Open Access Highly Accessed Open Badges Research article

The association between nurse staffing and hospital outcomes in injured patients

Laurent G Glance1*, Andrew W Dick2, Turner M Osler3, Dana B Mukamel4, Yue Li5 and Patricia W Stone6

Author affiliations

1 Departments of Anesthesiology, and Community and Preventive Medicine, University of Rochester School of Medicine, Rochester, NY, USA

2 RAND, RAND Health, Boston, MA, USA

3 Department of Surgery, University of Vermont Medical College, Burlington, VT, USA

4 Department of Medicine, Center for Health Policy Research, University of California, Irvine, CA, USA

5 University of Iowa, Iowa, IA, USA

6 Center for Health Policy, Columbia University School of Nursing, New York, NY, USA

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Citation and License

BMC Health Services Research 2012, 12:247  doi:10.1186/1472-6963-12-247

Published: 9 August 2012



The enormous fiscal pressures facing trauma centers may lead trauma centers to reduce nurse staffing and to make increased use of less expensive and less skilled personnel. The impact of nurse staffing and skill mix on trauma outcomes has not been previously reported. The goal of this study was to examine whether nurse staffing levels and nursing skill mix are associated with trauma patient outcomes.


We used data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample to perform a cross-sectional study of 70,142 patients admitted to 77 Level I and Level II centers. Logistic regression models were used to examine the association between nurse staffing measures and (1) mortality, (2) healthcare associated infections (HAI), and (3) failure-to-rescue. We controlled for patient risk factors (age, gender, injury severity, mechanism of injury, comorbidities) and hospital structural characteristics (trauma center status - Level I versus Level II, hospital size, ownership, teaching status, technology level, and geographic region).


A 1% increase in the ratio of licensed practical nurse (LPN) to total nursing time was associated with a 4% increase in the odds of mortality (adj OR 1.04; 95% CI: 1.02-1.06; pā€‰=ā€‰0.001) and a 6% increase in the odds of sepsis (adj OR 1.06: 1.03-1.10; pā€‰<ā€‰0.001). Hospitals in the highest quartile of LPN staffing had 3 excess deaths (95% CI: 1.2, 5.1) and 5 more episodes of sepsis (95% CI: 2.3, 7.6) per 1000 patients compared to hospitals in the lower quartile of LPN staffing.


Higher hospital LPN staffing levels are independently associated with slightly higher rates of mortality and sepsis in trauma patients admitted to Level I or Level II trauma centers.