PHILADELPHIA (April 20, 2026) – A new study from Penn Nursing 's Center for Health Outcomes and Policy Research (CHOPR) published in Nursing Outlook finds that nurses' assessments of their staffing adequacy is a more accurate predictor of patient safety on medical surgical units than traditional administrative data. The research, which analyzed data from over 1,200 nursing units across the United States, highlights a critical distinction in how staffing should be measured and managed across different hospital settings.
While hospitals typically rely on objective metrics like Registered Nurse hours-per-patient-day (RNHPPD), the study found that these numbers alone do not tell the whole story. In medical-surgical units, nurses' subjective perceptions of staffing adequacy were significantly associated with lower fall rates, whereas the objective RNHPPD metric was not. Conversely, in critical care settings, the objective RNHPPD metric proved to be the more effective predictor of patient falls.
"Nurses are uniquely positioned to judge staffing adequacy because they see the real-time complexity of patient care that administrative headcounts often overlook," says lead author Eileen T. Lake, PhD, RN, FAAN , the Edith Clemmer Steinbright Professor in Gerontology and CHOPR Associate Director. "Our findings suggest that for medical-surgical and step-down units, determining safe staffing levels requires engaging in a direct dialogue with bedside nurses rather than relying solely on quantitative reports. Their voice is a vital safety indicator that can prevent discomfort, injury, and excessive costs associated with patient falls".
The study comes at a pivotal time for health care policy, as new 2026 hospital accreditation standards from the Joint Commission now require nurse executives to implement staffing plans that ensure an adequate number of registered nurses. The research suggests that public reporting of nurse staffing adequacy—not just raw hours—would provide a more transparent and complete picture of patient safety.
In addition to Lake, co-authors include Angela Pascale, PhD (Press Ganey Associates LLC); Nora E. Warshawsky, PhD, RN, NEA-BC, FAAN (University of Texas at Arlington); Jennifer G. Henderson, MHCI, MSN, RN (University of Pennsylvania School of Nursing); Jessica G. Smith, PhD, RN (University of Pennsylvania School of Nursing); Douglas Staiger, PhD (Dartmouth College); Ysabella Perez (University of Pennsylvania School of Arts and Sciences); Eshwar Venkataswamy (The Pennsylvania State University); and Jeannette A. Rogowski, PhD (The Pennsylvania State University).
