Yes, many of the settings were comparable to Houston Methodist. The settings included: general hospital settings (27), teaching hospital settings (11), and a military hospital (1). Twenty-nine of the studies were performed in the United States of America (USA), while the remaining 10 were conducted outside of the US.

Patient-focused outcome indicators included nosocomial infections, mortality, failure to rescue cardiac arrest, patient falls, patient falls with injury, pressure ulcer, deep vein thrombosis, medication administration errors, adverse drug events, length of stay and patient satisfaction as dependent categories. A negative, positive or no relationship between those specific patient-focused outcome indicators was evaluated across studies to the independent categories such as length of stay, licensed practical nurses (LPN), nursing care hours per patient day, registered nurses (RN) and unlicensed assistance personnel (UAP) and total nurses (RN+LPN+UAP) (see figure 6, 7, 8,9 and 10).

Nurse-focused outcome indicators included nurse job satisfaction, nurse burnout and nurse turnover as dependent categories in relationship to the registered nurse specifically. A negative, positive or no relationship was evaluated based on the RN’s experience and the ratio of patients assigned to the RN (independent categories).

The novice and even experienced reviewer may have difficulty understanding results due to the inverse, positive, negative and significant relationships discussed but not clearly defined. The most consistent nurse-sensitive indicators in this study were the ratio of patients to RNs, RN proportion (the amount of nursing staff that are RNs) and nurse education. In a review of the ratio of patients to the RN, Oner et al. (2020) noted a positive relationship between mortality, failure to thrive, nurse job satisfaction and nurse burnout. Nursing education was significant for nurse retention and patient mortality. There were inverse relationships with nosocomial infections, mortality, pressure ulcer and medication administration errors regarding RN proportion.