Association of objective and subjective nurse staffing metrics with patient fall rate by unit type

BACKGROUND: Nurses are responsible for surveillance to prevent patient falls. Staffing inadequacies may compromise surveillance. Accurate measurement of staffing adequacy is needed to guide staffing decisions. Staffing metrics may differ in explained variance in fall rates. PURPOSE: Evaluate whether objective and subjective staffing metrics are associated with fall rates across nursing units with differing patient acuity. METHODS: In a cross-sectional design, objective and subjective staffing metrics from the 2024 National Database of Nursing Quality Indicators were linked to fall rates on 1,269 adult medical-surgical, stepdown, and adult critical care units from 217 U.S. hospitals. FINDINGS: Registered nurse hours-per-patient-day was associated with falls in critical care and stepdown units. Perceived staffing adequacy was significantly associated with fall rates in acute care and stepdown units. DISCUSSION: The findings inform nurse staffing decision-making and fulfillment of new hospital accreditation standards requiring a nurse staffing plan with an adequate number of nurses.