# Understanding the relationship between nurse staffing and outcomes: impact of individual nurse education, expertise, and effort level on individual patient outcomes

> **NIH VA I01** · VETERANS ADMIN PALO ALTO HEALTH CARE SYS · 2024 · —

## Abstract

Background: There is a growing body of evidence that nurse staffing (nurse to patient ratio, adjusted
for patient acuity/need for nursing care) and characteristics of the nurse such as experience,
education level, tenure working on specific unit, affects patient outcomes. Except for a few smaller,
single site studies, these investigations have not matched patients with the nurses that directly cared
for them during each shift. Previous studies have only been able to produce limited
recommendations, such as suggested minimum staffing ratios or to increase the percentage of RNs
with baccalaureate degrees. Virtually nothing is known about how individual nurse-patient
assignments impact patient outcomes, thus precluding us from developing smart staffing approaches
tailored to the needs of each patient.
Significance: Match individual patients to the nurses who directly cared for them each shift to
address the current gap in the understanding of how individual nurse-patient assignments affect
patient outcomes. Controlling for other factors known to affect the relationship between nurse staffing
and patient outcomes such as patient acuity and unit- and hospital-level characteristics.
Innovation and Impact: This innovative project will be the first large-scale study of the effects of
nurse staffing that links nurses to patients. It will provide the information needed for VA to effectively
utilize the nurse staffing tools in the Clarvia component of the Cerner electronic medical record.
Specific Aims: Aim 1: Examine the joint effects of the association of nurse staffing levels and
individual nurse characteristics and outcomes for hospitalized Veterans. Examine independent
and joint associations of individual nurses’ characteristics (e.g., education and experience) with the
outcomes of the patients assigned to these nurses’ direct care (in-hospital mortality, failure to rescue,
hospital-acquired infections, and risk-adjusted length of stay (LOS)).
Aim 2. Test how the associations of nurse staffing and nurse characterstings with patient
outcomes are modified by varying unit-shift circumstances. Nurses don’t care for patients in
isolation; the nurses working each shift work as a team and often help each other; we will test how
the effects of this teamwork vary by the staffing levels each shift for the unit as a whole, the
characteristics of the staff each shift, and the unit work, measured by the patient acuity/need for
nursing care and the patient throughput (admissions and discharges).
Aim 3: We will work with the Office of Nursing Services to present the project findings to key
stakeholders to facilate the translation of project findings into recommendations for nurse-
patient assignments that promote high quality outcomes for hospitalized Veterans.
Methodology: VA 2010-2023 nurse staffing data, including the characteristics of each nurse (e.g.,
experience) will be matched with the extensive VA clinical data available for each patient using the
TIU Nursin...

## Key facts

- **NIH application ID:** 10834104
- **Project number:** 5I01HX003546-02
- **Recipient organization:** VETERANS ADMIN PALO ALTO HEALTH CARE SYS
- **Principal Investigator:** CIARAN S. PHIBBS
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2023-05-01 → 2026-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10834104

## Citation

> US National Institutes of Health, RePORTER application 10834104, Understanding the relationship between nurse staffing and outcomes: impact of individual nurse education, expertise, and effort level on individual patient outcomes (5I01HX003546-02). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10834104. Licensed CC0.

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