Hospital nurse staffing and patient outcomes in Chile
Authors: Motoi Miura, Tetsuya Tanimoto
Journal: The Lancet Global Health (2021)

Linda Aiken and colleagues (August, 2021)1Aiken LH Simonetti M Soane MD et al.Hospital nurse staffing and patient outcomes in Chile: a multilevel cross-sectional study.Lancet Glob Health. 2021; 9: e1145-e1153Summary Full Text Full Text PDF PubMed Scopus (11) Google Scholar studied the relation between nurse staffing and work environment and several clinical indicators, and they concluded that improved hospital nurse staffing in Chile was associated with better outcomes, such as lower 30-day hospitalisation mortality. Although this study is very important for providing quality nursing care, the generalisability of the results might be limited by several points. First, most of the nurses included in the study were relatively inexperienced, at a mean age of 31·7 years. Previous research has indicated that productivity and quality of care can increase with experience. For example, a previous study done in nurses in South Korea showed that productivity increased with the age of nurses (β=0·32, p<0·001).2Park E Lee HY Park CS Association between sleep quality and nurse productivity among Korean clinical nurses.J Nurs Manag. 2018; 26: 1051-1058Crossref PubMed Scopus (47) Google Scholar Additionally, a study done in 2439 American nurses that examined the relation between strong professional nursing values and years of experience (by use of a scoring system), significantly better scores were observed in nurses with more than 10 years of experience compared with those with 2–5 years of experience (mean difference 2·18, 95% CI 0·45–3·92, p=0·01).3Monroe HA Nurses’ professional values: influences of experience and ethics education.J Clin Nurs. 2019; 28: 2009-2019Crossref PubMed Scopus (18) Google Scholar Therefore, it is unclear whether results similar to those of Aiken and colleagues’ study would be obtained among more experienced or older nurses. Second, the data used in the study were limited to patients in hospitals participating in the Diagnosis Related Group system, meaning those in an acute phase of their condition and treated with a short hospitalisation period. Several previous studies have suggested that the association between nurse staffing and mortality might not be applicable to specific patients in chronic care hospitals. For example, according to a study using data from 6386 nursing home admissions registered with the National Nursing Home Survey, no significant relationship was found between mortality and registered and licensed practical nurse staffing among patients who had been hospitalised for more than 60 days.4Decker FH Nursing staff and the outcomes of nursing home stays.Med Care. 2006; 44: 812-821Crossref PubMed Scopus (34) Google Scholar TT reports receiving personal fees from Bionics and Medical Network Systems, outside the submitted work. MM declares no competing interests. Hospital nurse staffing and patient outcomes in Chile – Author's replyWe thank Motoi Miura and Tetsuya Tanimoto for their interest in our study. The intent of our Article on hospital nurse staffing and patient outcomes was to provide evidence that could inform acute hospital nurse workforce policies in Chile.1 Our study had a rigorous design that included most large complex acute public hospitals, outcomes of 762 000 of their patients, and reports from 1652 direct care nurses practising in these same hospitals. Our large sample of hospitals, patients, and nurses is representative of complex, acute general hospitals in Chile. Full-Text PDF Open AccessHospital nurse staffing and patient outcomes in Chile: a multilevel cross-sectional studyImproved hospital nurse staffing in Chile was associated with lower inpatient mortality, higher patient satisfaction, fewer readmissions, and shorter hospital stays, suggesting that greater investments in nurses could return higher quality of care and greater value. Full-Text PDF Open Access