ASSESSING THE IMPACT OF NURSE STAFFING RATIOS ON CLINICAL OUTCOMES IN MEDICAL AND SURGICAL ICU PATIENTS: A RETROSPECTIVE COHORT STUDY

Abstract

Adequate nurse staffing is crucial in intensive care units (ICUs) to ensure safe quality care, but optimal nurse-patient ratios remain undefined. This retrospective cohort study aimed to examine associations between nurse staffing ratios and patient clinical outcomes among 750 patients admitted to medical and surgical ICUs in a tertiary hospital in Riyadh, Saudi Arabia. Nurse staffing was determined for each ICU unit-day as patient-nurse ratios. Outcomes assessed through chart review included in-hospital mortality, ICU length of stay, 30-day readmissions, and adverse events. Risk-adjusted regression modeling assessed the impact of staffing ratios on outcomes. A significant dose-response relationship was found, with higher patient-nurse ratios associated with increased mortality risk (odds ratio 1.15, 95% confidence interval 1.04-1.29). Ratios above 1:2 were also associated with longer ICU stays, higher 30-day readmission rates, and increased adverse events. Maintaining ratios at 1:2 or lower was associated with improved outcomes. Findings support recommendations to limit medical-surgical ICU nurse-patient ratios to a maximum of 1:2 to optimize patient outcomes.