Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association

The impact of nurses on patient morbidity and mortality – the need for a policy change in response to the nursing shortage

Di Twigg A B , Christine Duffield C H , Peter L. Thompson D E F and Pat Rapley B G
+ Author Affiliations
- Author Affiliations

A School of Nursing, Midwifery and Postgraduate Medicine, Edith Cowan University, Joondalup, WA 6027, Australia.

B Centre for Nursing Research, Innovation and Quality, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia.

C Centre for Health Services Management, Faculty of Nursing, Midwifery and Health, and World Health Organization Collaborating Centre for Nursing, Midwifery and Health Development (WHO CC), University of Technology, Sydney, Ultimo, NSW 2007, Australia.

D School of Medicine and Pharmacology, The University of Western Australia, Crawley, WA 6009, Australia.

E West Australian Institute of Medical Research (WAIMR), Nedlands Campus, QEII Medical Centre, Nedlands, WA 6009, Australia.

F Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia.

G School of Nursing and Midwifery, Curtin University of Technology, Bentley, WA 6102, Australia.

H Corresponding author. Email:

Australian Health Review 34(3) 312-316
Submitted: 24 July 2008  Accepted: 18 November 2009   Published: 25 August 2010


Context. Workforce projections indicate that by 2012 there will be a shortfall of 61 000 registered nurses in Australia. There is a growing body of evidence that links registered nurse staffing to better patient outcomes.

Purpose. This article provides a comprehensive review of the research linking nurse staffing to patient outcomes at a time of growing shortages, highlighting that a policy response based on substituting registered nurses with lower skilled workers may have adverse effects on patient outcomes.

Method. An electronic search of articles published in English using the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Journals @ OVID and Medline was undertaken.

Findings. Robust evidence exists nationally and internationally that links nurse staffing to patient outcomes. Recent meta-analyses have found that there was a 3–12% reduction in adverse outcomes and a 16% reduction in the risk of mortality in surgical patients with higher registered nurse staffing. Evidence confirms that improvements in nurse staffing is a cost-effective investment for the health system but this is not fully appreciated by health policy advisors.

Conclusions. An appropriate policy response demands that the evidence that patient safety is linked to nurse staffing be recognised. Policy makers must ensure there are sufficient registered nurses to guarantee patient safety.

What is known about the topic? Projections indicate that by 2012 there will be an estimated shortfall of 61 000 registered nurses in Australia. However, research demonstrates the number of registered nurses caring for patients is critically important to prevent adverse patient outcomes. Evidence also confirms that improvements in nurse staffing is a cost-effective investment for the health system.

What this paper adds? The paper exposes the lack of an appropriate policy response to the evidence in regard to nurse staffing and patient outcomes. It argues that patient safety must be recognised as a shared responsibility between policy makers and the nursing profession.

What are the implications for practitioners? Policy makers, health departments, Chief Executives and Nurse Leaders need to ensure that adequate nurse staffing includes a high proportion of registered nurses to prevent adverse patient outcomes.


Prof D. Twigg was awarded the Western Australian Nurses Memorial Charitable Trust Grant of AU$19 613.


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