The association between nurse staffing and outcomes for both patients and nurses is not new. In 2002, Aiken and colleagues1 published a landmark study reporting that higher nursing workloads increased odds of patients dying and of nurses experiencing burnout and emotional exhaustion. These relationships, which may partially be explained by missed nursing care, have been confirmed in numerous other studies.2–7 Care omissions may result as nurses experience time pressures that affect surveillance and attention to complex needs of patients.8,9 Thus, inadequate staffing affects patient safety and nurse well-being, further eroding the quality and safety of care.Appropriate staffing ensures an effective match between the needs of patients and their families and the knowledge, skills, and abilities of nurses.10 It has been identified as an essential ingredient of the American Association of Critical-Care Nurses (AACN) framework for a healthy work environment. Growing research has examined the effect of work environments on patient and nurse outcomes, especially as the Magnet Recognition Program has grown. As a culture of excellence evolves, positive practice environments offer benefits to patients, including better safety and quality of care and greater satisfaction with nursing care. Nurses benefit from greater autonomy and control over practice, better relationships with physicians, and higher nurse to patient ratios and workplace safety that increases engagement and job satisfaction and lowers burnout and turnover.9,11–17 The PICO (problem/patient/population, intervention/indicator, comparison, outcome) question that guided this synthesis was “How do nurse staffing and the quality of practice environments affect patient, nurse, and organizational outcomes?”
