Categories defined by authors Page number Variable Ratios Registered nurse/patient ratio Licensed nurse/patient ratio Aid/patient ratio.Post-anesthesia Psychiatry Specialty Step down units Telemetry Combined Unknown Data extraction tables.

Patient outcomes. /*Add lines for interactions Exposure*Interaction factor*/ Exposure categories (treatment groups) Outcomes Mortality Rate in % Mean STD 95%CL Rate in % Median Events Subjects Page Nurse quality outcomes Urinary tract infection Falls Injury Pressure ulcers Any complication Any Medical complication Any surgical complication Nosocomial infections Sepsis Surgical wound infection Postoperative complications Gastrointestinal bleeding Post surgical bleeding Hospital-acquired pneumonia Atelectasis or pulmonal failure Accidental extubation Post surgical Thrombosis Cardio-pulmonary arrest Failure to rescue Shock Continuation of the previous table: Exposure categories Relative Risk (RR) Lower 95%CL of RR Outcomes Mortality Nurse quality outcomes Falls Injury Pressure ulcers Urinary tract infection Any complication Any Medical complication Any surgical complication Upper 95%CL of RR Page D-12 .

Nosocomial infections Sepsis Surgical wound infection Postoperative complications Gastrointestinal bleeding Post surgical bleeding Hospital-acquired pneumonia Atelectasis or pulmonal failure Accidental extubation Post surgical Thrombosis Cardio-pulmonary arrest Failure to rescue Shock Patient Satisfaction Exposure categories (treatment groups) Outcomes Satisfaction with nurse care Continuation of the previous table: Exposure Mean STD 95%CL Median Page Outcomes Satisfaction with nurse care Satisfaction with pain management Nurse characteristics: Exposure categories Relative Risk (RR) Lower 95%CL of RR Upper 95%CL of RR Page Variable Nurses characteristics Nurse experience in years Nurses education (%) Associate degree BSN MS PhD Proportion of nurses with temporary positions (pool nurses) in % Organization characteristics Duration of shift in hours Proportion of nurses working full time Categories defined by authors Mean STD 95%CL Median Page D-13 .

% perceived as adequate Perception of quality care. % of perceived as significant Categories defined by authors Mean STD 95%CL Median Page D-14 . % perceived as adequate Stress. % Nurses self-reported variables Satisfaction with job. % perceived as adequate Nurses Governance. % of satisfied Autonomy of nurses.Variable Turnover rate Burnout. % Vacancy. % satisfied Perception of adequacy of staffing.

April 2002) Score each domain on a scale of 0 (poor.ASSESSMENT OF STUDY QUALITY OBSERVATIONAL STUDIES (based on “Systems to Rate the Strength Of Scientific Evidence. 02-E016. 95%CL) Notes: Conclusions supported by results with possible bias and limitations taken into consideration Notes: Single versus Multi-site study (note one of the other) Notes: Co morbidities mentioned Notes: Co morbidities incorporated in the analyses Notes: Total score Score D-15 . regression modeling -see methods in paper Notes: Measure of effect for outcomes and appropriate measure of precision (SE. not defined) to 5 (excellent. clearly defined) Observational Studies Quality Domains/Elements Study question clearly focused and appropriate Notes: Sampling of Study Population Random Convenient Self-selected Notes: Clear definition of exposure Notes: Primary/secondary outcomes defined Notes: Statistical Analysis: Assessment of confounding attempted Did the analysis adjust for or examine the effects of various factors Patient characteristics Hospital characteristics Cluster of patients and hospitals Notes: Statistical methods used to take into account the effect of more than one variable on the outcome such as multiple regression. multivariate analysis. AHRQ Publication No.

on site computer system which can only be accessed after entering the characteristics of an enrolled participant. All eligible patients (units) included into analysis.INTERVENTIONAL STUDIES. 95% confidence interval). randomization scheme controlled by pharmacy.). and the estimated effect size and its precision (SE. Intervention Studies Quality Domains/Elements Study question clearly focused and appropriate Notes: Sampling of Study Population Random Convenient Self-selected Notes: Clear definition of exposure Notes: Randomization used to allocate patients (units) into treatment groups Notes: Randomization allocation concealment method Clearly adequate: Centralized randomization by telephone. Clearly Inadequate: Alternation (consequent. a summary of results for each group.distribution of confounding factors at baseline in treatment groups: Patient characteristics Hospital characteristics Cluster of patients and hospitals Notes: Intention to treat analysis. Notes: Conclusions supported by results with clinical significance of effect size Notes: Single versus Multi-site study (note one of the other) Notes: Total score Score D-16 . date of week Sample size Justification of the sample size for each tested hypothesis Statistical Analysis: Assessment of adequacy of randomization . Notes: For each primary and secondary outcome. sequentially numbered sealed opaque envelopes. numbered or coded identical containers administered sequentially. odd-even. date of birth. etc.

Study design characteristics Adequacy of the sampling (random selection or not) (check one) random sampling convenience sampling non-random sampling single hospital study self-selected not specified all sampled subjects were analyzed sampled subjects were excluded from the analysis___________% 95% CL as reported estimates of the association between exposure and outcomes Yes No P value as reported estimates of the association between exposure and outcomes Yes No Correlation coefficient reported between exposure and outcomes Yes No Propensity scores used for nonrandom unequal distribution of confounding factors among treatment groups Yes No Adjustment for confounding factors: Adjustment for age of the patients Yes No Adjustment for race of the patients Yes No Adjustment for patient sex Yes No Adjustment for patient Diagnoses/comorbidities Yes No Adjustment for socioeconomic status of the patients Yes No Adjustment for hospital (provider) characteristics Yes No Country Canada State or province abbreviation Combined D-17 .

Well-designed cohort (retrospective) study with concurrent controls II-3 – Well-designed case-controlled (retrospective) study III – Large differences from comparisons between times and/or places IY – Opinion of respected authorities based in clinical experience D-18 .Well-designed cohort (prospective) study with concurrent controls I-2B .Well-designed cohort (prospective) study with historical controls II-2C .Sampling units (can be more than one) patients  hospitals hospital units nurses other (define)_______________ Analytic unit (can be more than one) patients hospitals  hospital units  nurses Level of evidence of the individual study (check one) Interventions: I – Well-designed randomized controlled trial II-1A .Well-designed controlled trial without randomization Observational studies I-2A .Well-designed controlled trial with pseudo-randomization I-1B .

define Use of part time nurses  Yes No If Yes. define D-19 . Mark Yes/No by assessment in the study. 1. Provide the definition of each variable used in the article.Nurse Staffing in North American Hospitals Nursing Staffing Strategies /Patient Outcomes Abstraction Form (Complete for each study) Number of the study First author Year of the publication Journal of the publication Database to identify the study Person to score the study Publication type (check one) Published article Administrative report Dissertation Abstract/Presentation Book/book chapter Purpose/aim of study Design of the study (check one) prospective cohort retrospective cohort cross-sectional descriptive study case-control case-series randomized controlled clinical trial not randomized clinical interventions ecologic Nurse staffing strategies (independent variables). define Experience mix of the nursing staffs Yes No If Yes. define Proportion of registered nurses Yes No If Yes. Data source for variables (define) Use of temporary nursing agencies Yes No If Yes. 2.

Continuing nurse education Yes No If Yes. 2. define Evidence Based Clinical Pathway Yes No If Yes. define Staff scheduling strategies: Shift Yes If Yes. define Over time work Yes No If Yes. define Decentralized scheduling – nurse manager Yes No If Yes. Mark Yes/No by assessment in the study. Provide the definition of staffing strategies (changes in staffing) used in the article Patient Focused Care Yes No If Yes. define Nurse staffing models 1. define No Duration of shift in hours Yes No If Yes. define Magnet Hospital Environment/Shared governance Yes No If Yes. define Team or Functional Nursing Care Yes No If Yes. define D-20 . define Primary or Total Nursing Care Yes No If Yes.

days Yes No Length of stay in the hospital. Mortality Yes If Yes. in days_______________ Mortality rate in groups with different staffing levels Yes No If yes.Patient outcomes variables 1. days Yes No Data source to measure LOS D-21 . 2. in days____________ Time of follow up from hospitalization to death . how reported (mark all applicable): Number of events Proportion in % Relative risk Adverse Drug Events. Length of stay in the unit. Provide the definition of each variable used in the article. 2. define Data source to measure mortality :___________ Time of follow up from the day of surgery to death. Mark how the outcome was reported Source to measure Reporting number of events No Variable Assessment in the study Yes No Definition Proportion in % Relative risk Adverse events Other Length of stay. Mark Yes/No by assessment in the study. 4. 1. 3. Provide the data source to measure the outcome. Mark Yes/No by assessment in the study. Provide the definition of the variable used in the article.

3. 4. 2. Mark how the outcome was reported Source to measure Reporting number of events Variable Assessment in the study Yes No Definition Proportion in % Relative risk Falls Injury Pressure ulcers Failure to rescue D-22 . Provide the data source to measure the outcome. Mark Yes/No by assessment in the study.Data extraction table: Complete cells with values of LOS reported in the article Categories of independent staffing variable Exposure variable LOS in hospital in days Mean STD Median LOS Lower 95%CL Upper 95%CL RR LOS in units in days Nurse quality outcomes 1. Provide the definition of each variable used in the article.

4. 3. Provide the data source to measure the outcome. 1. Mark how the outcome was reported Assessment in the study Yes No Reporting scores % of favorable responses Relative risk Variable Satisfaction with nurse care Satisfaction with education Satisfaction with pain management Time from the hospitalization to the measurement of the patient satisfaction. 2. 2. Mark Yes/No by assessment in the study. Mark Yes/No by assessment in the study. in days __________ days Patient satisfaction scale (define)______________________________ Other Quality Measures: Patient related: 1. Provide the definition of each variable used in the article. Mark how the outcome was reported Source to measure Reporting number of events Variable Assessment in the study Yes No Definition Proportion in % Relative risk Urinary tract infection Postoperative complications Gastrointestinal bleeding Hospital-acquired pneumonia Shock Atelectasis or pulmonal failure Accidental extubation Nosocomial infection D-23 .Patient satisfaction.

3. 2. Mark Yes/No by assessment in the study. Provide the definition of each variable used in the article. 4. Mark how the outcome was reported Source to measure Reporting number of events Variable Assessment in the study Yes No Definition Proportion in % Relative risk Turnover rate Burnout Vacancy D-24 .Surgical wound infection Post surgical thrombosis Cardio-pulmonary arrest Any complication Any Medical complication Any surgical complication Sepsis Post surgical bleeding Other Nurses related: 1. Provide the data source to measure the outcome.

Mark how the outcome was reported Assessment in the study Yes Satisfaction with job Perception of adequacy of staffing Perception of quality care No Scale to measure Reporting scores % favorable responses Relative risk Variable Definition Patient characteristics. 2. 3. Mark Yes/No by assessment in the study. Provide the definition of each variable used in the article. Provide scale to measure the outcome. Patient Eligibility criteria Complete the table with definitions used in the article: Inclusion criteria Age Sex Race Insurance Residency Hospitalization Availability of records Diagnosis (ICD code) Comorbidities Severity Acuity Other Exclusion criteria Patients Medical Surgical Adults Pediatric combined % of the sample % of the sample % of the sample % of the sample D-25 .Nurse self-reported. 4. 1.

Sample characteristics: Complete with values reported in the article and with page number in the article where the data was extracted: Page in the article Exposure : # Subjects Mean age Sex % of males Not reported Race (%) White Black Asian Other Not reported Ethnicity(%) Hispanic Not Hispanic Other Not reported Socioeconomic status (Scores) Not reported Primary diagnosis % ICD codes Co morbidities (case-mix index) Severity Acuity DRG Exposure categories D-26 .

Nurse characteristics. Nurse eligibility criteria Complete the table with definitions used in the article: Inclusion criteria Exclusion criteria

Age License Experience Gender Working status Self-selection Other

Nurses sample characteristics: Complete with values reported in the article and with page number in the article where the data was extracted: Page in the article Exposure : Mean age Gender % of males Not reported Race (%) White Black Asian Other Not reported Ethnicity (%) Hispanic Not Hispanic Other Not reported Foreign graduates % Not reported Exposure categories

D-27

Organization characteristics which may impact patient outcomes. Hospital eligibility criteria Complete the table with definitions used in the article: Inclusion criteria Data source Location Size Care Teaching status Ownership Availability of information Self-selection Other Exclusion criteria

Status of selected hospital(s) Number of eligible hospitals Number of enrolled hospitals Number of analyzed hospitals if more than 1: Teaching, % of the sample Not teaching, % of the sample Combined sample Location Size (number of beds) Ownership profit, % of the sample non profit, % of the sample public, % of the sample private, % of the sample Technology index not reported Computerization of communication and records not reported Central hospital support adequacy not reported HMO penetrating not reported Clinical units Intensive care unit Labor and delivery Pre-natal Post-natal Nursery Emergency Trauma Critical care Visits Hospital general Medical Surgical Operating room Pediatric

D-28

Post-anesthesia Psychiatry Specialty Step down units Telemetry Combined Unknown

Data extraction tables. /*Complete with values reported in the article with the page number in the articles the data was extracted for a quality control*/ /*Add as many lines for categories as necessary*/ /*Median is calculated when ranges only reported assuming normal distribution*/ /* Increment is analyzed when regression coefficients only reported*/ Staffing variables: Categories defined by authors Page number

Variable Proportion of part time nurses, in% Proportion of registered nurses, in % Proportion of nurses with BS, in % Proportion of nurses with MS, in % Duration of shift in hours

Mean

STD

95%CL

Median

Patient outcomes. /*Add lines for interactions Exposure*Interaction factor*/ Exposure categories (treatment groups)

Outcomes Mortality Adverse events Adverse events Nurse quality outcomes Urinary tract infection Falls Injury Pressure ulcers Any complication Any Medical complication

Rate in % Mean

STD

95%CL

Rate in % Median

Events

Subjects

Page

D-29

Any surgical complication Nosocomial infections Sepsis Surgical wound infection Postoperative complications Gastrointestinal bleeding Post surgical bleeding Hospital-acquired pneumonia Atelectasis or pulmonal failure Accidental extubation Post surgical Thrombosis Cardio-pulmonary arrest Failure to rescue Shock Relative Risk (RR) Lower 95%CL of RR

Outcomes Mortality Adverse events Nurse quality outcomes Falls Injury Pressure ulcers Urinary tract infection Any complication Any Medical complication Any surgical complication Nosocomial infections Sepsis Surgical wound infection Postoperative complications Gastrointestinal bleeding Post surgical bleeding Hospital-acquired pneumonia Atelectasis or pulmonal failure Accidental extubation Post surgical Thrombosis Cardio-pulmonary arrest Failure to rescue Shock

Exposure categories

Upper 95%CL of RR

Page

D-30

Patient Satisfaction Exposure categories (treatment groups)

Outcomes Satisfaction with nurse care Satisfaction with pain management

Exposure

Mean

STD

95%CL

Median

Page

D-31

ASSESSMENT OF STUDY QUALITY OBSERVATIONAL STUDIES (based on “Systems to Rate the Strength of Scientific Evidence, AHRQ Publication No. 02-E016, April 2002) Score each domain on a scale of 0 (poor, not defined) to 5 (excellent, clearly defined) Observational Studies Quality Domains/Elements Study question clearly focused and appropriate Notes: Sampling of Study Population Random Convenient Self-selected Notes: Clear definition of exposure Notes: Primary/secondary outcomes defined Notes: Statistical Analysis: Assessment of confounding attempted Did the analysis adjust for or examine the effects of various factors Patient characteristics Hospital characteristics Cluster of patients and hospitals Notes: Statistical methods used to take into account the effect of more than one variable on the outcome such as multiple regression, multivariate analysis, regression modeling -see methods in paper Notes: Measure of effect for outcomes and appropriate measure of precision (SE, 95%CL) Notes: Conclusions supported by results with possible bias and limitations taken into consideration Notes: Single versus Multi-site study (note one of the other) Notes: Co morbidities mentioned Notes: Co morbidities incorporated in the analyses Notes: Total score Score

D-32

INTERVENTIONAL STUDIES. Intervention Studies Quality Domains/Elements Study question clearly focused and appropriate Notes: Sampling of Study Population Random Convenient Self-selected Notes: Clear definition of exposure Notes: Randomization used to allocate patients (units) into treatment groups Notes: Randomization allocation concealment method Clearly adequate: Centralized randomization by telephone, randomization scheme controlled by pharmacy, numbered or coded identical containers administered sequentially, on site computer system which can only be accessed after entering the characteristics of an enrolled participant, sequentially numbered sealed opaque envelopes. Clearly Inadequate: Alternation (consequent, odd-even, etc.), date of birth, date of week Sample size Justification of the sample size for each tested hypothesis Statistical Analysis: Assessment of adequacy of randomization - distribution of confounding factors at baseline in treatment groups: Patient characteristics Hospital characteristics Cluster of patients and hospitals Notes: Intention to treat analysis. All eligible patients (units) included into analysis. Notes: For each primary and secondary outcome, a summary of results for each group, and the estimated effect size and its precision (SE, 95% confidence interval). Notes: Conclusions supported by results with clinical significance of effect size Notes: Single versus Multi-site study (note one of the other) Notes: Total score Score

D-33

Study design characteristics Adequacy of the sampling (random selection or not) (check one) random sampling convenience sampling non-random sampling single hospital study self-selected not specified all sampled subjects were analyzed sampled subjects were excluded from the analysis___________% 95% CL as reported estimates of the association between exposure and outcomes Yes No

P value as reported estimates of the association between exposure and outcomes Yes No

Correlation coefficient reported between exposure and outcomes Yes No

Propensity scores used for nonrandom unequal distribution of confounding factors among treatment groups Yes No

Adjustment for confounding factors: Adjustment for age of the patients Yes No

Adjustment for race of the patients Yes No

Adjustment for patient sex Yes No

Adjustment for patient Diagnoses/comorbidities Yes No

Adjustment for socioeconomic status of the patients Yes No

Adjustment for hospital (provider) characteristics Yes No

Country Canada State or province abbreviation Combined

D-34

Sampling units (can be more than one) patients  hospitals hospital units nurses other (define)_______________ Analytic unit (can be more than one) patients hospitals  hospital units  nurses Level of evidence of the individual study (check one) Interventions: I – Well-designed randomized controlled trial II-1A - Well-designed controlled trial with pseudo-randomization I-1B - Well-designed controlled trial without randomization Observational studies I-2A - Well-designed cohort (prospective) study with concurrent controls I-2B - Well-designed cohort (prospective) study with historical controls II-2C - Well-designed cohort (retrospective) study with concurrent controls II-3 – Well-designed case-controlled (retrospective) study III – Large differences from comparisons between times and/or places IY – Opinion of respected authorities based in clinical experience

D-35

race. Sampling of study population: 5 = Random population based sampling 4 = Random clinic based sampling 3 = Convenient 2 = Self-selected 1 = Single hospital study 0 = Not specified G. sex. External validity: single hospital study. using a 5 score scale from 0 (poorest) to 5 (highest): A. Conclusions supported by results with possible bias and limitations taken into consideration. We summarized scores (maximum possible 50) to have the overall quality score and to compare with the maximum. 95% CI) K. Clear definition of the primary and secondary outcomes D. multi-site study. Study question clearly focused and appropriate B. Total score as a percentage of the maximum possible (50) Each item was graded with 0 to 5 scores.Appendix E: Quality of the Studies Table E1 shows the quality of the studies. multivariate analysis. SES . Clear definition of exposure C. Validation of exposure (yes or no. Internal validity – the extent to which the findings of a study accurately represent the causal relationship between nurse staffing and patient outcomes.1+2+3 . clinical significance of effect size provided M. the responses do not count for the total scores) E. E-1 . The truth why patients had different outcomes may be related to patient characteristics or quality of the treatments (surgical quality) more than nurse care. Measure of effect for outcomes and appropriate measure of precision (SE. the responses do not count for the total scores) F.4 scores 3) Cluster of patients and hospitals . nationally representative sample L. To examine how nurse ratios and hours may affect patient outcomes independent of all known factors they measured. Validation of outcomes (yes or no. Statistical methods used to take into account the effect of more than one variable on the outcome such as multiple regression.5 scores I. the authors adjusted the results for confounding factors. regression modeling J. Definitions External validity – applicability of the results from the studies on different clinical settings. Statistical Analysis: Assessment of confounding attempted H. Adjustment to examine the effects of various factors 1) Patient characteristics: age. comorbidities.1-3 scores 2) Hospital characteristics – 1+2 .

Quality of the studies Year 1982 1987 1988 1989 1992 1992 1993 1994 1994 1994 1988 1994 1995 1995 1996 1996 1997 1997 1997 1997 1997 1998 1998 1998 1998 1998 1999 1999 1999 1999 1999 1999 2000 2000 2000 2000 2000 2000 2000 2001 2001 Author Arnow1 Wan2 Flood3 Hartz4 McDaniel5 Krakauer6 Halpine7 Aiken8 Shamian9 Taunton10 Shortell11 Shortell12 Grillo-Peck13 Thorson14 Fridkin15 Dugan16 Bloom17 Archibald18 Minnick19 Melberg20 ANA21 Blegen22 Blegen23 Kovner24 Leiter25 Aiken26 Pronovost27 Aiken28 Robertson29 Lichtig30 Seago31 Bond32 Amaravadi33 Gandjour34 Robert35 Silber36 ANA37 Hoover38 Unruh39 Pronovost40 Dimick41 Class II-2C II-2C III III III III III II-2B III III II-2C II-2C III II-2C II-2C III III II-2C III III II-2C II-2C II-2C III III II-2C II-2C II-2C II-2C II-2C III II-2C II-2C III II-2C II-2C II-2C III II-2C II-2C II-2C A 5 5 4 5 4 5 5 5 4 5 5 5 5 5 5 3 4 5 3 0 5 5 5 5 4 5 5 5 5 5 4 5 5 3 5 5 5 5 5 5 5 B 4 4 4 3 4 3 4 4 3 4 3 4 5 5 4 3 4 4 3 4 4 4 4 4 4 3 3 3 4 4 4 4 4 3 5 4 3 4 4 4 4 C 5 4 4 4 5 4 5 5 3 4 4 4 4 4 5 4 5 5 3 5 4 4 5 4 4 5 5 5 5 4 3 4 5 5 5 5 4 5 4 5 5 D Yes E Yes F 5 3 1 3 4 5 3 4 3 2 5 4 3 4 4 2 4 3 4 3 3 3 3 4 2 3 2 3 3 3 3 5 2 3 4 5 5 3 3 3 2 G 3 4 3 3 3 5 3 5 3 3 4 3 2 4 5 0 3 3 3 0 3 3 4 4 3 5 5 5 4 4 0 4 5 4 4 4 3 4 4 5 5 H 0 2 1 3 0 5 2 5 2 0 4 3 1 4 4 0 3 2 2 0 4 3 3 4 0 4 5 4 4 4 0 4 5 3 2 5 3 4 4 4 4 I 3 4 3 3 2 4 3 4 3 2 4 3 3 4 5 3 4 3 4 2 3 4 4 4 3 4 5 4 4 3 3 5 5 3 5 5 4 3 3 5 4 J 2 4 3 3 2 5 3 5 3 3 4 4 2 4 4 2 4 3 4 2 4 2 4 4 3 5 5 5 4 4 3 5 5 4 4 5 3 3 4 5 5 K 2 4 2 4 2 5 3 4 4 3 5 4 3 4 3 2 5 2 4 3 4 4 3 4 3 4 4 4 4 3 3 5 4 3 3 5 5 3 4 4 4 L 4 4 3 3 3 4 4 4 4 4 4 4 3 5 4 3 4 4 4 3 4 4 4 4 4 4 5 4 4 4 4 4 5 4 5 4 4 4 4 5 5 Total Score 33 38 28 34 29 45 35 45 32 30 42 38 31 43 43 22 40 34 34 22 38 36 39 41 30 42 44 42 41 38 27 45 45 35 42 47 39 38 39 45 43 M% 66 76 56 68 58 90 70 90 64 60 84 76 62 86 86 44 80 68 68 44 76 72 78 82 60 84 88 84 82 76 54 90 90 70 84 94 78 76 78 90 86 Yes Yes E-2 Yes Yes Yes Yes Yes .Table E1.

67 Langemo68 Needleman69 Mark70 Alonso-Echanove71 Bolton72 Potter73 Hope74 Simmonds75 Zidek76 Tallier77 Person78 Sochalski79 Mark80 Van Doren81 Vahey82 Boyle83 Cimiotti84 Estabrooks85 Class II-2C III III III II-2A II-2C III II-2C II-2C II-2C III II-2C III III III III II-2C III III III III III II-2C II-2C II-2C III III II-1B II-2A III III II-2C II-2C II-2C II-2C II-2C III II-2C III III III II-2C III A 4 5 5 4 4 5 5 5 5 5 5 5 5 5 5 5 5 5 3 5 5 5 5 5 4 4 5 5 5 5 4 5 5 5 4 5 5 5 4 5 3 5 5 B 3 5 4 3 4 4 5 4 4 3 4 4 4 3 4 4 5 4 5 5 4 5 5 5 4 3 4 3 5 4 4 5 4 4 4 4 3 4 5 3 3 4 3 C 3 5 4 3 5 4 4 4 5 5 5 5 4 4 4 5 5 4 5 5 5 5 5 5 4 3 4 4 5 4 5 5 5 4 4 5 3 4 5 4 4 4 5 D E F 3 4 3 3 3 3 4 5 3 3 3 3 5 3 3 3 3 3 3 3 4 4 3 3 3 3 4 3 4 3 3 3 3 3 3 5 5 4 4 3 3 3 3 G 4 5 3 3 2 3 3 4 4 5 4 5 4 3 5 2 4 3 3 4 5 4 5 4 5 2 4 2 4 2 3 5 4 3 2 5 3 4 2 4 3 4 4 H 3 4 2 0 2 2 3 4 4 5 4 4 4 0 4 0 0 0 2 3 5 4 5 4 4 0 4 1 4 1 2 4 3 3 0 5 2 4 0 4 2 4 4 I 4 4 2 2 3 3 3 4 5 5 4 4 4 2 5 2 5 3 2 4 5 3 4 4 5 2 4 3 5 2 3 5 4 3 3 5 4 5 3 5 3 4 5 J 4 5 2 2 3 3 3 4 5 4 4 4 5 0 5 2 4 2 3 3 5 3 5 4 5 2 4 2 4 3 3 5 4 3 1 5 3 5 2 5 3 4 5 K 4 5 4 3 3 3 2 5 4 4 3 5 4 3 5 1 2 3 2 3 4 2 4 4 4 2 5 3 4 4 2 3 2 3 2 5 4 4 3 3 2 3 4 L 4 5 4 4 4 4 4 5 5 4 4 5 5 3 5 3 4 3 3 3 5 3 5 5 5 3 4 4 5 3 4 5 3 3 3 5 3 5 4 4 3 4 4 Total Score 36 47 33 27 33 34 36 44 44 43 40 44 44 26 45 27 37 30 31 38 47 38 46 43 43 24 42 30 45 31 33 45 37 34 26 49 35 44 32 40 29 39 42 M% 72 94 66 54 66 68 72 88 88 86 80 88 88 52 90 54 74 60 62 76 94 76 92 86 86 48 84 60 90 62 66 90 74 68 52 98 70 88 64 80 58 78 84 Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes E-3 Yes Yes Yes Yes Yes Yes Yes .Table E1. Quality of the studies (continued) Year 2001 2001 2001 2001 2001 2001 2001 2001 2002 2002 2002 2002 2002 2002 2002 2002 2002 2002 2002 2002 2003 2003 2003 2003 2003 2003 2003 2003 2003 2003 2003 2003 2003 2003 2003 2004 2004 2004 2004 2004 2004 2004 2005 Author Blegen42 Needleman43 Bolton44 Aiken45 Whitman46 Sovie47 Ridge48 Ritter-Teitel49 Dang50 Aiken51 Seago52 Tourangeau53 Kovner54 Langemo55 Needleman56 Barkell57 Stegenga58 Whitman59 Cheung60 Oster61 Aiken62 Beckman63 Berney64 Unruh65 Cho66.

Quality of the studies (continued) Year 2005 2005 2005 2004 2005 2005 2005 2005 2005 2006 Author Marcin86 Elting87 Mark88 Donaldson89 Tschannen90 Houser91 Halm92 Donaldson93 Stratton94 Seago95 Class II-2C II-2C II-2C III III III III III II-2C II-2C A 5 5 5 5 5 5 5 5 5 5 B 5 3 4 4 5 4 5 5 4 4 C 5 5 4 3 5 5 5 4 4 5 D Yes E Yes F 3 3 4 3 3 5 3 3 3 3 G 4 5 4 3 5 4 3 4 4 3 H 4 5 4 2 4 4 3 5 4 2 I 5 5 4 4 4 4 4 4 3 3 J 5 5 4 3 4 4 4 5 3 3 K 3 4 4 4 2 5 2 4 4 3 L 4 4 5 4 3 5 4 4 4 3 Total Score 43 44 42 35 40 45 38 43 38 34 M% 86 88 84 70 80 90 76 86 76 68 Yes Yes E-4 .Table E1.

Figure E1 plots the quality scores (expressed as the percent of maximum possible scores) over time to look for changes in ratings. Association between quality of studies and time of publication 100 90 80 Percent 70 60 50 40 1980 1985 1990 1995 Year 2000 2005 2010 E-5 . Although there is a modestly positive overall trend. Figure E1. it is not significant.

Table E2. Studies published in peer reviewed journals indexed in Medline Number of Publications 1 1 2 1 1 1 15 1 1 1 4 1 1 4 1 1 12 1 1 1 3 1 1 8 3 1 4 3 4 1 1 1 1 1 1 1 1 1 1 1 2 Source* Am J Crit Care Anesthesiology book Can J Nurs Res Cancer Clin Nurse Spec Dissertation Eff Clin Pract Health Econ Health Serv Manage Res Health Serv Res Heart Lung Image J Nurs Sch Infect Control Hosp Epidemiol Intensive Care Med J Health Hum Serv Adm J Nurs Adm J Nurs Care Qual J Nurs Scholarsh J Trauma JAMA Lippincotts Case Manag Manag Care Interface Med Care N Engl J Med Nurs Adm Q Nurs Econ Nurs Manage Nurs Res Outcomes Manag Pediatr Crit Care Med Pediatr Infect Dis J Pharmacotherapy Phys Rev B Condens Matter Phys Rev C Nucl Phys Policy Polit Nurs Pract QRB Qual Rev Bull Qual Health C Report Report Soc Sci Med Quality (% from maximum) 86 94 77 88 88 76 77 90 84 82 88 88 82 84 90 54 65 44 66 66 89 64 70 82 81 65 49 79 54 86 68 90 76 78 70 76 84 94 86 64 *Title abbreviations from the National Library of Medicine E-6 .

Area Resource File Hospital Medicare mortality rates from the Health Care Financing Administration Hospital discharge data State inpatient databases Boyle Cho Cimiotti Dang Patient discharges and medical records reviewed by study's nurse epidemiologist Uniform Hospital Health Discharge Data Set Dimick Uniform Health Discharge Data Set Elting Center for Medicare and Medicaid Services and the American Hospital Association Dartmouth Manitoba Adaptation of Charlson comorbidity score Analytic unit: Hospital Charlson index modified by Devo Analytic unit: Patient Estabrooks Hospital inpatient database E-7 . clinical AIDS Prognostic Staging Analytic unit: Patient ICD codes for pre-existing comorbid conditions Analytic unit: Patient ICD codes for pre-existing co morbid conditions Analytic unit :Patient Medicare Case Mix Index Analytic unit: Hospital HIV risk categories. Severity of Illness scores Analytic unit: Hospital Patients case mix index Analytic unit: Patient DRG codes to calculate the number of diagnoses at admission Analytic unit: Patient and hospitals DRG for comorbid conditions and procedures Analytic unit: Patient ICD codes for comorbid conditions (secondary diagnoses and procedures) Analytic unit: Patient ICD codes for comorbid conditions (secondary diagnoses and procedures) Analytic unit: Patient Comorbid conditions were coded using the Aiken Aiken Aiken Aiken AlonsoEchanove Amaravadi Hospitals discharge database Health Care Cost Containment Council HCFA database Patients survey Medical charts Uniform Hospital Health Discharge Data Set ANA HCFA discharges database ANA Uniform Hospital Discharge Data Set Berney Blegen Blegen Blegen New York Statewide Planning and Research Cooperative System Comparative occurrence reporting service (CORS) Hospitals discharge database Hospital discharge records Bloom Bond Transaction Cost Analysis. Assessment of patient comorbidities in included studies Author Aiken Source to Measure Patient Outcomes Medical charts of consecutively admitted patients Assessment of Comorbid Conditions Analytic Unit Severity classification for AIDS hospitalization. APACHE scores.Table E3. illness severity Analytic unit: Patient Secondary diagnoses and individual medical history present at the time of the admission Analytic unit: Patient ICD codes for comorbid conditions (secondary diagnoses and procedures) Analytic unit: Patient Patients’ case mix index and severity of Illness index Analytic unit: Hospital Patient case mix index and severity of Illness index Analytic unit: Hospital DRG codes for comorbid conditions Analytic unit: Hospital Hospital Medicare Case Mix Scores Analytic unit: Hospital Unit Hospital Medicare Case Mix Index Analytic unit: Hospital Unit Patient’s acuity data from the monthly acuity system reports Analytic unit: Hospital Unit Medicare Case Mix Index Analytic unit: Hospital Medicare case mix.

and HCUP files Hospital’s incident reporting system Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) Hospital discharge data from 11 states (all patients and Medicare sample) and MedPAR national database (all Medicare patients) Medicare database Uniform Hospital Health Discharge Data Set Uniform Hospital Health Discharge Data Set Needleman CMS Case Mix Index File Analytic unit: Patient (survey) CMS case mix index file. Discharge Abstract Database Nationwide inpatient sample of 2001 with hospital discharge records National Inpatient Sample (NIS) Nationwide inpatient sample of hospital discharges Medical records for all Medicare discharges Assessment of Comorbid Conditions Analytic Unit Severity of illness with APACHE II scores Analytic unit: Patient Medicare case-mix Analytic unit: Hospital DRGs codes for comorbid conditions Analytic unit: Patient Case Mix Groups Analytic unit: Patient ICD codes for 4 secondary diagnoses. Assessment of patient comorbidities in included studies (continued) Author Fridkin Gandjour Halm Halpine Hartz Source to Measure Patient Outcomes Medical records Health Care Financing Administration Hospital's data warehouse with patient discharges Hospital Medical Records Institute database Hospital discharges data from The Health Care Financing Administration (HCFA) Health Care Financing Administration. HealthCareReportCards. MEDPAR database Medical Microbiology Laboratory and Infection Control Services.com. Medstat's Disease Staging methodology Analytic unit: Hospital DRGs codes for comorbid conditions Analytic unit: Hospital and units Patients severity of illness index Analytic unit :Patient ICD codes for comorbid conditions Analytic unit: Patient ICD codes for comorbid conditions (secondary diagnoses and procedures) Analytic unit: Patient Medicare case mix Analytic unit: Patient Patients case mix index Analytic unit: Unit Severity of illness with APACHE II scores Analytic unit: Patient Medicare Case Mix Index Analytic unit: Hospital Patients severity of illness index Analytic unit: Hospital Person Pronovost Pronovost Ridge Ritter-Teitel Robert Robertson Seago Patient survey 2 weeks after discharge with computerized phone interview system Hospitals Incidence reports and patient surveys Medical charts HCFA database and Hospitals Information Reports California Office of Statewide Health Planning and Development (OSHPD) Hospital Disclosure Report database E-8 . CMS Provider of Services File. Pediatric Intensive Care Unit Evaluations Database Centers for Medicare Services Minimum Cost and Capital File.Table E3. Severity of Illness index Analytic unit: Hospital Medicare Case Mix Index Analytic unit: Hospital Patient severity of Illness index Analytic unit: Patient ICD codes for comorbid conditions Analytic unit: Patient Medicare Case Mix Index Analytic unit: Hospital Medicare Case Mix Index Analytic unit: Hospital ICD codes for 4 comorbid conditions and additional clinical data with MediQual system Analytic unit: Hospital Pediatric Risk of Mortality (PRISM) III index Analytic unit: Patient CMS Case Mix Index Analytic unit: Hospital Hoover Hope Houser Kovner Kovner Krakauer Marcin Mark Mark Mark Medical charts. CMS Online Survey Certification and Reporting system (OSCAR) files. CMS Case Mix Index File.

Table E3. patient records. Medicare Standard Analytic Files. and chart audits E-9 . APACHE III scores Analytic unit: Unit ICD codes for comorbid conditions present at admission and physician’s current procedural terminology for outpatient visits within 3 months before index hospital stay Analytic unit: Hospital DCID codes for pre-existing comorbid conditions (Manitoba adaptation of the Charlson index) Analytic unit: Hospital Patient Acuity Index. ICD codes for comorbid conditions Analytic unit: Patient MediQual severity measure to calculate scores Analytic unit: Hospital MediQual severity scores Analytic unit: Patient Patient Acuity Index Analytic unit: Hospital Patients severity of illness index Analytic unit: Patient Shortell Shortell Silber Pennsylvania Medicare claims records. patient survey National Comparative Database for Nursing Resource Consumption MedPAR dataset of hospital discharges Hospitals discharge data Assessment of Comorbid Conditions Analytic Unit Case-mix index Analytic unit: Patient ICD codes for secondary diagnoses present at admission Analytic unit: Unit Medicare case mix Analytic unit: Hospital DRG codes for comorbid conditions. Assessment of patient comorbidities in included studies (continued) Author Seago Shamian Source to Measure Patient Outcomes Incident reporting system. random sample of 50% of Medicare patients who underwent general surgical or orthopedic procedures Ontario Acute Care Hospitals Dataset Tourangeau Tschannen Patient medical records Unruh Unruh Wan Zidek Pennsylvania Health Care Cost Containment Council State Health Care Cost Containment Council Hospital records Hospital discharge data.

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This ratio can be expressed as FTE/patient or patients/FTE per shift. LVN. sick time). and aides counted per patient day (a patient day is the number of days any one patient stays in the hospital. one patient staying 10 days would be 10 patient days). 2.3 We made the following assumptions: 37. we used the latter estimate:2 Nurse hours per patient day = (FTE*40)/patient days3 One nurse/patient day = 8 working hours per patient day 2 Then the patient/nurse ratio = 24 hours/nurse hours per patient day.080 hours per year and can be composed of multiple part-time or one full-time individual. holidays. hypotheses. some researchers use this term to mean nurse hours per inpatient day. 48 working weeks/year (4 weeks vacation. Different methods have been used to estimate nurse hours per patient day from FTEs. We reported nursing rates as they were used by individual authors.5 hour work week on average.080 hours/year). 1. LPN. Others use more conservative estimates (e. i. Differences in definitions of nurse staffing. Some investigators assume a 40 hour week and 52 working weeks per year (2. this ratio may be calculated by shift or by nursing unit.800 hours/year). or LVN full-time equivalents per patient day: (an FTE is 2. LPN.e. In our conversions. Various authors used different operational definitions for the nurse to patient ratio. The variation in the ways nurse staffing rates are calculated and expressed makes it difficult to summarize data across studies. or LVN). and statistical models.1 FTE/occupied bed ratios were calculated based on FTE/mean annual number of occupied bed-days (patient-days). The number of patients cared by one nurse per shift. 37. but we have also created two standardized rates for purposes of comparison. and with surgical and medical patients.000 patient-days • nurse/patient-day or FTE/occupied bed Total nursing staff or hours per patient day represent all staff or all hours of care including RN.Appendix F. including: • number of patients cared for by one nurse per shift • FTE/1. F-1 . The nurse to patient or patients to nurse ratio reflects the number of patients cared for by one nurse typically specified by job category (RN. LPN. Analytic Framework Appendix F contains details on analytical framework of the meta-analysis: definitions. RN.5 hours per week for 48 weeks = 1.g. RN FTE/patient day ratio We conducted separate analysis and report the results in these ways: • with definitions the authors used • corresponding to increase by 1 RN FTE/patient day • in categories of patients/RN per shift in ICUs.

800)/1.4 patients 2. The authors reported RN/patient day We calculated RN hours/patient days: (FTE*40)/5 patient days per week3 RN hours/patient day = FTE*8 Patients/RN per shift ratio = 24 hours/RN hours per patient day3 Numeric example: The authors reported 0. We defined a reference nurse staffing level equal to the published means4. Length of shift does not modify the association between nurse staffing and patient outcomes. The same estimation was used for the each nurse job category. 1.5 FTE*8 hours = 4 hours/patient day Patients/RN per shift ratio = 24 hours/4 = 6 patients 3.800hours)]/1.4 RN hours/patient day Patients/RN per shift ratio = 24 hours/5.000 patient-days. The authors reported RN FTE/1.000=5.000 patient days RN hours/patient day = (3*1.5 FTE/patient day RN hours/patient day: 0. When the authors reported regression coefficients form several statistical models. We calculated RN hours/patient day = 24 hours/reported ratio of patients/RN3 RN FTE/patient day = RN hours per patient day/8 hours Numeric example: The authors reported 2 patients/RN/shift RN hours/patient day = 24 hours/2 = 12 hours/patient day RN FTE/patient day = 12 hours per patient day/8 hours = 1. LPN. F-2 .000 Nurse to patient per shift ratio: Patient/nurse ratio = 24 hours/nurse hours per patient day3 Numeric example: The authors reported 3 RN FTE/1. we used maximum likelihood criteria to extract one regression coefficient for the pooled analysis— models with significant regression coefficient for the association: • the smallest number of nonsignificant regression coefficients for confounding factors in the model • main effects models without interaction and nonlinear associations. and UAP. Patient density is the same over the year.All FTE are full-time nurses with the same shift distribution (assume 3 8-hour shifts). We calculated: RN hours/patient days: [(RN FTE/1. This assumption ignores nonlinearity but provides more realistic staffing estimation.000 *1. we extracted the reported means or calculated medians of nurse staffing ranges.RN.5 in different clinical settings assuming that the same linear association would be observed corresponding to an increase by 1 unit from the mean. When the authors reported changes in outcomes corresponding to 1 unit increase in nurse staffing ratio. The following examples of calculations may help clarify the approach to conversions.5 RN FTE When the authors reported outcome rates among different categories of nurse staffing. The authors reported patients/RN per shift ratio.4 = 4.

60 3.12 8.61 0. and quartiles of nurse staffing variables in different clinical settings to compare with published articles.31 3. 2.8 ± 1.57 1.32 2.20 0.00 12.09 4.73 7.28 0.11 11.81 1.52 8. and 4 extracted from the studies: RN FTE/patient day as a continuous variable Patients/RN/shift ratio as a continuous variable Quartiles of patients/RN/shift ratio as a categorical variable Patients/LPN/shift ratio as a continuous variable Patients/UAP/shift ratio as a continuous variable Total nursing hours as a continuous variable equal nursing hours/patient or patient day RN hours/patient day as a continuous variable equal RN hours/patient day LPN hours/patient day as a continuous variable equal LPN hours/patient day UAP hours/patient day as a continuous variable equal UAP hours/patient day Licensed hours/patient day as a continuous variable equal RN and LPN hours/patient day We calculated means.23 6.99 2.07 7.82 5.3 68 ± 10 The present report: Nurse Staffing ICUs RN FTE/patient day Patients/RN per shift Total nursing hours/patient day RN hours/patient day LPN hours/patient day UAP hours/patient day Licensed nurse hours/patient day Surgical patients RN FTE/patient day Patients/RN per shift Patients/LPN per shift Total nursing hours/patient day RN hours/patient day LPN hours/patient day UAP hours/patient day Medical patients RN FTE/patient day Patients/RN per shift Patients/LPN per shift Patients/UAP per shift Patients/licensed nurse per shift Total nursing hours/patient day RN hours/patient day LPN hours/patient day UAP hours/patient day Licensed nurse hours/patient day Number of Studies 15 15 15 10 3 4 1 13 13 2 12 11 7 5 20 20 6 4 2 27 23 13 12 4 Mean 1.2 11.4.31 5.43 0.34 2.32 Standard Deviation 0.62 0.Independent staffing variables for questions 1. standard deviations.95 4.87 1.9 1.94 8.92 F-3 .07 1.26 7.22 2.58 0.97 3.0 2.14 4.4 ± 2.06 2.5 Nurse Variables Number of hours of nursing care per patient-day Registered nurse–hours Licensed-practical nurse–hours Aide hours Total Proportion of total hours of nursing care (%) Registered nurse hours Needleman et al Mean ± STD 7.10 4.84 2.70 1.04 3.29 1.4 ± 1.2 ± 1.84 2.23 5.49 2.28 1.42 13.25 11.21 4.36 3.33 3.

Quality scores 6. Adjustment for clustering between providers and patients 8. Analytic unit 2. Adjustment for provider characteristics and patient socio-economic status 7. The outcome is associated with nurse staffing as a continuous variable.Independent staffing strategies variables: Skill mix % of RN nurses/total nursing personnel as a continuous variable % of nurses with BSN degrees/total nursing personnel as a continuous variable % of licensed nurses (RNs + LPNs)/total nursing personnel as a continuous variable Experience mix: nurse experience in years as a continuous variable % of overtime nursing hours as a continuous variable % of temporary nurses as a continuous variable % of full-time nurses as a continuous variable The authors used different operational definitions of the outcomes rates: the percentage of the patients with outcomes among all hospitalized patients and the rates of the outcomes per 1. Adjustment for comorbidities 4.000 patient days. weighted by the study sample size * number of hospitals. but we have also standardized rates as the percentage of patients with outcomes among all hospitalized patients for purposes of comparison. We use published averages of length of stay in ICUs. in a random effects model—random intercept for each study 2. The outcome is associated with nurse staffing as a continuous variable.4 Weighting variable: Sample size as patient or analytic unit number (when patient number was not reported). Source of the data (administrative vs. We reported these rates as they were used by the individual authors. Study design 3. Hypotheses tested in pooled analysis: 1. Definition of nurse to patient ratio 5. Tested sources of heterogeneity: 1. medical record) 9. in a fixed effects model F-4 . Patient population 3. in medical.000 patient days/10) * an average length of stay. and surgical patients. We estimated that Percentage of patients with outcomes = (rate per 1. Hospital unit 2. hospital number per every level of exposure. weighted by the study sample size * number of hospitals. Definition of outcomes We tested the possible sources of heterogeneity as interaction variables which could modify the effect of nurse staffing on patient outcomes and conducted sensitivity analysis within each category of effect modifiers.

when the model is weighted by the study sample size * number of hospitals in a random effects model—random intercept for each study 6. in a fixed effects model 5. and surgical and the patients are medical and surgical 14. The association with nurse staffing as a continuous variable can be modified by patient type (medical vs. A sensitivity analysis by analytic units. and patient levels). Interaction models and sensitivity analysis examined the effects of the year of outcomes occurrence and adjustment for patient and provider characteristics and clustering of patients and providers. medical. unit. The association with nurse staffing as a continuous variable can be modified by analytic unit (hospital. The association with nurse staffing as continuous variables can be modified by patient type (medical vs. surgical) when the model is weighted by the study sample size * number of hospitals in a fixed effects model 11. The association with nurse staffing as a continuous variable can be modified by hospital unit (ICU. surgical) when the model is weighted by the study sample size * number of hospitals in a random effects model with a random intercept for each study. and patients and the hospital units are ICU. and patient population tested all previous hypotheses with random and fixed effects models weighted by the sample size in subgroups where the analytic units are hospitals. The association with nurse staffing as a continuous variable can be modified by analytic unit when the model is weighted by the study sample size * number of hospitals in a fixed effects model 7.3. weighted by the study sample size * number of hospitals. The outcome is associated with nurse staffing as a continuous variable with nonlinear association. weighted by the study sample size * number of hospitals. The outcome is associated with nurse staffing as a continuous variable with nonlinear association. Algorithms of meta-analysis6 Pooled estimate as a weighted average: ∑ wiθi θ IV = i ∑ wi i F-5 . The association with nurse staffing as a continuous variable can be modified by hospital unit when the model is weighted by the study sample size * number of hospitals in a fixed effects model 9. Individual studies were analyzed with simple linear regression in STATA to find slopes for each study when possible. Meta-analysis was used to estimate pooled regression coefficients: changes in outcomes corresponding to incremental changes by one unit in nurse staffing 15. The outcome is associated with nurse staffing as continuous variable weighted by the study sample size * number of hospitals in a fixed effects model 13. medical. The outcome was associated with nurse staffing as a categorical variables. surgical) when the model is weighted by the study sample size * number of hospitals in a random effects model—random intercept for each study 8. hospital units. in a random effects model—random intercept for each study 12. weighted by the study sample size * number of hospitals in a random effects model 4. hospital units. 10.

but now incorporate a component for between-study variation: 1 w'i = SE (θ i ) 2 + τ 2 Standard error of pooled estimate 1 SE (θ DL ) = ∑ w'i i The likelihood-based approach to general linear mixed models was used to analyze the association between independent variable and outcomes with the basic assumption that the data are linearly related to unobserved multivariate normal random variables. F-6 .Weights are inverse of variance (standard error):2 wi = 1 SE (θ i ) 2 Standard error of pooled estimate: 1 SE (θ IV ) = ∑ wi i Heterogeneity (between-study variability) measured by: Q = ∑ wi (θ i − θ IV ) 2 i Assumptions for random effects model: true effect sizes qi have a normal distribution with mean q and variance t2. t2 is the between-study variance Between study variance: τ2 = Q − (k − 1) ⎛ ∑ wi2 ⎞ ⎜ ⎟ ∑ wi − ⎜ i w ⎟ i ⎜∑ i ⎟ ⎝ i ⎠ Where: wi are the weights from the fixed effect inverse-variance method Q is the heterogeneity test statistic from before (either from inverse-variance method or MantelHaenszel method) k is the number of studies. and t2 is set to zero if Q<k-1 Random effect pooled estimate is weighted average: θ DL ∑ w' θ = ∑ w' i i i i i Weights used for the pooled estimate are similar to the inverse-variance.

General linear model Y = Xβ + ε (Y .known matrix of xij's.5 Inappropriate [too hot or too cold] temperature in local application and packing F-7 .1 Infusion or transfusion E870. β.5 Aspiration of fluid or tissue.12 Correlation between nurse distribution and fatal adverse events related to health care were computed with 95%confidence level to determine a strength and directions of the correlations. puncture.1 Incorrect dilution of fluid during infusion E873.2 Kidney dialysis or other perfusion E870.0 Excessive amount of blood or other fluid during transfusion or infusion E873.13 Definitions of fatal injuries related to health care: Misadventures to patients during surgical and medical care (E870-E876): E870 Accidental cut.the unknown fixed-effects parameter vector. and catheterization Abdominal paracentesis Aspirating needle biopsy Blood sampling Lumbar puncture Thoracentesis E871 Foreign object left in body during procedure E872 Failure of sterile precautions during procedure E873 Failure in dosage E873. The model assumes that λ and ε are normally distributed.7-9 Attributable risk of the outcome = rate of events in patients with below of the recommended nurse/patient ratio x (relative risk = 1) Number needed to treat to prevent one adverse event was calculated as reciprocal to absolute risk differences in rates of outcomes events in the groups of the patients with different nurse staffing levels. perforation.3 Inadvertent exposure of patient to radiation during medical care E873.11.3 Injection or vaccination E870. puncture.known design matrix. Attributable risk was calculated as the outcome events rate in patients exposed to different nurse staffing levels.4 Endoscopic examination E870.0 Surgical operation E870.10 Administrative data was obtained to estimate nurse shortage and distribution in a state level in the USA. or hemorrhage during medical careE870.the vector of observed yi's.the unobserved vector of independent and identically distributed Gaussian random errors) is written in the mixed model: Y = Xβ + Zλ + ε where Z . and ε . and λ the vector of unknown random-effects parameters.2 Overdose of radiation in therapy E873. X .4 Failure in dosage in electroshock or insulin-shock therapy E873.

medicinal and biological substances causing adverse effects in therapeutic use (E930-E949) Includes: correct drug properly administered in therapeutic or prophylactic dosage.3 Endotracheal tube wrongly placed during anesthetic procedure E876. or of later complication Drugs. as the cause of abnormal reaction of patient.9 Unspecified failure in dosage E874 Mechanical failure of instrument or apparatus during procedure E875 Contaminated or infected blood.0 Mismatched blood in transfusion E876.9 Unspecified misadventure during medical care Surgical and medical procedures as the cause of abnormal reaction of patient or later complication. as the cause of any adverse effect including allergic or hypersensitivity reactions F-8 . or biological substance Includes: presence of: bacterial pyrogens endotoxin-producing bacteria serum hepatitis-producing agent E876 Other and unspecified misadventures during medical care E876. such as: displacement or malfunction of prosthetic device hepatorenal failure.2 Failure in suture and ligature during surgical operation E876. without mention of misadventure at the time of procedure. without mention of misadventure at the time of procedure (E878-E879) Includes: procedures as the cause of abnormal reaction.E873. other fluid.8 Other specified misadventures during medical care Performance of inappropriate treatment NEC E876.6 Nonadministration of necessary drug or medicinal substance E873.1 Wrong fluid in infusion E876. without mention of misadventure at the time of operation E879 Other procedures. or of later complication.4 Failure to introduce or to remove other tube or instrument E876. drug.5 Performance of inappropriate operation E876. postoperative malfunction of external stoma postoperative intestinal obstruction rejection of transplanted organ E878 Surgical operation and other surgical procedures as the cause of abnormal reaction of patient.8 Other specified failure in dosage E873.

com/medicine/bmj/sy streviews/pdfs/chapter18. Caveats and pitfalls. Public Health Services.pdf. London. Making health care safer: a critical analysis of patient safety practices. Nurse Staffing and Patient Outcomes: In the Inpatient Hospital Setting. Contract No. 1989. Oxford University Press. Jones CB. Needleman J. Division of Nursing. of Health and Human Services. BMJ. OCLC: 44350522: http://www. United States: Agency for Healthcare Research and Quality. University of California SF-SE-BPC. Nurse Staffing. MD: Agency for Healthcare Research and Quality. 2000: http://www. San Francisco: California Workforce Initiative. Dawson B and Trapp RG. American Nurses Association. Chapter 39. Spratley E.S.cdc. Cho S-H. 11. MD. Laird N. March 2000. Kovner C. Statistical Methods in Epidemiology (Monographs in Epidemiology and Biostatistics). 9. Rockville. Sep 1986. 2001. 3.1(3):194-204. Centers for Disease Control. 4. DerSimonian R. The registered nurse population. Ebrahim S. Policy. 13. 2004. 10. Minimum nurse staffing ratios in California acute care hospitals. USA. Bureau of Health Professions. Dept. The use of numbers needed to treat derived from systematic reviews and meta-analysis. Egger M. Models of Care Delivery. Kahn CTS. U. 2. Systematic Reviews in Health Care. F-9 . McGrawHill/Appleton & Lange. Gergen PJ.24(2):152-64. of Health & Human Services. 12. Health Resources and Services Administration. 8. Control Clin Trials. 2000. Politics. Nurse staffing and adverse patient outcomes [PhD]: Dissertation. Harold A. Final Report for Health Resources Services Administration. 2001. Basic & Clinical Biostatistics (LANGE Basic Science).7(3):177-88. findings from the National Sample Survey of Registered Nurses.hrsa.blackwellpublishing. 2000.htm. Meta-analysis in clinical trials. 230990021. http://www. 2002. 6.gov/ncipc/. Rockville. & Nursing Practice. Jun 2001. University of Michigan. 1999-2003. Washington DC: American Nurses Association.References 1.gov/healthworkforce/reports/rns urvey/rnss1.bhpr. 7. 5. WISQARS Injury Mortality Reports. Dept. 1990-1996. and Interventions. Spetz J. Nurse Staffing in Acute Care Hospitals. Nurse staffing and patient outcomes in hospitals. Eval Health Prof. 2000. 2001 ISBN:0-7279-1488-X.

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........................................ more studies contributed to pooled analysis) ...... 3 Table G2.............. Relative risk of patient outcomes corresponding to an increase by 1 RN hour/patient day as reported by authors.......... 150 G-1 ... Calculated change in hospital-related mortality corresponding to an increase by 1 RN................. 79 Table G8................. Patient outcomes corresponding to an increase by 1 LPN hour/patient day (effects reported by authors and calculated from published results............... 94 Table G12......................................... Calculated change in hospital related mortality corresponding to an increase by 1 nursing hour/patient day (results from individual studies)............................................... more studies contributed to pooled analysis) ........................................... 138 Table G13................... Design................................. Evidence of the association between nurse staffing and mortality ........... more studies contributed to pooled analysis)......... 54 Table G5.... Patient outcomes corresponding to an increase by 1 nursing hour/patient day (calculated from published results.......................................... Evidence of the association between nurse/patient ratio and patient outcomes................................. Patient outcomes corresponding to an increase by 1 RN hour/patient day (calculated from published results...................................... more studies contributed to pooled analysis) ... 36 Table G4.. 140 Table G14....Appendix G: Evidence Tables Table G1.. 143 Table G15................................ 93 Table G11.................................................. The association between nurse staffing and length of stay ............................. 35 Table G3................... Patient outcomes corresponding to an increase by 1 unlicensed assistive personnel hour/patient day (effects reported by authors and calculated from published results........... and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes............. 145 Table G16.............................................................. The relative risk of hospital-related mortality among estimated categories or patients/nurse/shift ratio............................ 55 Table G6 Patient outcomes corresponding to an increase by one RN/patient day (effects reported by authors and calculated from published results...................................................................... Patient outcomes corresponding to an increase by one patient/LPN (effects reported by authors and calculated from published results............................................................................................................ more studies contributed to pooled analysis) ...................................................... more studies contributed to pooled analysis)............................. and UAP/patient day (results from individual studies)................... more studies contributed to pooled analysis) .................... 81 Table G10............ Evidence of the association between nurse hours/patient day and patient outcomes .... 77 Table G7...... Relative risk of patient outcomes corresponding to an increase by 1 nurse hour/patient day as reported by authors ......... LPN...................... external..... Patient outcomes corresponding to an increase by one patient/UAP (effects reported by authors and calculated from published results.................... 149 Table G17............. 80 Table G9.....

................ Research studies related to use of agency/contract nursing staff in hospitals ............................................ 154 Table G20. 165 Table G22................................................................ 184 Table G27............ 209 Table G29................. The evidence of the association between nurse staffing and patient satisfaction ...... 151 Table G19........ temporary nurse hours........ 2...................................Table G18.............................. 177 Table G25....................... The significant effect modification by the study design of the association between nurse staffing and patient outcomes ....... 161 Table G21.............. 216 References for Evidence Tables ...... 173 Table G24.................. and 4).... full-time hours) and patient outcomes...... Research studies related to staffing ratios/hours/skill mix in acute care hospitals (not included in questions 1... 169 Table G23..................................................................................................... Evidence of the association between nurse skill mix (proportion of registered nurses) and patient outcomes ........ 181 Table G26........................................... 211 Table G30........ Research studies related to shift work of nurses (types of shifts....... Research related to nursing staff overtime ................................ Relative risk of patient outcomes corresponding to an increase by 1% of RNs in nurse skill mix as reported by authors... Research studies related to internationally educated nurses (IEN) ............. The association between nurse characteristics and patient outcomes ...................and part-time nursing staff.................................... Research studies related to full.... Evidence of the association between nurse education and experience and patient outcomes ....................................................... Evidence of the association between nurse strategies (overtime hours.............. length of shifts) ................. 217 G-2 ................... 189 Table G28............

and c) severity of illness as defined by PRISM III.21% Medical records. % of Teaching Hospitals. Design. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes Case control studies Author. Children Matching: a) weaning status and duration of intubation. Random sample of 1. sedation. external. patient agitation Unplanned extubation . gender. Catheterassociated bloodstream infections. Sample Size.760 patients Patient Eligibility Criteria: Database. Assessment of Sampling Bias 1992-1993. length of stay. Medical records 1975. Publication Type Aim of the Study Hospital Eligibility Criteria. Patient. % of Hospitals for Profit. b) patient age. % of HMO Single hospital study: university-affiliated Veterans Affairs medical center Time. Population. Adults. % Excluded from Analysis. severity of illness Bloodstream infections G-3 Single unit study. 19661 Article Arnow. Sampling. Diagnosis. Age. primary diagnosis. Year. Patient.Table G1. 220 patients Medical records. 19822 Article Marcin. Patient. Medical Care Medical records. Adjustment: patient age. 20053 Article Examine the associations between nurse staffing and central venous catheterassociated bloodstream infections Examine association between staffing by overtime or temporary nurses and nosocomial infection in a burn unit Examine the association between unplanned extubation and years of nurse experience and nurse-to-patient ratio in the pediatric intensive care unit Patient age. Adults Not reported Nosocomial infection Single hospital study 1999-2002. Veterans Affairs Adjustment for Confounding Factors Outcomes Fridkin. 27. 147 patients. Analytic Units. Database. physical restraints.

length of stay Patient satisfaction Mortality. admitting physician as a part of an AIDS specialty service. Sample Size. Publication Type Aim of the Study Hospital Eligibility Criteria. Patient. AIDS Adjustment for Confounding Factors Outcomes Aiken. Age. scattered-bed units in hospitals with and without dedicated AIDS units. Patient. race. AIDS Patient sex. % Excluded from Analysis. Analytic Units. Sampling. 13.50% Patient Eligibility Criteria: Database.393 patients. an patient satisfaction Aiken. Adults. illness severity. the extent of nurse control over practice environment Patient age. 20006 Article Compare differences in AIDS patients' 30day mortality and satisfaction with care in dedicated AIDS units. 1. Design. 19984 Article Examine association between hospital organization . South 1994-1995. and in magnet hospitals known to provide good nursing care Examine the association between nosocomial primary bloodstream infections (BSIs) and nursing-staff levels in surgical intensive care unit (SICU) patients American Hospital Association Annual Hospital Survey 1990-1991. race. Random sample of 127 patients Medical records. 100. Diagnosis. patient satisfaction G-4 Single hospital study 20-bed SICU in a 1. illness severity. external. Nosocomial primary bloodstream infections Bloodstream infection . 13.50% Medical records. the extent of nurse control over practice environment Patient sex. type of insurance. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author.000-bed inner-city public hospital. % of Hospitals for Profit. Database. Population. age. Patient. 1. nurse burnout. Medical Care Medical records. Assessment of Sampling Bias 1990-1991. Adults. Year. diagnosis. HIV risk categories. 19995 Article Robert. % of Teaching Hospitals. age. Adults. comorbidity. % of HMO American Hospital Association Annual Hospital Survey Time. type of insurance.Table G1.393 patients. HIV risk categories. admitting physician as a part of an AIDS specialty service.

falls 2004-2005. 39. sex. Random sample of 234 hospitals Patient Eligibility Criteria: Database. % of Teaching Hospitals. Adults. 19947 Article Examine the association between Medicare mortality and hospitals with different nursing care Patient age. selected using a multivariate matched sampling procedure that controls for hospital characteristics. Hospital. Age. % of Hospitals for Profit. Sampling. Analytic Units. 7. Medical Care Medical records. technology index) Mortality G-5 Case-series Author. location. Population. Publication Type Aim of the Study Hospital Eligibility Criteria. Year. % Excluded from Analysis. propensity scores for 12 hospital characteristics census. Database. Publication Type Aim of the Study Hospital Eligibility Criteria.Table G1. Medicare Adjustment for Confounding Factors Outcomes Aiken. Design.7% Time. 19998 Article Donaldson. Medical Care Administrative. Population. 20059 Article Examine the association of patientfocused care at one tertiary care university teaching hospital on patient outcomes Examine patients’ outcomes before and after legislations for mandatory nurse/patient ratios in California hospitals Not reported Patient satisfaction. Diagnosis. Analytic Units. Diagnosis. type and source of admission. % of Teaching Hospitals.55% Administrative. Sample Size. 65. Sample Size. Assessment of Sampling Bias 1988. Patient. % of HMO Single tertiary care hospital study before and after implementation of patient-focused care Convenience sample of 68 acute hospitals participating in the California Nursing Outcomes Coalition project Time. Assessment of Sampling Bias 1996-1997. 89. pressure ulcers. Database. external. 268. Unit. 28.256 patients Patient Eligibility Criteria: Database. % of Hospitals for Profit. falls . size occupancy rate. % of HMO 39 magnet hospitals and 195 control hospitals. Age. Adults Adjustment for Confounding Factors Outcomes Seago. comorbidities. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author. % Excluded from Analysis Sampling.2%. Year. Adults Not reported. before-after comparison were conducted in the same units Pressure ulcers.

Age. Analytic Units.1%.38% Patient Eligibility Criteria: Database. Design. 156 patients Patient Eligibility Criteria: Database.Table G1. 198911 Article Examine the association between nurse staffing and mortality in Medicare population Severity of illness Mortality . Medical Care Medical records. Hospital. Database. falls Cross-sectional studies Author. Sample Size. Medical Care Administrative.781 patients 46. Population. 8. nosocomial infection. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author. % of HMO 3. Sampling. Adults >65years. 10 1995 Article Examine the impact of implementation of a new nursing partnership model with a reduction of RN from 80% to 60% on patient outcomes in neuroscience unit Not reported. % Excluded from Analysis Sampling. Sample Size. The authors reported that patients had similar demographic characteristics Length of stay. Medicare Adjustment for Confounding Factors Outcomes G-6 Hartz. Cerebro vascular diseases Adjustment for Confounding Factors Outcomes Grillo-Peck. Assessment of Sampling Bias 1995-1993. Adults. % Excluded from Analysis.9% Time. Population.100 hospitals from the 1986 HCFA mortality study and the American Hospital Association's 1986 annual survey of hospitals. Diagnosis. 11. Diagnosis. Age. Assessment of Sampling Bias 1986. % of HMO Single hospital study Time. % of Teaching Hospitals. Patient. Publication Type Aim of the Study Hospital Eligibility Criteria. Year. Analytic Units. % of Hospitals for Profit. Database. % of Teaching Hospitals. 5. Publication Type Aim of the Study Hospital Eligibility Criteria. % of Hospitals for Profit. Year. external.

hospital size. Design.000 patients. 199212 Article Examine the association of nurse staffing on mortality in Medicare population McDaniel. 199415 Article Examine relationship between nurse turnover and patient and nurse satisfaction Examine the association between nurse staffing and length of stay in Ontario hospitals Examine relationship between length of stay and hours per patient day in 11 clinical specialty areas Examine associations between patient outcomes and staff registered nurse absenteeism Single hospital study Patient.S. Population. Medical Care Medical records Adults. Year. finances. unit computerization. 199213 Article Halpine. Unit. up to four secondary diagnoses. 40. 25% 1989-1990. Random sampling. hospital ownership Not reported Length of stay Urinary tract infection. external. cluster patients and hospitals Not reported Mortality G-7 Patient satisfaction The Hospital Medical Records Institute. falls. % of HMO 84 statistically selected hospitals from 1986 American Hospital Association (AHA) survey. 42. Hospital. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author. % of Hospitals for Profit. Adults Patient age. Publication Type Aim of the Study Hospital Eligibility Criteria.733 patients Administrative Taunton. Sample Size. transfer status. % of Teaching Hospitals. age. primary and secondary diagnosis. sex.36% Administrative Nursing intensity index Length of stay 58 hospitals in the U. Hospital. 22. bias assessed Patient Eligibility Criteria: Database. technical capability of the hospital. hospital unionization. >65 years. Age. Medicare Adjustment for Confounding Factors Outcomes Krakauer. 199314 Article Shamian. Analytic Units. location.. Database.Table G1. bloodstream infection . Adults Patient one principal discharge diagnosis. % Excluded from Analysis. 300 patients Medical records. 33% Unit. Assessment of Sampling Bias 1986. Single hospital study Time. 1. comorbidities. 65 units Administrative. 75% 1989-1990. Sampling. 199416 Article Taunton.773 patients. race. Diagnosis.

Adults Hospital size.595 patients. Analytic Units. marital status. Adults Not reported Length of stay . 600 nurses. 5% Administrative. 199719 Article Examine association between nurse staffing and patient satisfaction Melberg. Nurse. Year. Diagnosis. 199720 Book Examine the association between nurse staffing and length of stay 117 no intensive medical-surgical inpatient units in 17 hospitals selected from a pool of 69 institutions within a metropolitan area by a stratified random sample Single system in California. Publication Type Aim of the Study Hospital Eligibility Criteria. 20. education. geographic region. % Excluded from Analysis.Table G1. Unit. teaching status. Age. Hospital. external. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author. RN rich skill mix. ownership/control. including falls Examine association between registered nurses (RNs) from temporary agencies. % of Teaching Hospitals. urban/rural status. and organizationally experienced RNs on operational and total hospital cost Not reported Falls 1981 AHA annual survey of hospitals. gender. Pacific 1991-1992. Sample Size. 2. Adults Minnick. 199718 Article Examine the association between nurses’ perceived stress and patient incidents. race. 732 hospitals. A 20% random sample (1. 199617 Article Bloom. Database. Assessment of Sampling Bias 1996. Medical Care Survey Adjustment for Confounding Factors Outcomes Dugan.17% Patient Eligibility Criteria: Database. supply of nursing labor within the community Patient age. % of Hospitals for Profit. operating capacity. part-time career RNs.36%. Population. local economic climate. 100%. 51. diagnosis Length of stay G-8 Patient satisfaction 1994-1995. Design. Sampling.96% Survey. sample bias assessed Administrative. % of HMO Single hospital study Time. 20. Random sampling.222 hospitals) Hospital. hospital wage rates.

S. procedure. location.8% 1993.06% Administrative. and meaningfulness of work as assessed on a staff survey with patient satisfaction with nursing care Examine the relationship between nurse staffing and adverse events controlling for related hospital characteristics Not reported Patient satisfaction Stratified probability sample of U. Adults. Diagnosis. nurse staffing. external. 199822 Article Examine the relationships of nurse burnout. Age. length of stay G-9 . 271 hospitals. Mississippi State Department of Public Health Office of Rural Health. sex. gastrointestinal bleeding. Sampling. Analytic Units. % of Teaching Hospitals. region Hoover. Assessment of Sampling Bias 1998. Patient Random sample of 605 patients Patient Eligibility Criteria: Database. % of HMO Single hospital study Time.56% Administrative. race. % of Hospitals for Profit. Hospital. intention to quit. Population. and teaching status Urinary tract infection. Design. Chronic obstructive pulmonary disease. stroke. Adults. % Excluded from Analysis. Census Bureau 1995-1997. Hospital. Sample Size. pulmonary failure. 35.Table G1. Health Care Financing Administration. Medical Care Survey Adjustment for Confounding Factors Outcomes Leiter. 34. viral pneumonia. hospital size. pneumonia. sex. Medicare Patient age. community hospitals 589 acute-care hospitals in 10 states. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author. 199821 Article Kovner. shock. >18years Case mix (patient age. thrombosis. 11. and hip procedures. >65 years. Year. U. 21%. heart attack. acute myocardial infarction as a secondary diagnosis after surgery Mortality. and comorbidity). comorbidity. ownership. 900 hospitals. hospital teaching status. bed size.S. Database. and hospital outcomes in three southern states American Hospital Association Annual Survey. Publication Type Aim of the Study Hospital Eligibility Criteria. 200023 Dissertation Examine the association between managed care penetration.

and acuity. Assessed Administrative. Adults. and critical care patient care units. 25. Unit. average salary. Adults. Sampling. % of HMO Tennessee Department of Health. 24-hour observation units. gender. 17%. medical-surgical combined. 257 medical. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author. Hospital. 200024 Article Determine the effect of managed health care plans on hospital staffing Ridge. 5. Medical Care Administrative. 257 units. race. Diagnosis. Medicare Not reported Mortality . 200125 Dissertation Examine the association between nurse staffing and patient satisfaction Single hospital studyJCAHO-accredited tertiary care hospital. 80. % Excluded from Analysis.Table G1. Patient. external. 22 hospitals Administrative. % of Teaching Hospitals. surgical. 151 hospitals. falls 1997-1998.01% Patient Eligibility Criteria: Database. Population.509 patients. hospital status. primary and secondary diagnoses Not reported Length of stay Length of stay. % of Hospitals for Profit. 9% of all general acute care hospitals in California Hospital Association Annual Survey 1998-1999. Sampling bias. Publication Type Aim of the Study Hospital Eligibility Criteria. step-down. Assessment of Sampling Bias 1995. 200126 Article Examine association between nurse staffing and patient safety outcomes Aiken. number of patient days. 200127 Article Examine the association between nurse staffing and mortality Voluntary sample of California acute care hospitals. hospital beds. Hospital. Design. Year. Adults Bolton. 2960% Time. Sample Size.97%. >16 years Medicare case-mix. Analytic Units.47% Survey. Age. Database. Adults Adjustment for Confounding Factors Outcomes Gandjour. 49. Medicare case mix. 100% 1997-1999. occupancy rate Patient age. patient satisfaction G-10 Pressure ulcers.

age. 11 states across the U. Database. teaching status.S. health care. pneumonia. Sample Size. % of Teaching Hospitals. pressure ulcers. surgical wound infection. sex. emergency admission. reactive depression). Publication Type Aim of the Study Hospital Eligibility Criteria. comorbidities.173. shock. CNS complications (coma and stupor. failure to rescue. hospital patient discharge data and state hospital financial reports or hospital staffing surveys. 200128. Time. occupancy rate. thrombosis. 3. cardiac arrest and CPR. % Excluded from Analysis.705 patients Patient Eligibility Criteria: Database. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author. number of beds. Design. % of HMO American Hospital Association Annual Survey of hospitals. % of Hospitals for Profit. hospital location. reactive confusion. Assessment of Sampling Bias 1997. pulmonary failure.29 Report Examine the relationship between patient outcomes potentially sensitive to nursing and nurse staffing in inpatient units in acute care hospitals Patient diagnosis. external. Hospital.Table G1. Analytic Units. physiologic/ metabolic complications bloodstream infection G-11 . Population. Age. acute delirium. Year. Sampling. Medical Care Administrative Adjustment for Confounding Factors Outcomes Needleman. patient acuity in each hospital’s mix of patients Gastrointestinal bleeding. Diagnosis.

ownership. Population. Analytic Units. sex. and adverse events in five inpatient units in acute care hospital Single hospital study in an academic medical center 2000-2001. decubitus ulcers. medication errors. bloodstream infection G-12 Length of stay Single hospital study Nurse. DRG. % of HMO Hospital Financial Data and HCUP State Inpatient Database. Database. % Excluded from Analysis. Age. ethnicity. falls. pressure ulcers. Year. size. unexpected injury not due to underlying condition of the patients that occurs during the care: falls. % of Hospitals for Profit. Adults. external. events. surgical wound infection. Design. Medical Care Administrative. number of diagnoses at admission.Table G1. Patient. clustering patients in hospitals (two levels model) Patient age. >17 years Unit acuity. Hospital. 200230 Dissertation Examine the association between nurse staffing and adverse patient outcomes Oster. and nursing characteristics Pressure ulcers. teaching status.204 patients Patient Eligibility Criteria: Database.007 nurses Medical records. and type of admission (scheduled or unscheduled). hospital location. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author.6%. primary payer. 124.7% Time. race. 200232 Dissertation Examine the association between nurse staffing and patient outcomes in patient with acute myocardial infarction in urban emergency department Examine the association between nurse staffing. sex. Assessment of Sampling Bias 1997. 200231 Dissertation Cheung. Diagnosis. Publication Type Aim of the Study Hospital Eligibility Criteria. Adults. Sampling. Sample Size. and blood stream infections . payer type Urinary tract infection. 543 patients Medical records. skill mix. % of Teaching Hospitals. Adults. 5. falls. Acute myocardial infarction Patient age. nosocomial infection. 29. 1. time spent on direct and indirect care. total number of nursing personnel. >18 years Adjustment for Confounding Factors Outcomes Cho.

200233 Article Seago. teaching status. Adults Adjustment for Confounding Factors Outcomes Langemo. Sample Size. failure to rescue . Adults. pneumonia. 385 hospitals. Sampling bias assessed Medical records. sex. Sampling. and comorbidities. Publication Type Aim of the Study Hospital Eligibility Criteria. Medical Care Administrative. 29 2002 Article based on the report Examine the relationship between the amount of care provided by nurses at the hospital and patients' outcomes American Hospital Association's Annual Survey of Hospitals 1997. Assessment of Sampling Bias 2003. Hospital.91%. % Excluded from Analysis. age.180. Design. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author. sex. emergency admission. external. the cardiac technology index. falls California Office of Statewide Health Planning and Development (OSHPD) Hospital Disclosure Report database 1991-1993. Database. Analytic Units. % of Teaching Hospitals. hospital number of beds. 6. Year. 200234 Article Examine nursing quality outcome indicators (falls and pressure ulcers) after implementation of ANA Nursing Care Report Card Examine the relationship between the presence of a bargaining unit for registered nurses and the acute myocardial infarction mortality rate for acute care hospitals in California Not reported Patient satisfaction. Population. hospital services. teaching status. Age.Table G1. state of residence. 942 patients Patient Eligibility Criteria: Database. gastrointestinal bleeding. patient volume. Hospital. % of HMO North Dakota Nurses Association (NDNA) Research Council Time. % of Hospitals for Profit. severity of illness. Acute myocardial infarction Needleman. state. Diagnosis.628 patients Administrative. Adults Patient age. shock. primary health insurer. rural status and the Hospital Service Area (HSA) wage index Rate of the outcome in the patient's diagnosisrelated group. urinary tract infection. pressure ulcers. and metropolitan or non metropolitan location Mortality G-13 Mortality. 10. number of MDs per acute myocardial infarction-related discharges. Patient.

80. hospital bed size. location. sex. Patient. length of stay . race Random. pneumonia. and restraint application duration rates) across specialty units Examine association between nurse management and patient outcomes Medicare Case Mix Index. Unit. pulmonary failure. Year.Table G1. % of Teaching Hospitals. Age. 200236 Article Beckman. Analytic Units. Design. 200337 Dissertation Examine the association between nurse staffing and patient adverse events after controlling for hospital characteristics Determine the relationships between nursing staffing and specific nursesensitive outcomes (central line bloodassociated infection. falls. HMO penetration Not reported Urinary tract infection. Sample Size. 429 patients. 100%. Medical Care Administrative. 200235 Article Whitman. Population. external. Diagnosis. Random sample of 570 hospitals Patient Eligibility Criteria: Database. observational data from 10 adult acute care hospitals 1999. Adults. Hospital. Adults G-14 Single hospital study. ownership.5% Time. % of HMO National Inpatient Sample. 74. 95 units Administrative. Assessment of Sampling Bias 1990-1996. % of Hospitals for Profit. region. thrombosis Pressure ulcers.36% Survey. teaching status. fall. bloodstream infection Secondary analysis of prospective. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author. medication error. >18 years Adjustment for Confounding Factors Outcomes Kovner. % Excluded from Analysis. Sampling. Adults Patient age. 17% 1999-2000. Database. pressure ulcer. Publication Type Aim of the Study Hospital Eligibility Criteria.

36% 1998-1999. falls. hospital size. 100% 1999-2001. sex. Patient. surgical wound infection. teaching status. 20% Time. >20 years. failure to rescue Single hospital study. Adults Patient satisfaction. 124. Design. Publication Type Aim of the Study Hospital Eligibility Criteria. % of Hospitals for Profit. % Excluded from Analysis. Age. ownership. % of HMO Hospital financial data. Sampling. race. ICD-9CM for adverse drug event G-15 Mortality. falls . hospital location. Population. referral from another hospital. Assessment of Sampling Bias 1996-1999. Adults. Database. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author. Diagnosis. teaching status. state Inpatient databases. >18 years Adjustment for Confounding Factors Outcomes Cho. orthopedic. 232. vascular operation Patient age. DRG.204 patients Patient Eligibility Criteria: Database. sex. comorbidities. general surgical. number of diagnoses at admission. Patient. Year. % of Teaching Hospitals. Unit. pressure ulcers. 200338 Article Examine the effects of nurse staffing on adverse events. clustering patients in hospitals (two levels model) Patient age. Sample Size. Medical Care Administrative. and type of admission (scheduled or unscheduled). 32 units Medical records.342 patients Administrative. Adults. external. having a boardcertified surgeon Not reported Urinary tract infection. Analytic Units.Table G1. size. and medical costs Aiken. 5%. mortality. 200340 Article Examine whether the proportion of hospital RNs educated at the baccalaureate level or higher is associated with risk-adjusted mortality and failure to rescue (deaths in surgical patients with serious complications Examine the association between nurse staffing and patient outcomes at the unit level in the acute care adjusting for patient acuity and proportion of floating nurses Pennsylvania Health Care Cost Containment Council. morbidity. 200339 Article Potter. and technology. bloodstream infection. primary payer.

Assessment of Sampling Bias 2003. and bed size Length of stay. surgical wound infection. Adults Not reported Patient satisfaction G-16 1997-1998. gastrointestinal bleeding.Table G1. state hospital staffing surveys or financial reports. health insurance. shock. present sample is 26% of all discharges in the U. American Hospital Association Annual Survey. Hospital. Analytic Units. % of Hospitals for Profit. 200342 Article Examine the association between pressure ulcer incidence. Hospital.180. sex. Year. bloodstream infection . Age. 113 hospitals Administrative. cardiac arrest and CPR. % of HMO Midwest Research Institute/National Database of Nursing Quality Indicators Time. % of Teaching Hospitals. and nursing care hours Examine the relationship between nurse staffing and patient perceptions of nursing care in a convenience sample of 40 California hospitals Not reported Pressure ulcers Needleman.S. failure to rescue. Sampling.628 patients Administrative.357 hospitals. Publication Type Aim of the Study Hospital Eligibility Criteria. primary DRG. Sample Size. % Excluded from Analysis. emergency admission. and comorbidities. Diagnosis. Medical Care Administrative Adjustment for Confounding Factors Outcomes Langemo. Hospital. Adults Patient age. pneumonia. 200343 Article Assess whether adverse outcomes in Medicare patients can be used as a surrogate for measures from all patients in quality of care research using administrative datasets Hospitals participating in both the ongoing California Nursing Outcomes Coalition statewide database project and the statewide Patients' Evaluation of Performance in California project National MedPAR discharge data for Medicare patients from 3. Design. hospital teaching. 200341 Article Bolton. urinary tract infection. in 1997 1998-2000. pressure ulcers. Population. 6. 942 hospitals Patient Eligibility Criteria: Database. metropolitan status. Database. staff mix. external. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author.

57%.500 nurses.496 patients Survey. pneumonia. % Excluded from Analysis. 75% 1998. Design. race. 722 patients. pressure ulcers. Random of 175 patients Medical records. Unit. Random sample. Adults Case mix index Mortality. clustering nurses and patients within hospitals Nurses clustered within hospitals. Patient. Adults. % of HMO 40 units in 20 urban hospitals across the U. % of Teaching Hospitals. Sampling. 11. Population. Medical Care Survey. nurse sex. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author. and CPR . external.99% Patient Eligibility Criteria: Database. failure to rescue.S. sex. 0. 200445 Article Van Doren. Age. Diagnosis. experience in nursing and in the unit. Sample Size. Database. and race. cardiac arrest. Analytic Units. length of stay. 200447 Article Examine the effects of nurse staffing and process of nursing care indicators on assessments of the quality of nursing care Examine the relationships between congestive heart failure patient outcomes and RN hours Examine the association between nurse autonomy and collaboration and patient outcomes Hospitals where responding licensed RNs in Pennsylvania worked in 1999 1999. age. severity of illness. AIDS Adjustment for Confounding Factors Outcomes Vahey. Publication Type Aim of the Study Hospital Eligibility Criteria. 8. % of Hospitals for Profit. falls. Bias assessed Survey Patient age. urinary tract infection. 200444 Article Examine the effects of the nurse work environment and nurse burnout on patients' satisfaction with their nursing care Sochalski. 7.70%. (sample from the study of quality of care in AIDS patients) Time. 200446 Article Boyle. Heart failure Length of stay Single hospital study. Year.Table G1. nurses perceived quality of care and patient safety Not reported Patient satisfaction Falls G-17 Single hospital study. Nurse. Adults. 13. Assessment of Sampling Bias 1991. 100% 2001.

Table G1. thrombosis . pulmonary failure. Adults Patient DRG. average daily census Tschannen. location. Database. nursing characteristics Patient age. 200548 Dissertation Examine association between patient length of stay and nurse staffing and nurse-physician collaboration Single hospital study 2005. % of Hospitals for Profit. licensed acute care beds.727 patients. falls. 20% random sample of U. 20059 Report Test associations between daily nurse staffing in adult medical-surgical units and hospital acquired pressure ulcers. failure to rescue. Random sample Administrative. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author. % Excluded from Analysis. Adults Adjustment for Confounding Factors Outcomes Donaldson. age. Design. Year. Analytic Units. Sample Size. or adversely affects the patient care quality or outcomes Length of stay G-18 Length of stay. race. Assessment of Sampling Bias 2002-2003. no. 200549 Dissertation Examine the association between nurse staffing and nurse-sensitive patient outcomes American Hospital Association Annual Survey (685 hospitals). 23. teaching status. acuity scores. unexpected clinical events not related to the patient’s illness or underlying condition resulting in unanticipated death or major permanent loss of function.65% Medical records Houser. hospital size. 24. Publication Type Aim of the Study Hospital Eligibility Criteria. unit of admission. comorbidity. ownership Pressure ulcers. ownership. the part of the California Nursing Outcomes Coalition (CalNOC) Time. patient falls Hospital rural/urban designation. Diagnosis. external. 7. hospitals 2001. Patient. 406 patients. health insurance. and comorbidities. Population. Medical Care Administrative. admission type and source.452.S. gender. % of HMO 25 acute care. notfor-profit California hospitals. 77 units Patient Eligibility Criteria: Database. Patient.37%. Unit. adverse events. pressure ulcers. Age. % of Teaching Hospitals. sex. Sampling.

Medical Care Administrative. chronic obstructive pulmonary disease. Population. General. Age.216 patients. hospital survey Time. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author. >18 years. % of Teaching Hospitals. Sampling. pneumonia Administrative. Database. stroke. Severity of adverse event Falls . % of HMO Health area resources file. orthopedic.S. Adults. Adults Adjustment for Confounding Factors Outcomes Examine association between nurse staffing and patient adverse events in 45 community acute care hospitals across the U. emergency department admission. Diagnosis. acute myocardial infarction. comorbidity and complications Mortality. Medical Care Administrative.Table G1. 200551 Article Examine the association between nurse education and skill mix. % of HMO International Hospital Outcome Study. % Excluded from Analysis Sampling. Assessment of Sampling Bias 1998-1999. Retrospective Studies that assessed temporality in association between patient outcomes and nurse staffing patterns Aim of the Study Hospital Eligibility Criteria. Hospital. Patient. Sample Size. 25. patient age. 200550 Article Halm. and vascular surgery Adjustment for Confounding Factors Outcomes Estabrooks. Publication Type Aim of the Study Hospital Eligibility Criteria. Analytic Units. Data Collection Wan. Sample Size.2% Time. Publication Type. Year. Assessment of Sampling Bias 1985. % Excluded from Analysis. % of Hospitals for Profit. % of Hospitals for Profit. failure to rescue G-19 Author. 6. Adults. 8. Year. Age.142 patients Patient Eligibility Criteria: Database. 0% 2002. congestive heart failure. 56. Database. failure to rescue. 100%. Diagnosis. Patient. Population. and 30-day mortality after adjusting for institutional factors and individual patients characteristic Examine the association between nurse-to-patient ratio and patient mortality. Design. 60 hospitals.0% Patient Eligibility Criteria: Database. 18. 198752 Article. external. % of Teaching Hospitals. emotional exhaustion and job satisfaction of nurse Comorbidity scores.42% Patients demographics. Analytic Units. and gender Mortality Single hospital study.

146. Assessment of Sampling Bias 1986. Patient. major diagnostic category.839 patients. Population. teaching status. Selected clinical conditions. % of Teaching Hospitals. 46% 1983-1984. Sample Size. hospital’s size. 199555 Dissertation. Medicare case mix. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author. Retrospective Examine staffing factors associated with risk-adjusted mortality. Adults. location. Adults Patient demographic characteristics. Age. riskadjusted average length of stay. sex.440 patients. Prospective Examine association between nurse shortage and length of stay Not reported.S.000 patients Mortality. occupancy. length of stay. Design.Table G1. Medical Care Medical records. Publication Type. length of stay. 12% 1988-1990. adverse events. length of stay Acute care short term hospitals in North Carolina. gastrointestinal bleeding Mortality G-20 Mortality. 214. 17. bias assessed Administrative. 497 patients Patient Eligibility Criteria: Database.691 non federal U. Sample bias Assessed Administrative. 19% 1988-1993. 198853 Article. gender. >16 years. size. 199415 Article. location. Year. Adults. Hospital. hospitals with >200 beds. infections including urinary tract infection and gangrene. Analytic Units. % of Hospitals for Profit. defined as discharge disposition and death 1. Database. length of stay . and technology Length of stay. and arrhythmias. congestive heart failure. Patient. ownership Patient age. % of HMO Single hospital study Time. Adults Adjustment for Confounding Factors Outcomes Flood. primary DRG and comorbidity (APACHE III scores) Patient age. and nurse turnover Examine the association between the proportion of RNs on mortality rates in Medicare patients for 16 selected clinical conditions Relationship between the available hours of RN care and patient outcomes. hospital ownership. Retrospective Thorson. >65 years. subgroup analysis by patient acuity Shortell. % Excluded from Analysis Sampling. >16 years 981 hospitals in 45 states. comorbidity. external. Diagnosis. 53%. Data Collection Aim of the Study Hospital Eligibility Criteria. Random sample. Retrospective Shortell. 198854 Article. Medicare Medical records. Unit.

Design. Publication Type. 4. 199756 Report. Medicare Severity of illness: % of ICU days.96% Administrative. 8. Sample bias assessed Patient Eligibility Criteria: Database. pressure ulcers. 199859 Article. and adverse patient outcomes Determine the relationship between different levels of nurse staffing (total hours/patient day and proportion of RNs) and patient falls and cardiovascular arrests Examine associations between nurse staffing levels and mortality rates in 3. Adults Medicare case mix scores Falls. patient satisfaction. and % of Medicaid patients Mortality . % of Teaching Hospitals. Year. falls. Medical Care Administrative Adjustment for Confounding Factors Outcomes ANA.822 hospitals. Massachusetts. Analytic Units. 14. 21. Hospital. Sample Size. Assessment of Sampling Bias 1992-1994. Patient. Age. 199757 Article. Unit. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author. Retrospective Bond. and CPR American Hospital Association's Abridged Guide to the Health Care Field. Unit. pressure ulcers. Retrospective Examine the effect of fluctuations in cardiac intensive care unit nurse staffing levels and patient census on cardiac care unit nosocomial infection rate Describe. annual number of emergency room visits/average daily census. Adults. Retrospective Blegen. cardiac arrest. and New York Time. urinary tract infection. Data Collection Aim of the Study Hospital Eligibility Criteria. Diagnosis. nosocomial infection Nosocomial infection G-21 Consortium of hospitals members of Information and Quality Healthcare 1993. Children Not reported Length of stay. nursing acuity system Mortality.3%. % Excluded from Analysis Sampling. 199960 Article.2% 1992. % of Hospitals for Profit. external. Retrospective Examine association between nurse staffing and patient outcomes Nursing Intensity weights. the relationships among total hours of nursing care. Database.763 U. nosocomial infection Consortium of hospitals members of Information and Quality Healthcare 1993-1995. % of HMO 502 hospitals from California. hospital teaching status. Population. 42 units Administrative. location Archibald. 782 patients Medical records. Adults Patient severity. at the level of the nursing care unit. pneumonia. Retrospective Blegen. hospitals Single hospital study 1994-1995. 39 Administrative. 199858 Article. Hospital. 502 hospitals.Table G1. registered nurse skill mix.S.

race. chronic obstructive pulmonary disease. Diagnosis. type of aneurism. 0. 199963 Article. and mortality in patients with chronic obstructive lung disease Patients’ age. 33. Adults. technologists) Nursing intensity weights based on patients’ characteristics. 691. Adults. % of HMO Maryland Health Services Cost Review Commission Time. % of Teaching Hospitals. >30 years. 2. Patient. sex. surgeon and hospital volumes Severity of illness and comorbidity (Medicare case mix index). size. and location Mortality. pressure ulcers. Hospital. Design.1994.708 patients. comorbidity. Year. Population. Medical Care Medical records. nature of admission. staffing variables (nursing. skill mix. Age. Analytic Units. Abdominal aortic surgery Adjustment for Confounding Factors Outcomes Pronovost. technology index. Sample bias assessed Patient Eligibility Criteria: Database. Assessment of Sampling Bias 1994-1996. 199961 Article. surgical wound infection . Medicare Mortality G-22 Lichtig. Publication Type.996 patients.Table G1. % Excluded from Analysis Sampling. % of Hospitals for Profit. Sample bias assessed Administrative. Sample Size. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author. 199962 Article. physicians. Retrospective Examine the relationships between patient outcome indicators and nurse staffing Hospital cost reports from New York and California 1992.00% Administrative. teaching status. ownership. Database. urinary tract infection. Hospital. Adults Length of stay.30%. pneumonia. length of stay American Hospital Association 1989-1991. hospital’s financial status. Retrospective Robertson. Retrospective Determine whether nurse to patient ratio in ICUs is associated with length of stay in abdominal aortic surgery patients who typically receive care in an ICU Examine the association between staffing intensity. 5. Data Collection Aim of the Study Hospital Eligibility Criteria. external.

Year. >18 years. nature of admission. % of Teaching Hospitals. pulmonary failure. Patient. acute renal failure G-23 . % Excluded from Analysis Sampling. sex. Publication Type. Assessment of Sampling Bias 1994-1996. unplanned extubation. pneumonia. clustering of outcomes within a hospital Mortality. septicemia postoperative infection. Medical Care Adults. 200064 Article. % of Hospitals for Profit. Sample Size.Table G1. Data Collection Aim of the Study Hospital Eligibility Criteria. Population. length of stay. Analytic Units. Esophageal resection Adjustment for Confounding Factors Outcomes Amaravadi. Retrospective Determine if a nighttime nurse-to-patient ratio in the intensive care unit is associated with clinical and economic outcomes following esophageal resection Patient age. comorbid disease and hospital and surgeon volume. cardiac arrest and CPR. myocardial infarction. Age. surgical complications. external. Diagnosis. 366 patients in 32 hospitals Patient Eligibility Criteria: Database. Design. type of operation. Database. % of HMO Maryland Health Service Cost Review Commission Time. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author.

rural location (Y/N). Retrospective Examine the association between nurse staffing and patient outcomes in the inpatient hospital settings Large urban location (Y/N). Database. communicable conditions. % Excluded from Analysis Sampling. personal care complications. Sample Size. % of HMO HCFA Time.32% Patient Eligibility Criteria: Database. Medical Care Administrative. teaching status. external. anoxic brain damage. psychiatric secondary diagnosis. % of Teaching Hospitals. 9. Analytic Units. Age. Diagnosis. >75 years. nursing intensity weights Length of stay. Data Collection Aim of the Study Hospital Eligibility Criteria. complications in post-partum period. surgical wound infection. Adults. 14.Table G1. % of Hospitals for Profit.251. urinary tract infection. Assessment of Sampling Bias 1992-1996. pneumonia. thrombosis. Publication Type. metabolic imbalances. trauma in non-trauma patients. diabetic complications.921 patients. Medicare Adjustment for Confounding Factors Outcomes ANA. Population. Design. pressure ulcers. joint effusion. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author. Year. Hospital. adverse drug reactions G-24 . transfusion reactions. 200065 Report.

Age. ratio of board certified physicians/ adjusted patients days of care. % of Hospitals for Profit.4% Time. Medical Care Administrative Adjustment for Confounding Factors Outcomes Unruh. cardiac arrest and CPR. gender. falls. % of Teaching Hospitals. % Excluded from Analysis Sampling. Population.477 during 7 years acute care hospitals in Pennsylvania. 1. external. Diagnosis. number of administrators/ adjusted patients days of care Mortality. 200066 Dissertation. hospital location. % of HMO 211 hospitals yearly. Sample Size. Retrospective Examine the association between nurse staffing and quality of patient care Patient age. Database. Data Collection Aim of the Study Hospital Eligibility Criteria. ownership. 83. Publication Type.Table G1. 0. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author. Year. size. hospital restructuring including capacity utilization. complications: secondary diagnosis of misadventures to patients during surgical and medical care G-25 . merger status. length of stay. surgical wound infection. Patient. Analytic Units. pulmonary failure. urinary tract infection. Assessment of Sampling Bias 1991-1997. Design. race. acuity (Mediqual. pneumonia.924 patients Patient Eligibility Criteria: Database. State Department of health with unique information on nurse staffing and patients discharge. pressure ulcers.

Medicare Adjustment for Confounding Factors Outcomes Silber. observational data from 10 adult acute care hospitals with bed capacity ranging from 59–861 beds. Year. however. external. inhospital complication rate. Diagnosis. % of Teaching Hospitals.440 patients Patient Eligibility Criteria: Database. Assessment of Sampling Bias 1991-1994. race. transient ischemic attack. the authors obtained hierarchical longitudinal linear models (random coefficient regression models) Mortality. 50% 1999. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author. 200168 Article.574 patients Medical records. % of Hospitals for Profit.Table G1. pressure ulcers. Design. wound infections. shock. % of HMO Medicare patients in 245 hospitals Time. stroke. diagnosis and comorbidities. sepsis. location. hospital size. Adults. Database. % Excluded from Analysis Sampling. Publication Type. technology. Retrospective Examine the association between nurse staffing and patient outcomes in surgical Medicare patients 27 patient characteristics including age. in an integrated healthcare system in the east. pneumonia. 370. % of certified physicians and anesthesiologists Whitman. Medical Care Administrative. coma. Age. Unit. Prospective Examine the relationship between restraint use and staffing A secondary analysis of prospective. bleeding Restraint use G-26 . pulmonary failure. Data Collection Aim of the Study Hospital Eligibility Criteria. failure to rescue. sex. deep vein thrombosis and pulmonary embolus. >65 years. cardiac event. Sample Size. Analytic Units. nosocomial infections. congestive heart failure. Population. Adults Not reported. Hospital. 217. 200067 Article.

acute renal failure. Data Collection Aim of the Study Hospital Eligibility Criteria. Analytic Units. Retrospective Examine the association between nurse staffing and patient outcomes Age. 69 2001 Dissertation. Age. Assessment of Sampling Bias 1997-1998. hepatic resection Patient age. cardiac arrest and CPR. 200171 Article. 2. 100% Hospital. Unit. 569 patients. Retrospective Examine the association between nurse staffing and patient outcomes 29 university teaching hospitals based on the MECON-PEERx Operations Benchmarking Database Reports. 56. bloodstream infection Patient satisfaction. Medical Care Administrative Adjustment for Confounding Factors Outcomes Ritter-Teitel. Adults Year of submission and type of unit . Year. % Excluded from Analysis Sampling.28% Administrative. primary diagnosis and case-mix index. random effects of hospitals Patient satisfaction. falls Mortality.Table G1. Diagnosis. hospital and surgeon volumes G-27 Sovie. pressure ulcers. postoperative myocardial infarction. Retrospective Determine if nurse-topatient ratio in the intensive care unit at night is associated with differences in clinical and economic outcomes after hepatectomy 1994-1998. urinary tract infection. type of operation. nature of admission. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author. Patient. Sample Size. transient ischemic attack. falls Dimick. % of HMO Sample from HRIO study (“Hospital Restructuring’s Impact on Outcomes”) of 42 teaching hospitals. Database. external. pulmonary failure. 29 hospitals Administrative. comorbidity. % of Hospitals for Profit. 100% Maryland Health Services Cost Review Commission Time. unplanned extubation. Sample bias assessed Patient Eligibility Criteria: Database. Publication Type. >18 years. pneumonia. Population. length of stay. Design. sex. % of Teaching Hospitals. Adults. 200170 Article. pressure ulcers.

Unit.2% 1998-1999.615 patients. >30 years. sex. Analytic Units. Patient. Population.Table G1. hospital size. % of Teaching Hospitals. orthopedic. education Mortality. teaching status. Medical Care Administrative. Retrospective Evaluate the association between nurse-to-patient ratio in the ICU and risk for medical and surgical complications after abdominal aortic surgery Number of hospital beds and the volume of aortic surgery performed during the study period by each hospital and each surgeon in the database. Age. 2. or vascular operation Patient age. 0. septicemia. and factors related to nurse retention 1993-1995. comorbidity. failure to rescue . length of stay. bloodstream infection Falls G-28 American Hospital Association (AHA) annual survey and 1999 Pennsylvania Department of Health Hospital Survey. sex. >20 years. 36. General surgical. race. and technology. and comorbidities Blegen. Patient. Publication Type. surgical complications. % of HMO Health Services Cost Review Commission Time. failure to rescue (deaths following complications) among surgical patients. nurse’s sex. Year. Sampling bias assessed Patient Eligibility Criteria: Database.342 patients Administrative. 200172 Article. medical complications acute renal failure. 81 units Administrative. Data Collection Aim of the Study Hospital Eligibility Criteria. Abdominal aortic surgery Adjustment for Confounding Factors Outcomes Pronovost. surgery types. Retrospective Aiken. % Excluded from Analysis Sampling. reoperation for bleeding. Adults. Retrospective Describe the relationships between the quality of patient care and the education and experience of the nurses providing that care Determine the association between the patient-to-nurse ratio and patient mortality. Diagnosis.34%. external. 200274 Article. Assessment of Sampling Bias 1994-1996. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author. Design. Adults. % of Hospitals for Profit. 200173 Article. 232. pulmonary failure. acute myocardial infarction. patient age (in years). Database. Sample Size. years of experience in nursing. unplanned extubation. Adults Hospital Medicare case mix index Mortality. cardiac arrest and CPR.

type of unit. >18 years. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author. % Excluded from Analysis Sampling. hospital and surgeon volume. nature of admission. urinary tract infection. external. patient satisfaction. Medical Care Administrative. unplanned extubation. 46. Population. and pain management in bowel resection patients Ontario Hospital Reporting system. pneumonia. Publication Type. Retrospective Examine the association between ICU nurse staffing and the likelihood of complications for patients undergoing abdominal aortic surgery Patient age.76% Patient Eligibility Criteria: Database. Acute myocardial infarction. incidence of urinary tract infection and pneumonia. use of clinical pathways Tourangeau. hospital and ICU bed size. Retrospective Barkell. Age. Adults. bloodstream infection Mortality G-29 Single hospital study: 508-bed full service community-based teaching hospital 1999-2000. cardiac arrest and CPR. Patient. Database. cardiac complications after a procedure. >21 years. and location Not reported Pulmonary failure. 13. Design. RN attendance at daily rounds. Year. Adults. % of Teaching Hospitals. 12. 200277 Article. patient satisfaction.Table G1. % of Hospitals for Profit. Abdominal aortic surgery Adjustment for Confounding Factors Outcomes Dang. comorbidities. sex. sex. comorbidity. pneumonia . Hospital. severity of illness. variable cost. Postoperative bowel procedure Patient age. Patient.941 hospitals Administrative. complications: acute myocardial infarction.987 patients. hospital teaching status. 2. % of HMO Maryland Health Services Cost Review Commission Time. stroke. Adults. platelet transfusion. Assessment of Sampling Bias 1994-1996. fulltime medical director and nurse manager.3% 1998-1999. race. 30. 96 patients Length of stay. Sample Size. 76 2002 Article. Retrospective Examine the association between nursing-related hospital variables and 30-day mortality rates for hospitalized patients Examine the effects of a change in the staffing model on length of stay. 200275 Article. Data Collection Aim of the Study Hospital Eligibility Criteria. Analytic Units. Diagnosis. or septicemia Medical records. acute renal failure. socio-economic status.

tertiary-care pediatric institution Part of Detailed ICU Surveillance Component (DISC) Study (prospective.Table G1. falls Unruh. Canada. hospital size. number of boardcertified physicians. Sampling bias assessed Administrative. falls. Assessment of Sampling Bias 1997-1999. pulmonary failure. Analytic Units. and level of severity. % of HMO Single hospital study. rate of reported medication errors. weight. nosocomial infection . 6 hospitals. Design. Database.929 patients Patient Eligibility Criteria: Database. 200381 Article. 83. pressure ulcers. ethnic status.924 patients. 1.593 patients Medical records. gender. 34% Pennsylvania Department of Health Time. Prospective 1995-2000. external. 8. % Excluded from Analysis Sampling. not-forprofit. ownership status. Central venous catheter Patient age. patient satisfaction. Diagnosis. 200379 Article. Hospital. a 320-bed. Patient. technology Length of stay. Adults. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author. comorbidity Bloodstream infection G-30 Mark. Age. Population. gender. Year. Children Adjustment for Confounding Factors Outcomes Stegenga. Random sampling Survey. pneumonia. and capacity utilization Urinary tract infection. Patient. hospital mergers. no psychiatric. Retrospective 1991-1997. % of Teaching Hospitals. Ontario. and to assess the relationship of licensed nursing staff with patient adverse events in hospitals Not reported Nosocomial infection 1997-1999. 2. Patient.326 patients. 8 ICU units 68 randomly selected non-federal. and falls) Examine the changes in licensed nursing staff in Pennsylvania hospitals from 1991 to 1997. Prospective Examine the relationship between nurse staffing levels and the rate of nosocomial viral gastrointestinal infections (NVGIs) in a general pediatrics population Examine the association between nurse staffing and bloodstream infections in intensive care units Examine the association between nurse practice and patient outcomes (patient satisfaction. accredited acute care hospitals with more than 150 beds in 10 southeastern states. diagnosis. Sample Size. Adults Case mix index. 200278 Article. Medical Care Medical records. Adults Patient age. multi center cohort study). general pediatrics ward at The Hospital for Sick Children in Toronto. Data Collection Aim of the Study Hospital Eligibility Criteria. Retrospective Alonso-Echanove. height. 200380 Article. % of Hospitals for Profit. race. Publication Type.

sex. Retrospective Examine the association between nurse staffing and colonization vancomycin-resistant enterococci colonization in chronic dialysis patients Examine the relationship between nurse staffing and patient outcomes Nursing workload index. 26. Analytic Units. 5. size. % of HMO Single hospital study Time. Adults. falls .897 patients Medical records. Medical Care Medical records. gastrointestinal bleeding. 1. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author. Age. Patient. and acuity Nosocomial infection Single hospital study including 7 nursing units with patients at high risk of acquiring events 2000-2001. Hospital. 10. primary diagnosis and comorbidities (DRGs). Patient. unionization. pneumonia. % Excluded from Analysis Sampling. Retrospective Tallier. % of Teaching Hospitals. 200384 Dissertation. 2. primary payer. 41.Table G1. Assessment of Sampling Bias 2000-2002. Year.210.2% 1995-2000. 200385 Dissertation. Data Collection Aim of the Study Hospital Eligibility Criteria.067 patients Medical records Patient age's. urinary tract infection. Population. % of Hospitals for Profit. 200383 Dissertation. teaching status. Design. patient age. emergency admission. Database. failure to rescue. clustering patient within hospitals Patient age.11% Patient Eligibility Criteria: Database. organizational leadership Patient satisfaction. acuity. shock. hospital variables (location. primary diagnosis. Adults Zidek. 200382 Dissertation. Patient. race. external. Diagnosis. Retrospective Examine association between nurse overtime and patient mortality and 6 nursesensitive patient outcomes Hospitals in New York state completed Institutional Cost Reports. bloodstream infection G-31 Length of stay. pressure ulcers. >18 years Not reported Berney. Sample Size. margins). Retrospective Examine the association between changes in nurse staffing determined based on a new patient classification system and patient outcomes Single hospital study: rural acute tertiary care facility 1999-2001. unit size. urinary tract infection.084 patients. pressure ulcers.556 patients Administrative. nosocomial infection Mortality. cardiac arrest and CPR. Chronic renal diseases that requires hemodialysis Adjustment for Confounding Factors Outcomes Simmonds. Publication Type.

754 patients. external. urinary tract infection.481 patients. Sample Size. Random Administrative. ethnicity. severity of illness. hospital size. Medical Care Administrative Adjustment for Confounding Factors Outcomes Hope. Prospective Examined the association between nurse staffing. Random Administrative Patient age. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author. % of Hospitals for Profit. Assessment of Sampling Bias 1998-2000. Year. 200488 Article. Analytic Units. Patient.Table G1. and primary diagnosis. 37.33%. pressure ulcers . gender. Retrospective American Hospital Association 1990-1995. surgical wound infection. healthcare-associated infection. national risk of infection. 49. Publication Type. pneumonia. gender. 200386 Dissertation. Patient. and teaching status Patient’s age. Retrospective Examine the relationship between nursing workload and nosocomial infections in acute care hospital Cimiotti. % of Teaching Hospitals. and type of treatment (medical vs. 2. Population. admission type. Medicare Mark. and severity of illness. Children Person. >65 years. case mix. Data Collection Aim of the Study Hospital Eligibility Criteria. Adults. nosocomial infection. use of surgery and invasive medical devices. gender. Acute myocardial infarction.23% Patient Eligibility Criteria: Database. rural/urban location. hospital volume. Age. differences in practices in study's sites Patient age. 39. and length of stay among infants in the neonatal ICU Two Level lII-IY neonatal ICU units in New York City participated in a clinical trial to test hygiene regimens 2001-2003. birth weight. and the availability of high technology services Urinary tract infections. resource intensity weight Patient acuity based on DRG and nursing Intensity weight.2% 1994-1995. % of HMO Single hospital study Time. 234. % Excluded from Analysis Sampling. Database. 39. Design. surgical). Diagnosis. 200487 Dissertation. Patient. ward type. nosocomial infection G-32 Mortality Mortality.675 patients Medical records. pneumonia. 422 patients. Retrospective Assess the association of nurse staffing with inhospital mortality for patients with acute myocardial infarction Examine the effects of change in registered nurse staffing on change in quality of care Cooperative Cardiovascular Project (CCP) dataset. bloodstream infection Length of stay. Hospital. admission source. 200489 Article.

gender. Hospital. hospital size. Publication Type. unit/hospital type. flexible staffing. admission type. patient satisfaction. external. and the availability of high technology services Patient age. Different % HMO penetration Time. and 12 intensive care units 2002. 0%. paid continuing nursing education. Unit. case mix. Assessment of Sampling Bias 1990-1995. academic. length of shift. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author.26% Seven. % of HMO Longitudinal cohort of the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS). surgical). admission source. nosocomial infection G-33 . Medical Care Administrative Adjustment for Confounding Factors Outcomes Mark. Age. 422 hospitals. and type of treatment (medical vs. Population.011 patients Administrative. relationships with physicians Mortality. % Excluded from Analysis Sampling. Analytic Units. community hospitals from 11 states. a 20% probability sample of U.Table G1. size. socio economic status. 200590 Article. technological complexity. Data Collection Aim of the Study Hospital Eligibility Criteria. Retrospective Relationships between pediatric nurse staffing and 5 indicators of quality care (measured as adverse occurrence rates) in 17 medical/surgical. transfers. organizational factors including care model. length of stay Stratton. Sampling bias assessed Patient Eligibility Criteria: Database. Database. 5 oncology. 200591 Dissertation. selfgovernance. sex.S. 0. 3. Random sampling. 6. and occupancy. Diagnosis. Children. not-for-profit children's hospitals from the National Association of Children's Hospitals and Related Institutions (NACHRI). >1year Length of stay. 100%. Design. % of Teaching Hospitals. Retrospective Examine structural differences in the relationship between nurse staffing and quality of care in different levels of managed care penetration Patient’s age. % of Hospitals for Profit. Sample Size. race. Year.122%.

Age.Table G1. pneumonia. RN = Registered Nurse . % of Teaching Hospitals. MedPAR = Medicare Provider Analysis Review. Population. gender. CPR = Cardio-pulmonary Resuscitation. Data Collection Aim of the Study Hospital Eligibility Criteria. ICU = Intensive Care Unit. HMO = Health Maintenance Organization. and distance from the closest highvolume hospital Seago.302 hospitals Patient Eligibility Criteria: Database. Retrospective Examine the association between nurse staffing (RN/patient ratio) and patient mortality and complication after cystectomy Age. 100% 1999-2002. Retrospective Examine the association between nurse staffing and patient outcomes for 3 adult medicalsurgical nursing units in one university teaching hospital across 4 years (16 fiscal quarters) Single hospital study. Publication Type. % Excluded from Analysis Sampling. deep venous thrombosis. pulmonary compromise. Sample Size. Diagnosis.9 and 236. failure to rescue. Analytic Units. and internal validity of the studies that examined the associations between nurse staffing and strategies and patient outcomes (continued) Author. 1. Adults Case-mix Mortality. pressure ulcers. external. 200592 Article.7) after total cystectomy Adjustment for Confounding Factors Outcomes Elting. Assessment of Sampling Bias 1999-2001. Bladder carcinoma (ICD-9 codes 188. Patient. ethnicity. 200693 Article. postoperative coma or shock. comorbidities. Year. Database. Design.0-188. falls G-34 CNS = Central Nervous System. wound infections. DRG = Diagnosis Related Group. acute myocardial infarction. Medical Care Administrative. reoperation. 1.012 patients Administrative. Hospital. race. Adults. arrhythmia. pulmonary embolus. % of Hospitals for Profit. bacteremia. and cardiac arrest or shock Patient satisfaction. % of HMO Texas Hospital Discharge Public Use Data Time.

05 <0. RN = Registered Nurse.05 LPN = Licensed Practical Nurse.14 <0.5 NS NS 1. AHA database Aiken5 Aiken39 Aiken74 Amaravadi64 Bond60 Dimick70 Elting92 0. CMS Online Survey CCP and AHA datasets Survey of ICU directors Survey of ICU directors AHA database Hospital administrative databases. LPN FTE/1. and the Pennsylvania Health Care Cost Containment Council Data Base for years 1991–1994 State Department of Health.05 NS NS 0.4 <0.99 NS RN.41 0.05 NS <0. LPN FTE/ patient day Patients/RN/shift Patients/RN/shift RN FTE/patient day Patients/RN/shift 1. CMS Online Survey Area Resource Files.05 1.02 <0. daily staffing plans and unit census records Area Resource Files.05 <0. CMS Wage Rate File. CMS Wage Rate File.08 1. and the American Hospital Association Survey Survey of staff nurses.05 NS NS 1.000 patient days Unruh66 -1. LPN FTE/ number of occupied beds Patients/RN/shift Survey of RNs Survey of RNs Survey of RNs Survey of ICU directors AHA and HCFA data bases Survey of ICU directors Hospital Cost Report Information System. LPN FTE/ 1. Calculated change in hospital-related mortality corresponding to an increase by one patient/RN.12 <0. RR = Relative Risk .Table G2. American Hospital Association Annual Survey.83 1.05 <0. American Hospital Association Annual Survey.42 NS 1. Provider of Services files.05 RN.11 4.000 patient days RN.05 0.9 1.7 Increase by One Patient/LPN/Shift Death Rate p Value RR p Value p Value RR 1. LPN FTE/1.000 patient days RN.2 p Value NS <0.001 NS NS G-35 Mark89 1 NS NS Person88 Pronovost72 Pronovost61 Robertson62 Shortell94 Silber67 1.1 <0. NS = Not Significant.18 NS <0. LPN/shift (results from individual studies) Definition of Nurse to Patient Ratio Source to Measure Ratio Author Increase by One Patient/RN/Shift Death Rate RN/patient day Patients/RN/shift Patients/RN/shift Patients/RN/shift Nurse/patient day Patients/RN/shift RN. survey of nursing directors in each unit AHA Annual Surveys for 1991– 1993.05 NS Patients/RN/shift 1.05 Halm51 Mark90 0.06 1.

199961 The Uniform Hospital Health Discharge Data Set In-hospital mortality Amaravadi. 11-13% emergency admissions. Source to Measure Mortality. % of Emergency Admissions Mean age 68 years. Units: ICU Patients: surgical 32 hospitals Units: ICU Patients: surgical Age % Whites 63 77 60 83 60 83 63 77 Units: ICU Patients: surgical Age % Whites 56 82 57 67 Nurse Staffing Categories Mortality More nurses: RN/patient 1:1 or 1:2 (7 hospitals) Fewer nurses: RN/patient 1:3 or 1:4 (31 hospitals) Decreased nurse to patient ratio in evening (7 hospitals) Nurse to patient ratio >1:2 in evening (31 hospitals) Crude rate % ± SD 7 ± 26 8 ± 36 Relative risk (95% CI) 1. 200064 The Uniform Health Discharge Data Set In-hospital mortality Source to Measure Nurse Staffing. 200170 The Uniform Health Discharge Data Se In-hospital mortality Survey of ICU directors.3.29) .2. Evidence of the association between nurse staffing and mortality Author. An average nurse-topatient ratio during the day and at night Number of Hospitals. An average ICU nurse-to-patient ratio during the day and evening Survey of intensive care unit directors. % of Whites. Definition of Mortality Pronovost.9 (1.1.18. 3) Reference G-36 Males 70 79 79 70 Night time nurse to patient ratio >1:2 Night time nurse to patient ratio <1:2 Night time nurse to patient ratio >1:2 Night time nurse to patient ratio <1:2 Relative Risk (95% CI) 0.7 (0. 89% whites.2) Reference Crude rate % 5. Patient Age.49 (0.6 15 Dimick. 200172 The Uniform Health Discharge Data Set In-hospital mortality from all causes Pronovost. % of Males. 89% whites. 66% males. An average nurse to patient ratio in day and in evening. Definition of Nurse Staffing Survey to the ICU directors. Units: ICU Patients: surgical Mean age 68 years. 66% males. An average nurse-topatient ratio in the ICU during the day and evening and at night Males 51 55 More nurses: RN/patient 1:1-1:2 (8 hospitals) Fewer nurses: RN/patient 1:3-1:4 (25 hospitals) Relative risk (95% CI) Reference 0. decreased nurse to patient ratio in evening Survey of ICU directors. Units. 11-13% emergency admissions.Table G3.

unexpected. Units. Definition of Mortality Blegen.7. Patient Age.59 1. 199859 Hospital records Death rates per 1.43 0. or do not resuscitate. sick leave.03 0. whether expected.53 0.5% Increase by 1 hour in total nursing hours Mean nurse staffing Total nursing hours 10. The hours of care per patient day from all nursing personnel: Hours of direct patient care by RNs.000 patient days. were included Source to Measure Nurse Staffing. Source to Measure Mortality.41 1 1 1 1. % of Emergency Admissions Single hospital study. 42 units Nurse Staffing Categories Mortality Increase by 1% in proportion of RN nurses Proportion of RN >87.9 0. Evidence of the association between nurse staffing and mortality (continued) Author. procedurerelated. % of Males. RN hours 7. 19995 Medical charts of consecutively admitted patients Mortality within 30 days from admission Hospitals Units 20 40 5 8 5 8 5 8 20 40 Age % Whites Males 37 47 88 39 29 77 37 45 87 Increase by 1 RN/patient Dedicated AIDS units AIDS hospital-scattered bed units Conventional scattered bed units Nurse control over practice setting Increase by 1 RN/patient Dedicated AIDS units AIDS hospital-scattered bed units Relative risk (95% CI) 0.64 0.13 . The hours of direct patient care from RNs divided by patient days excluding hours for non patient care (meetings. Definition of Nurse Staffing A record of hours worked for each individual employee was completed by the staffing clerk and approved by the employee and nurse manager before being entered into the computerized payroll database.24 0.02 ± 0. LPNs. vacation. and holidays) Survey of all registered and licensed practical nurses who worked at least 16 hours per week The average number of nurses per patient day (self-reported) Nurse autonomy: nurse control over the practice environment across hospital units (Clinical Environment Index) Number of Hospitals. All deaths.34 1.14 ± 0.7 Changes in death rate/100 patient days -0.06 0.78 1.Table G3.94 1.06 G-37 Aiken.69 0. and nursing assistants each month divided by the patient days of care on the unit for the month. % of Whites.07 Death Rate 0.36 ± 1.

highest credential in nursing: a hospital school diploma. Patient Age.91 1. % of Males.2 2.06 0. the mean number of years of experience working as an RN for nurses from each hospital Number of Hospitals.38 1. 6 patients/nurse 20% of hospital workforce with BSN or higher. 4 patients/nurse 20% of hospital workforce with BSN or higher. 8 patients/nurse >50% of hospital workforce with BSN or higher 40-49% of hospital workforce with BSN or higher 30-39% of hospital workforce with BSN or higher 40% of hospital workforce with BSN or higher 60% of hospital workforce with BSN or higher.9 1.95 1.Table G3. or another degree.3 2. an associate degree. Source to Measure Mortality. % of Emergency Admissions Units: ICU Patients: surgical Nurse Staffing Categories Mortality Increase by 1 year in nurse experience Increase in workload of 1 patient 10% increase in nurses with BSN degree 40% of hospital workforce with BSN or higher. a master's degree. a bachelor's degree. Definition of Nurse Staffing Surveys of hospital nurses (the Pennsylvania Board of Nursing ) The mean number of patients assigned to all staff nurses who reported caring for at least 1 but fewer than 20 patients on the last shift they worked.98 2. 8 patients/day Relative risk (95% CI) 1 0.8 2. Units. 4 patients/nurse 20-29% of hospital workforce with BSN or higher <20% of hospital workforce with BSN or higher 20% of hospital workforce with BSN or higher.17 1. 4 patients/nurse 60% of hospital workforce with BSN or higher. 6 patients/nurse 40% of hospital workforce with BSN or higher.99 Mortality rate/100 patients 1.7 1.8 1.97 1.98 G-38 Hospitals 53 34 168 19 26 36 .8 1.98 1. 200339 Discharge abstracts Deaths within 30 days of hospital admission Source to Measure Nurse Staffing. % of Whites.01 0. Evidence of the association between nurse staffing and mortality (continued) Author. Definition of Mortality Aiken.64 2. 6 patients/nurse 60% of hospital workforce with BSN or higher.1 0.02 1.16 1.

02 0.5 17. ratio of RNs to LPNs Number of Hospitals.48 1.91 0. % of Males.4 20. Source to Measure Mortality.12 1.86 0.1 22.Table G3.19 1.07 1 1.5 1. Patient Age.9 1 1.5 17. % of Whites. Definition of Nurse Staffing Survey of 50% random sample of registered nurses who were on the Pennsylvania Board of Nursing rolls.09 0.8 Relative Risk (95% CI) 1 1 1 1 1 1 1 0.401 Age % Whites Males 77 90 50 Mortality Rate Skill Mix: % of RN 1 quartile of LPN staffing 1 quartile of LPN staffing 1 quartile of RN staffing 1 quartile of RN staffing 2 quartiles of LPN staffing 2 quartiles of LPN staffing 2 quartiles of RN staffing 2 quartiles of RN staffing 3 quartiles of LPN staffing 3 quartiles of LPN staffing 3 quartiles of RN staffing 3 quartiles of RN staffing 4 quartiles of LPN staffing 4 quartiles of LPN staffing 4 quartiles of RN staffing 4 quartiles of RN staffing 1 quartile of LPN staffing 1 quartile of RN staffing 2 quartiles of LPN staffing 2 quartiles of RN staffing 3 quartiles of LPN staffing 3 quartiles of RN staffing 4 quartiles of LPN staffing 4 quartiles of RN staffing 23. % of Emergency Admissions Patients Surgical Hospitals 168 % males 44 Mean age 44 years Nurse Staffing Categories Mortality Increase by 6 patients/nurse Increase by 1 patient/nurse Increase by 8 patients/nurse Increase by 4 patients/nurse Relative risk (95% CI) 1.1 17.96 0.07 1. Units. Evidence of the association between nurse staffing and mortality (continued) Author.03 1.94 1.9 21.97 G-39 .9 20 20. Definition of Mortality Aiken.07 0.3 17. Burnout: the Emotional Exhaustion scale of the Maslach Burnout Inventory Scale Nurse’ job satisfaction: 4point scale from very dissatisfied to very satisfied AHA Survey The ratio of full-time equivalent RNs to average daily census (ADC) categorized by their respective quartiles of nurse to ADC ratio.88 1 1. 2004 Medicare database In-hospital mortality and within 30 days of hospital admission 88 Hospitals 4.6 20.31 1.9 20.94 0.96 1.7 21.57 Person.27 2.6 18.72 1. the ratio of full-time equivalent licensed practical nurses (LPNs) to ADC categorized by their respective quartiles of nurse to ADC ratio. 200274 Hospital data (Health Care Cost Containment Council Death within 30 days of hospital admission Source to Measure Nurse Staffing.1 23.15 0.13 1.97 1.2 18.

Patient Age. Source to Measure Mortality.01 1. in-hospital mortality 0.01 1. Evidence of the association between nurse staffing and mortality (continued) Author.00 1.67 1.99 0.00 0.04 1.35 1. nurse practitioner excluding nursing directors. Licensed hours/patient-day NIW adjusted LPN/LVN.09 1. clinical nurse specialists. excluding the director of nursing.00 0.99 0.99 0.01 1.01 0. anesthetists.156 hospitals Nurse Staffing Categories Mortality 1% increase in RN overtime work 1 hour increase in RN hours/acute patient day 1% increase in RN hours/total licensed hours 1st (low overtime) quartile 4th (high overtime) quartile 1% increase in RN overtime work 1st (low overtime) quartile 4th (high overtime) quartile Increase by 1 hour of RN hours in medical patients Increase by 1 hour in RN hours in surgical patients Increase by 1 hour in LPN hours in medical patients Increase by 1 hour in LPN hours in surgical patients Increase by 1 hour in aide hours in medical patients Increase by 1 hour in aide hours in surgical patients Increase by 1 hour in total nursing hours in medical patients Increase by 1 hour in total nursing hours in surgical patients Increase by 1% in RN/total nursing hours in medical patients Increase by 1% in RN/total nursing hours in surgical patients Increase by 1 hour in licensed hours/patient-day in medical patients Increase by 1% of RN hours/total licensed hours per patient day in medical patients Increase by 1 hour in licensed hours/patient-day in surgical patients Increase by 1% in RN hours/total Relative risk (95% CI) 0.90 0.68 0.99 0. 200384 The New York Statewide Planning and Research Cooperative System In-hospital mortality Source to Measure Nurse Staffing.74 1.01 1.00 0. 200128 799 hospitals (11 states.00 1. % of Whites.98 Needleman.87 0.00 0. instructors.04 1. % of Males.97 0.98 0.99 0. Definition of Nurse Staffing The New York State Institutional Cost Reports RN total hours in inpatient cost units/patient-days in units adjusted for nursing acuity.00 1. Units.00 0. general duty nurses.00 0.99 0. Total nursing hours/patient-day NIW adjusted.99 1. National sample of 3. supervisors.00 1.00 1. Union: RN are represented by unions as reported in ICR State hospital financial reports or hospital staffing surveys.99 0.98 1.99 0. all-patients + Medicare patients) – hospital level analysis.01 1. excluding Number of Hospitals.00 1.99 0.02 1.99 1. RN acute hours/ (RN+LPN acute hours). the American Hospital Association Annual Survey of hospitals (2. orderlies and attendants.05 1.07 1.00 1.080 hours * each FTE category) + (1. Definition of Mortality Berney. LPN/LVN hours/patientday NIW adjusted Nursing aides.09 G-40 1.98 1. RN hours/patient day NIW adjusted. 256 California hospitals (part of the 11 state sample) – unit level analysis.00 1.357 hospitals (Medicare patients) –hospital level analysis.98 1.00 Relative risk (95% CI) 1.00 0.96 1.00 1.47 .97 0.01 1. % of total RN hours paid as overtime hours.71 0.00 1.99 0. managers. RNs.01 1.00 1.040 hours * number of part-time employees). administrators.Table G3.96 1.03 1.01 1. % of Emergency Admissions Hospitals: 161 Surgical Medical Surgical Medical Medical Medical Surgical Surgical 4. and midwifes.95 0.

RN hours/licensed hours = RN hours per day/licensed hours per day (RN + LPN) Number of Hospitals.98 1. hospital level analysis.01 1.48 0.98 1. Units.00 0.00 0.02 0. California hospitals Increase by 1 hour in aide hours in medical patients.01 1.00 1.Table G3.00 0.88 1.75 0. Evidence of the association between nurse staffing and mortality (continued) Author.01 1.00 0. Source to Measure Mortality.00 1.98 0.84 1.02 1.00 1.01 1.00 0. California hospitals Increase by 1 hour in LPN hours in medical patients.99 0. hospital level analysis.71 1. California hospitals Increase by 1 hour in total nursing 1.03 1. Definition of Mortality Source to Measure Nurse Staffing.99 1. Patient Age.00 1.98 0.00 0.70 0.99 G-41 0. Definition of Nurse Staffing ward clerks.03 1.89 1.08 1.00 1. % of Males.00 1.01 1.01 0.81 0.95 1.02 1.87 0. % of Emergency Admissions Nurse Staffing Categories Mortality licensed hours per patient-day in surgical patients Increase by 1 hour in RN hours in medical patients Increase by 1 hour in LPN hours in medical patients Increase by 1 hour in licensed hours in medical patients Increase by 1% in RN hours/total licensed hours in medical patients Incr