Healthcare Quarterly

Healthcare Quarterly 9(3) May 2006 : 18-20.doi:10.12927/hcq..18219

CHSRF Knowledge Transfer: Nurse Staffing and Patient Safety: Ratios and Beyond

Jennifer Ellis and Dave Clements


Since the publication of the Canadian Adverse Events Study, quality and safety have never been more prominent on the Canadian health policy agenda. Many voices have weighed in with quite different perspectives on what needs to happen in our healthcare system in order to address the situation
(see, for example, the recent special issue of Healthcare Quarterly

In terms of the relationship between nursing and the quality agenda, the debate in this country seems increasingly focused on the number of nurses available to provide care, and giving a lot of attention to the issue of mandatory nurse-patient ratios. While nurse-patient ratios have their benefits and are advocated by a range of organizations, it must be noted that the current evidence for their effectiveness remains inconclusive. In a discussion paper, Tomblin Murphy (2005) reiterates the need for further dialogue to determine whether nurse-patient ratios would in fact be an effective means to improve patient safety.

This preoccupation with the number of working nurses is understandable for a number of reasons, not the least of which is the dramatic and lasting effects of nursing staff reductions of the 1990s. However, improving patient safety will require more than looking at just nurse-patient ratios; it must be part of a much broader discussion on the state of nursing in Canada and its impact on patient care.  

To help, the Canadian Health Services Research Foundation and its partners1 commissioned a synthesis on nurse staffing and patient safety, to pull together what is known about the issue and provide evidence-based recommendations to policy-makers on moving ahead. The synthesis, which will be available in summer 2006, combines a background research report (McCutcheon et al.) with the findings of a round table with decision-makers and experts in the area.

The synthesis underscores the significant relationship between nurse staffing and patient safety and makes a number of key recommendations for moving forward. The report pulls together some of the better known findings of recent research on nurse staffing and patient safety with knowledge that has received less attention.  

For instance, the synthesis highlights the importance of the number of nurses working in the system, and the right mix of skills, education and experience. In addition, a critical area of focus in the report is the value and importance of working collaboratively with nurses when creating staffing plans at the organizational and unit levels, ensuring dialogue and giving appropriate decision-making authority to staff nurses and the nursing leadership.  

Similarly, research has already shown that nurses who are better educated are more likely to perform duties in a way that improves patient safety (Blegen et al. 2001; Hickam et al. 2003). However, the importance of nursing experience is highlighted less often. Also overlooked in the ongoing debate about the need for a baccalaureate nursing degree is the literature on the importance of nursing experience. The synthesis makes recommendations regarding both levels of experience and familiarity with the patient populations in decisions about the staffing of nursing units.  

Finally, while knowledge about the importance of nursing skill mix in acute care is fairly well known, this report also includes research about the critical importance of healthy relationships with other healthcare professionals, in particular physicians, for patient safety. That's why the synthesis makes recommendations about forming collaborative work relationships that recognize nursing autonomy and control over practice. In addition, it is critical to implement leadership and management structures and techniques that support positive change and improvements in the workplace.  

The CHSRF synthesis on nurse staffing and patient safety will be available in summer 2006. To reserve your copy, please e-mail (specifying whether you would like to receive a print or electronic copy of the report).

CHSRF has operated its synthesis program since 1998 and includes other reports on nursing, primary healthcare and other topics. Other reports on issues such as effective teamwork in healthcare are forthcoming in 2006. Please visit
for more information.

About the Author(s)

Jennifer Ellis is senior program officer, nursing, at the Canadian Health Services Research Foundation, where she coordinates a range of programs and activities at CHSRF, related to nursing leadership, organization and policy.

Dave Clements is a senior program officer within CHSRF's Knowledge Transfer and Exchange branch.


Blegen, M.A., T.E. Vaughn and C.J. Goode. 2001. "Nurse Experience and Education: Effect on Quality of Care." Journal of Nursing Administration 31(1): 33-39.

Hickam, D.H., S. Severance, A. Feldstein, L. Ray, P. Gorman and S. Schuldheis et al. 2003. The Effect of Health Care Working Conditions on Patient Safety (AHRQ Publication No. 03-E031). Rockville, MD: Agency for Healthcare Research and Quality. Retrieved May 9, 2005.

Sanchez-McCutcheon, MacPhee, Davidson, Doyle-Waters, Mason and Winslow. 2005. Evaluation of Patient Safety and Nurse Staffing. Forthcoming from the Canadian Health Services Research Foundation.

Tomblin Murphy, G. 2005. "Nurse-Patient Ratios and Patient Safety: A Review of the Literature." In Enhancement of Patient Safety through Formal Nurse-Patient Ratios: A Discussion Paper (pp. 7-29). Canadian Federation of Nurses Unions. Retrieved October 9, 2005.


1 Canadian Nurses Association; the Ontario Ministry of Health and Long-Term Care; the Canadian Patient Safety Institute; Health Canada's Office of Nursing Policy; the Canadian Council of Practical Nurse Regulators; the Registered Psychiatric Nurses of Canada.


Be the first to comment on this!

Note: Please enter a display name. Your email address will not be publically displayed