Table 2

Staffing, patient, organisational or environmental factors and nurse staffing requirements

StudyCountryDesignNumber of EDsComparisonsOutcomeKey resultsPatients seenInternal validityExternal validity
Green et al19USAProspective Observational1Workload as defined by nurse-patient ratiosStaff absenteeismFailure to incorporate absenteeism as an endogenous effect results in understaffing. Nurse absenteeism is exacerbated when fewer nurses are scheduled for a particular shift. No quantitative results were reportedNot stated
Harris and Sharma21AusRetrospective Observational38Annual average of nurses, physicians and beds at hospital levelPatient care time in the EDA 1% change in the mean number of nurses (from 998 to 1008) is associated with a 2.38% fall in waiting time (from 396 min to 3871/49 min) assuming all other variables remain at their mean values.Not stated+
Hobgood et al20USAProspective Observational1Workload
(nurse-patient ratio ED acuity index)
Task allocationRNs spent 25.6% of their time performing direct patient care; 48.4% on indirect patient care; 6.8% on non-RN care and 19.1% on personal time.
The correlation between the ED acuity index and the patient-to-nurse ratio was 0.98.
60 000
Sinclair et al18UKBefore and after2Prior to and following the introduction of a specialist psychiatric nursing serviceWaiting times
Onward referral
Repeat attendance
Patient satisfaction
Staff views
Average waiting times at each hospital shortest during the intervention period. No significant differences between preintervention and intervention periods at either site (hospital 1, p=0.763; hospital 2, p=0.076). Significant difference in onward referral patterns between intervention and non-intervention periods of the study at both sites (hospital 1, χ2=28.8, p=0.001; hospital 2, χ2=25.3, p=0.01). Levels of satisfaction recorded were high for all patients with no significant differences between intervention and non- intervention periods.Dept: 1=55 000
Dept: 2=70 000
  • ED, emergency department.