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. 2025 May;30(3):e70054.
doi: 10.1111/nicc.70054.

The Impact of Nurse-Patient Ratios on Patient Outcomes in Intensive Care Units

Ashraf Abdelrhman Elbashir Elmdni  1
Affiliations

The Impact of Nurse-Patient Ratios on Patient Outcomes in Intensive Care Units

Ashraf Abdelrhman Elbashir Elmdni. Nurs Crit Care. 2025 May.

Abstract

Background: Intensive care units (ICUs) are complex and fast-paced environments where nurse-to-patient ratios significantly influence patient outcomes. Existing research highlights the relationship between staffing levels and outcomes such as mortality, hospital-acquired infections, length of ICU stays, patient safety incidents, and nurse job satisfaction.

Aim: This systematic review aims to evaluate the impact of nurse-to-patient ratios on patient outcomes and nurse well-being in ICUs, providing evidence to guide staffing policies.

Study design: A systematic review of 20 studies conducted across various locations was undertaken. The review includes retrospective cohort studies, cross-sectional designs, and other methodologies. The studies were analysed to determine the influence of staffing levels on patient and nurse outcomes.

Results: Safe nurse staffing levels were associated with a 14% reduction in hospital mortality, shorter ICU stays, a 20% improvement in infection prevention, and an average ICU stay reduction of 1.5 days. Enhanced patient satisfaction by 18% in units with adequate staffing. Conversely, lower staffing ratios were linked to a 25% increase in adverse events, nurse fatigue, and diminished patient safety outcomes. The findings underscore the necessity of adequate staffing strategies and the adoption of workforce technologies to enhance care quality in ICUs.

Conclusions: This review highlights the critical role of nurse-to-patient ratios in improving patient outcomes and nurse well-being in ICUs. Future research should focus on standardizing methodologies to evaluate staffing strategies and exploring their long-term impacts on both patient and nurse outcomes.

Relevance to clinical practice: These findings emphasize the importance of implementing evidence-based staffing policies and integrating supportive technologies to ensure optimal care delivery and staff satisfaction in ICUs.

Keywords: critical care nursing; hospital mortality; intensive care units; nurse‐to‐patient ratio; patient safety.

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References

    1. M. B. Randa and J. M. Phale, “The Effects of High Nurses' Turnover on Patient Care: Perspectives of Unit Managers in Critical Care Units,” International Journal of Africa Nursing Sciences 19 (2023): 100580.
    1. P. G. Morton and P. Thurman, Critical Care Nursing: A Holistic Approach (Lippincott Williams & Wilkins, 2023).
    1. A. M. Assaye, R. Wiechula, T. J. Schultz, and R. Feo, “Impact of Nurse Staffing on Patient and Nurse Workforce Outcomes in Acute Care Settings in Low‐And Middle‐Income Countries: A Systematic Review,” JBI Evidence Synthesis 19, no. 4 (2021): 751–793.
    1. J. L. McCord, C. R. Lippincott, E. Abreu, and C. Schmer, “A Systematic Review of Nursing Practice Workarounds,” Dimensions of Critical Care Nursing 41, no. 6 (2022): 347–356.
    1. C. McTavish and A. Blain, Nurse‐Patient Ratios (Canadian Federation of Nurses Unions, 2024).

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