Adequate nursing staffing for emerging infectious disease: Integrative review

Purpose: This integrative review synthesizes existing literature on nursing staffing during COVID-19, focusing on nurse-to-patient ratios and their impact on patient outcomes, including mortality and safety, as well as on nurse outcomes such as job satisfaction and burnout. Method: Whittemore and Knafl's (2005) integrative review methodology was used for the review. Literature published between 2019 and 2024 was reviewed using PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) using the key words ‘nursing’, ‘staffing’, ‘Covid-19’, and ‘Nurse-to-patient ratio’. Studies were systematically selected and evaluated using Covidence software. Results: Twelve studies met the inclusion criteria, highlighting variation in nurse-to-patient ratios across countries and study settings. Although there were some differences across studies, the nurse-topatient ratio was found to be associated with patient mortality and the occurrence of nursing adverse events. During COVID-19 patient care, Nurse Activity Scores (NAS) notably increased compared to pre-pandemic levels, indicating a heavier workload for nurses, even if the recommended ICU ratio of 1:2 was maintained. Additionally, the expansion of isolation beds led to nursing shortages, with some units unable to meet targeted nurse-to-patient ratios. Conclusion: This review underscores the critical role of adequate nurse staffing in ensuring patient safety and nurse job satisfaction during public health crises. It also calls for flexible and systematic workforce allocation strategies to enhance readiness for future pandemics.