Acute care nursing staff shortages that compromise patient-to-nurse ratios: A Making Healthcare Safer rapid response review

Background The purpose of this review is to summarize the most relevant recent literature on patient safety practices focused on addressing acute care nursing staff shortages. Methods We followed the Evidence-based Practice Center Program's rapid response processes. We searched PubMed, CINAHL, and Cochrane for systematic reviews and original studies meeting specified inclusion criteria from January 2013 to October 2024. Results Our search identified six reviews and 16 primary studies. Our review found many approaches to addressing nursing shortages in acute care, but most studies were observational. The interventions ranged from individual staff support (e.g. training, incentives) and scheduling changes, to staffing level adjustments (e.g. acuity-based staffing), organizational changes (e.g. care models), and government policies (e.g. mandated ratios), as well as COVID-19-specific measures. Mandated staffing ratios were associated with positive patient and nurse outcomes. Patient acuity tools showed mixed results; some studies found improvements, while others did not. Conclusions While some nursing staff interventions show promise, inconsistent implementation and a lack of robust research limit our understanding of best practices. Strong studies are needed to test effective, comprehensive strategies for addressing nursing shortages.