"This work is partly intended to answer that question because it's the same unit, the same nurses, same doctors and same equipment," Needleman says. "And it's a great hospital, with mortality lower than you would expect, a magnet hospital that hits target 85% of the time. We asked what happens in the best of circumstances what happens when, as sometimes happens, you don't reach (staffing) target. So these other arguments are substantially put to bed."
A hospital that hits its own nurse staffing targets 85% of the time, he says "is pretty damn good."
The research paper stopped short of recommending nurse-patient ratios such as those in California, saying that the study was not designed to do that for a variety of reasons.
Needleman says that hospitals do not traditionally adjust their RN hours needed or workload to account "for new patients coming on and old patients leaving. They don't adjust for admissions, discharges or internal transfers in or out of the hospital and we felt that was also a potential situation.
"If you had an unusually large number of those, much more than typical number of admissions, discharges or transfers, the workload for the nurses would also be much higher than planned for in the system, and higher workload, would increase the risk of nurses trying to speed things up or (limit) the time or attention given to the individual patient...to observe how they're doing and identify whether something is not quite right."
For hospitals that know what its staffing levels are, the message from this study is to continue to be diligent, and for hospitals that don't know it or fail to hit those targets substantial amount of the time, the message is to do better," Needleman says.