Centers for Disease Control and Prevention
 CDC Home Search Health Topics A-Z
 CDC's Issues in Healthcare SettingsLink to DHQP Home PageLink to Issues in Healthcare Settings  Index
Main Topics
About DHQP
Antimicrobial
Resistance
Bloodborne
Pathogens
Child Care
Dialysis
Guidelines and
Recommendations
Infectious Diseases
Laboratory
Occupational Health
Outbreaks
Sterilization and Disinfection
Surveillance
Training

Nurse Staffing and Healthcare-Associated Infections:
A Review of the Literature
Compiled by Marguerite McMillan Jackson, PhD, RN, FAAN
December 2001


SELECTED REFERENCES

Page Index
Shortage of professional nurses
Overview of the problem
Nursing workforce now and in the future
Strategies for recruitment and retention of professional nurses

Health care system influences on nurse staffing and patient outcomes

Study Methods
Patient outcomes
Other

Studies of nurse staffing and patient outcomes
Infection
Morbidity/mortality
Other

Miscellaneous


Shortage of professional nurses

Overview of the problem

Aiken LH, Blendon RJ, Rogers DE. The shortage of hospital nurses: a new perspective. Ann Intern Med 1981;95:365-71.

Aiken LH. The nurse labor market. Am J Nurs 1983;83:1440-4.

Aiken LH. The hospital nursing shortage: a paradox of increasing supply and increasing vacancy rates. West J Med 1989;151:87-92.

Aiken LH, Sochalski J, Anderson GF. Downsizing the hospital nursing workforce. Health Aff (Millwood) 1996;15:88-92.

Buerhaus PI, Staiger DO, Auerbach DI. Implications of an aging registered nurse workforce. JAMA 2000;283:2948-54.

Buerhaus PI, Staiger DO, Auerbach DI. Associate degree graduates and the rapidly aging RN workforce. Nurs Econ 2000;18:178-84.

Buerhaus PI, Staiger DO, Auerbach DI. Why are shortages of hospital RNs concentrated in specialty care units? Nurs Econ 2000 (18) 111-6.

Staiger DO, Buerhaus PI, Auerbach DI. Expanding career opportunities for women and the declining interest in nursing as a career. Nurs Econ 2000;18:230-6.

Spetz J. Hospital employment of nursing personnel: has there really been a decline? J Nurs Adm 1998;28:20-7.

Top

Nursing workforce now and in the future

Aiken LH. Charting the future of hospital nursing. Image 1990;22:72-8.

Aiken LH, Salmon ME. Health care workforce priorities: what nursing should do now. Inquiry 1994;31:318-29.

Aiken LH, Gwyther ME, Friese CR. The registered nurse workforce: infrastructure for health care reform. Stat Bull Metrop Insur Co 1995;76:2-9.

Buerhaus PI, Staiger DO. Future of the nurse labor market according to health executives in high managed-care areas of the United States. Image 1997;29:313-8.

Geddes N, Salyer J, Mark BA. Nursing in the nineties: managing the uncertainty. J Nurs Adm 1999;29:40-8.

Jackson MM. The healthcare marketplace in the next millennium and nurses' roles in infection prevention and control. Nurs Clin North Am 1999;34:411-26.

Peterson CA. Nursing supply and demand: is the nursing profession facing a famine? Am J Nurs 1999;99:57-9.

Top

Strategies for recruitment and retention of professional nurses

Aiken L. Aiken calls for novel remedies to shortage. Calif Nurse 1989;85:10-1

American Nurses Association. Principles for nurse staffing. ANA: Washington, DC,
1999.

Buerhaus PI, Staiger DO, Auerbach DI. Policy responses to an aging registered nurse workforce. Nurs Econ 2000;18:278-303.

Hall LM. Staff mix models: complementary or substitution roles for nurses. Nurs Admin Quar 1997;21:31-9.

Havens DS, Aiken LH. Shaping systems to promote desired outcomes: the magnet hospital model. J Nurs Adm 1999;29:14-20. Erratum J Nurs Adm 1999;29:5.

McClure ML, Poulin MA, Sovie MD, Wandelt MA. Magnet hospitals: attraction and retention of professional nurses. Washington, DC: American Academy of Nursing, 1983.

Mills AC, Blaesing SL. A lesson from the last nursing shortage: the influence of work values on career satisfaction with nursing. J Nurs Adm 2000; 30(6):309-15.

Tonges MC, Rothstein H, Carter HK. Sources of satisfaction in hospital nursing practice: a guide to effective job design. J Nurs Adm 1998;28:47-61.

Top


Health care system influences on
nurse staffing and patient outcomes


Aiken LH, Smith HL, Lake ET. Lower Medicare mortality among a set of hospitals known for good nursing care. Med Care 1994;32:771-87.

Aiken LH, Sochalski J, Lake ET. Studying outcomes of organizational change in health services. Med Care 1997;35:NS6-NS18.

Aiken LH, Sloane DM, Sochalski J. Hospital organisation and outcomes. Qual Health Care 1998;7:222-6.

Aiken LH, Clark SP, Sloane DM. Hospital restructuring: does it adversely affect care and outcomes? J Nurs Adm 2000;30:447-65.

Aiken LH, Havens DS, Sloane DM. The Magnet Nursing Services Recognition Program: a comparison of two groups of magnet hospitals. Am J Nurs 2000;100:26-36.

Aiken, LH, Clarke SP, Sloane DM, Sochalski JA, Busse R, Clarke H, et al. Nurses' reports on hospital care in five countries. Health Aff (Millwood) 2001;20:43-53.

Bethel S, Ridder J. Evaluating nursing practice: satisfaction at what cost? Nurs Manage 1994;24:41-8.

Bloom JR, Alexander J, Nuchols BA. Nurse staffing patterns and hospital efficiency in the United States. Social Sci Med 1997;44:147-55.

Brewer CS, Frazier P. The influence of structure, staff type, and managed-care indicators on registered nurse staffing. J Nurs Adm 1998;28:28-36.

Buerhaus PI, Staiger DO. Managed care and the nurse workforce. JAMA 1996;276:1487-93.

Corey-Lisle P, Tarzian AJ, Cohen MZ, Trinkoff AM. Healthcare reform: its effects on nurses. J Nurs Adm 1999;29:30-7.

Ingersoll GL, Cook J-A, Fogel S, Applegate M, Frank B. The effect of patient-focused redesign on midlevel nurse managers' role responsibilities and work environment. J Nurs Adm 1999;29:21-7.

Institute of Medicine. Nursing staff in hospitals and nursing homes: is it adequate? National Academy Press, Washington, DC, 1996.

Li J, Birkhead GS, Strogatz DS, et al. Impact of institution size, staffing patterns, and infection control practices on communicable disease outbreaks in New York State nursing homes. Am J Epidemiol 1996;143:1042-9.

Sochalski J, Aiken LH. Accounting for variation in hospital outcomes: a cross-national study. Health Aff 1999;18:256-9.

Sovie MD, Jawad AF. Hospital restructuring and its impact on outcomes: nursing staff regulations are premature. J Nurs Adm 2001;31:588-600.

Van Servellen G, Schultz MA. Demystifying the influence of hospital characteristics on inpatient mortality rates. J Nurs Adm 1999;29:39-47.

Top


Study methods

Patient outcomes

American Nurses Association. Nursing quality indicators: definitions and implications. ANA: Washington, DC, 1996.

Cho S-H. Nurse staffing and adverse patient outcomes: a systems approach. Nurs Outlook 2001;49:780-5.

Larson E, Oram LF, Hedrick E. Nosocomial infection rates as an indicator of quality. Med Care 1988;26:676-84.

Maas ML, Johnson M, Moorhead S. Classifying nursing-sensitive patient outcomes. Image 1996;28:295-301.

Mark BA, Burleson DL. Measurement of patient outcomes: data availability and consistency across hospitals. J Nurs Adm 1995;25:52-9.

Minnich AF, Pabst MK. Improving the ability to detect the impact of labor on patient outcomes. J Nurs Adm 1998;28:17-21.

Reed L, Blegen MA, Goode CS. Adverse patient occurrences as a measure of nursing care quality. J Nurs Adm 1998;28:62-9.

Sochalski J, Aiken LH, Fagin CM. Hospital restructuring in the United States, Canada, and Western Europe: an outcomes research agenda. Med Care 1997;35:OS13-OS25.

Pierce SF. Nurse-sensitive health care outcomes in acute care settings: an integrative analysis of the literature. Care Qual 1997;11:60-72.

Price J, Ekleberry A, Grover A, Melendy S, Baddam K, McMahon J, et al. Evaluation of clinical practice guidelines on outcome of infection in patients in the surgical intensive care unit. Crit Care Med 1999;27:2118-24.

Top

Other

Aiken LH, Fagin CM. Evaluating the consequences of hospital restructuring. Med Care 1997;35:0S1-0S4.

Aiken LH, Sochalski J, Lake ET. Studying outcomes of organizational change in health services. Med Care 1997;35:NS6-NS18.

Scott JG, Sochalski J, Aiken LH. Review of magnet hospital research: findings and implications for professional nursing practice. J Nurs Adm 1999;29:9-19.

Top

Studies of nurse staffing and patient outcomes

Infection

Archibald LK, Manning ML, Bell LM, Banerjee SN, Jarvis WR. Patient density, nurse-to-patient ratio and nosocomial infection risk in a pediatric cardiac intensive care unit. Pediatr Infect Dis J 1997;16:1045-8.

Arnow PM, Allyn PA, Nichols EM, Hill DL, Pezzlo M, Bartlett RH. Control of methicillin-resistant Staphylococcus aureus in a burn unit: role of nurse staffing. J Trauma 1982;22:954-9.

Blegen MA, Goode CJ, Reed L. Nurse staffing and patient outcomes. Nurs Res 1998;47:43-50.

Farrington M., Trundle C, Redpath C, Anderson L. Effects on nursing workload of different methicillin-resistant Staphylococcus aureus (MRSA) control strategies. J Hosp Infect 2000;46:118-23.

Fridkin SK, Pear SM, Williamson TH, Galgiani JN, Jarvis WR. The role of understaffing in central venous catheter-associated bloodstream infections. Infect Control Hosp Epidemiol 1996;17:147-9.

Goldman DA, Durbin WA Jr, Freeman J. Nosocomial infections in a neonatal intensive care unit. J Infect Dis 1981;144:449-59.

Haley RW, Bregman DA. The role of understaffing and overcrowding in recurrent outbreaks of staphylococcal infections in neonatal special-care units. J Infect Dis 1982;145:875-85.

Haley RW, Cushion NB, Tenover FC, Bannerman TL, Dryer D, Ross J, et al. Eradication of endemic methicillin-resistant Staphylococcus aureus infections from a neonatal intensive care unit. J Infect Dis 1995;171:614-24.

Haley RW, Hightower AW, Khabbaz RF, Thornsberry C, Martone WJ, Allen JR, et al. The emergence of methicillin-resistance Staphylococcus aureus infections in United States hospitals: possible role of the house staff-patient transfer circuit. Ann Intern Med 1982;97:297-308.

Harbarth S, Sudre P, Dharan S, Cadenas S, Pittet D. Outbreak of Enterobacter cloacae related to understaffing, overcrowding, and poor hygiene practices. Infect Control Hosp Epidemiol 1999;20:598-603.

Isaacs D, Catterson J, Hope PL, Moxon ER, Wilkinson AR. Factors influencing colonisation with gentamicin resistant gram negative organisms in the neonatal unit. Arch Dis Child 1988;63:533-5.

Kovner C, Gergen P. Nurse staffing levels and adverse events following surgery in U.S. hospitals. Image 1998;30:315-21.

Robert J, Fridkin SK, Blumberg HM, Anderson B, White N, Ray SM, et al. The influence and composition of the nursing staff on primary bloodstream rates in surgical intensive care unit. Infect Control Hosp Epidemiol 2000;21:12-7.

Moisiuk SE, Robson D, Klass L, Kliewer G, Wasyliuk W, Davi M, et al. Outbreak of parainfluenza virus type 3 in an intermediate care nursery. Pediatr Infect Dis J 1998;17:49-53.

Vicca AF. Nursing staff workload as a determinant of methicillin-resistant Staphylococcus aureus spread in an adult intensive therapy unit. J Hosp Infect 1999;43:109-13.

Top

Morbidity/mortality

Flood SD, Diers D. Nurse staffing, patient outcome and cost. Nursing Management 1988;19(5):34-43.

Giraud T, Dhainaut J, Vaxelaire J, Joseph T, Journois D, Bleichner G, et al. Iatrogenic complication in adult intensive care units: a prospective two-center study. Crit Care Med 1993;21:40-51.

Gittell JH, Fairfield KM, Bierbaum B, Head W, Jackson R, Kelly M, et al. Impact of relational coordination on quality of care, postoperative pain and functioning, and length of stay: a nine-hospital study of surgical patients. Med Care 2000;38:807-19.

Tarnow-Mordi WO, Hau C, Warden A, Shearer AJ. Hospital mortality in relation to staff workload: a 4-year study in an adult intensive care unit. Lancet 2000;356:185-9.

Silber JH, Williams SV, Krakauer H, Schwartz JS. Hospital and patient characteristics associated with death after surgery: a study of adverse occurrence and failure to rescue. Med Care 1992;30:615-29.

Top

Other

American Nurses Association. Implementing nursing's report card: a study of RN staffing, length of stay and patient outcomes. American Nurses Publishing: Washington, DC, 1998.

American Nurses Association. Nurse staffing and patient outcomes in the inpatient hospital setting. ANA: Washington, DC, 2000.
Blegen MA, Vaughn T. A multisite study of nurse staffing and patient occurrences. Nurs Econ 1998;16(4):196-203.

Hunt J, Hagen S. Nurse to patient ratios and patient outcomes. Nurs Times 1998 (Nov 11-17);94(45):63-6.

McCloskey JM. Nurse staffing and patient outcomes. Nurs Outlook 1998;46(5):199-200.

Needleman J, Buerhaus PI, Mattke S, Stewart M, Zelevinsky K. Nurse Staffing and Patient Outcomes in Hospitals. Final Report: US Department of Health and Human Services, Health Resources and Services Administration, Contract No. 230-99-0021. February 28, 2001.

Rowell PA, Milholland DK. Nursing and threats to patient and nurse safety and quality of patient care. J Nurs Care Qual 1998;12:9-13.

Top

Miscellaneous

American Nurses Association. Nursing care report card for acute care. ANA: Washington, DC, 1995.

American Nurses Association. Implementing nursing's report card. ANA: Washington, DC, 1997.

Goldrich BA, Turner JG. Education and behavior change in prevention and control of infection. IN: Soule BM, Larson EL, Preston GA (eds). Infections and nursing practice: prevention and control. St. Louis: CV Mosby, 1995, 175-92.

Jackson MM, Massanari RM. Reengineering and infection control programs: commentary and a case study. Am J Infect Control 2000.28:44-50.

Kramer M, Hafner LP. Shared values: impact on staff nurse job satisfaction and perceived productivity. Nurs Res 1989;38:172-7.

Kupperschmidt BR. Understanding generation X employees. J Nurs Adm 1998;28(12):36-43.

Mitchell PH, Shortell SM. Adverse outcomes and variations of care delivery. Med Care 1997;35:NS19-NS32.

O'Boyle CA, Henly SJ, Larson E. Understanding adherence to hand hygiene recommendations: the theory of learned behavior. Am J Infect Control 2001;29:352-60.

Pettinger A, Nettleman M. Epidemiology of isolation precautions. Infect Control Hosp Epidemiol 1991;12:303-7.

Pittet D, Mourouga P, Perneger T, & members of the infection control program. Compliance with handwashing in a teaching hospital. Ann Intern Med 1999;130:126-30.

Rothschild JS. What's happening to patient care? Final results of the AJN Survey. Am J Nurs 1996;11:24-39.

Top

 


DHQP Home | DHQP Index

NCID Home
| CDC Home | CDC Search | CDC Health Topics A-Z
This page last reviewed June 7, 2002

Division of Healthcare Quality Promotion
National Center for Infectious Diseases
Centers for Disease Control and Prevention

Privacy Policy | Accessibility