Evaluating nursing hours per patient day as a nurse staffing measure

AIMS: To identify the techniques used to measure nurse staffing and to evaluate the reliability, validity and limitations of nursing hours per patient day (NHPPD). BACKGROUND: Numerous studies have attempted to identify appropriate nurse staffing levels; however, variations in nurse staffing measures may have caused inconsistent findings regarding the relationships between nurse staffing and quality of care. EVALUATION: Seventeen studies using nurse staffing measures were reviewed. KEY ISSUES: Six common nurse staffing measures were identified: nurse-to-patient ratios, full-time equivalents, NHPPD, skill mix, nurse-perceived staffing adequacy and nurse-reported number of assigned patients. CONCLUSIONS: Among nurse staffing measures, NHPPD is the most frequently used and is considered to be highly beneficial. This measure shows some evidence of high inter-rater reliability. The predictive validity of NHPPD for patient falls is high, whereas that for pressure ulcers is low. IMPLICATIONS FOR NURSING MANAGEMENT: For NHPPD to be applied more effectively as a nurse staffing measure, there is a need for additional reliability testing in various types of units with large sample sizes; further validity research for additional patient outcomes; appropriate adjustments in its application to capture variations in the characteristics of nurses, patients and hospital units; and a consistent data collection procedure.