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Quantitative study—other
Productive hours by direct-care providers is the best measure of nurse staffing in relation to patient outcomes
  1. Lynn Unruh
  1. Department of Health Management & Informatics, University of Central Florida, Orlando, Florida, USA
  1. Correspondence to : Dr Lynn Unruh, Department of Health Management & Informatics, University of Central Florida, 4000 Central Florida Blvd, Orlando, FL 32816, USA; lunruh{at}

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Implications for practice and research

  • The usual measures of registered nurse hours per patient day (RNHPPD) may not be the best to use when assessing the relationship to quality because they do not distinguish registered nurse (RN) hours spent directly with the patient.

  • Administrators should use productive direct-care hours when estimating workforce needs and setting daily staffing plans.

  • Patient churn and qualitative measures of nurses, such as educational level, tenure and expertise are important to examine when assessing staff adequacy.1


A growing body of evidence indicates that nurse staffing is positively related to patient outcomes. However, the evidence is not consistent across quality indicators.2 , …

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  • Competing interests None declared.