LAUSR

Evidence-based Nurse Staffing: ICN’s New Position Statement The recent position statement published by the International Council of Nurses (ICN) on evidence-based nurse staffing is important and timely and provides an action agenda for nurses globally. Rigorous studies are now available from many parts of the world documenting the association between nurses caring for fewer patients each (better nurse staffing) and better outcomes for hospitalized patients (International Council of Nurses 2018). Moreover, there is evidence of a business case for increased investments in nursing showing that when there are too few nurses in hospitals, the overall costs of care rise because of high expenses of treating patients with preventable complications like healthcare-associated infections. ICN is an influential global health organization representing the largest group of health professionals in the world – nurses. Its position statements carry weight with decision-makers. As I discussed in my keynote address on safe nursing staffing at the 2017 ICN Conference in Barcelona, good evidence is now available on the impact of safe nurse staffing on improved patient outcomes in over 30 countries. That large body of research, reviewed in ICN’s position statement, is more than sufficient for nurses everywhere to use the position statement to advocate for evidence-based investments in safe nurse staffing. Research does not need to be replicated in every country. There is sufficient evidence, as ICN concluded, to act now. Key studies to help influence stakeholders A strategy I have found effective in advocacy is to use the publication of a new position statement from an important organization like ICN’s position statement on evidence-based safe nurse staffing as the occasion to brief decision-makers and the media in your locale or country on the particulars of nurse staffing challenges and ICN’s recommended strategies. I have found that it is also helpful to give decision-makers and the media physical examples (via email and hard copy) of a couple of research papers published in high profile international journals where the journal’s prestige helps bolster the legitimacy of the research findings. ICN’s position statement has excellent references, although it is not meant to be a systematic review of all of the global research on safe nurse staffing. I have a few suggestions below for papers that I have found particularly useful with decision-makers and the media because they are in high profile interdisciplinary scientific journals and include multiple countries. A programme of research that has been an effective resource for staffing advocacy is the RN4CAST study of 12 European countries that has produced over 70 scientific papers on the link between nursing and patient and workforce outcomes. Several papers have been particularly influential because the scientific journals in which they were published are known around the world. If I were to choose one paper for advocacy, it would be the 2014 RN4CAST paper published in The Lancet showing in nine European countries that each additional patient added to professional