| Course | DNP 703 Innovation in Communication Scholarly and Professional Writing |
|---|---|
| Module | Module 4 |
| Paper type | Research synthesis essay |
| Length | About 559 words, 5 pages |
| Format | APA 7 student paper |
| School | Arizona State University |
| Program | Doctor of Nursing Practice |
| Updated | October 2026 |
Free sample paper for DNP 703 Module 4
More Patients per Nurse, More Deaths: A Synthesis of Research on Nurse Staffing and Hospital Mortality
Student Name
Edson College of Nursing and Health Innovation, Arizona State University
DNP 703: Innovation in Communication: Scholarly and Professional Writing
Instructor Name
Month Day, Year
More Patients per Nurse, More Deaths: A Synthesis of Research on Nurse Staffing and Hospital Mortality
Introduction
Hospital administrators often treat nurse staffing as a cost to be controlled. A body of research suggests that it is also a safety measure. This essay synthesizes three studies that examined the relationship between registered nurse staffing and inpatient mortality to answer one question: what does the evidence show about how staffing affects whether hospitalized patients survive?
Search Strategy
I searched CINAHL Complete and PubMed in the university library using the terms "nurse staffing" OR "nurse-to-patient ratio" AND "mortality" OR "failure to rescue," limited to English and peer-reviewed research. From the results, I selected three large observational studies that are widely cited, cover different health systems and use different methods: a cross-sectional study of Pennsylvania hospitals (Aiken et al., 2002), a longitudinal study of shift-level staffing in one United States academic medical center (Needleman et al., 2011), and a cross-sectional study across nine European countries (Aiken et al., 2014).
Theme 1: Workload and Patient Death
All three studies found that heavier nurse workloads were associated with higher mortality. Across Pennsylvania hospitals, adding one patient to a nurse's average load raised the odds of a surgical patient's death within 30 days by 7%, with a matching 7% rise for deaths after complications that went unrescued (Aiken et al., 2002). The European study found the same 7% increase in the odds of death for each additional patient per nurse, across hundreds of hospitals with different health systems (Aiken et al., 2014). The consistency across countries strengthens the case that the relationship is not a local artifact.
Theme 2: Nurse Education
Two of the studies looked beyond numbers to who the nurses were. In the European hospitals, wards with more bachelor's-prepared nurses lost fewer patients: 7% lower odds of death for each additional ten percentage points (Aiken et al., 2014). The Pennsylvania study focused on staffing and also found that nurses with heavier workloads reported more burnout and job dissatisfaction (Aiken et al., 2002), suggesting that the workforce effects and patient effects are linked.
Theme 3: Shortfalls on Individual Shifts
The first two studies compared hospitals. Needleman et al. (2011) asked a different question: does it matter when a particular patient experiences a short-staffed shift? Using records for each patient and shift, they showed that a patient's hazard of death climbed with every shift spent on a unit whose registered nurse hours fell eight or more below plan, as did every shift with unusually high turnover of patients. This design moves the evidence from hospital averages to the experience of individual patients.
Agreements, Differences and Gaps
The studies agree that more patients per nurse is associated with more deaths. They differ in level of analysis: hospitals in two, patients and shifts in one. Because none of the three assigned staffing levels, they cannot prove cause, although the consistency, dose-response pattern and shift-level timing make a causal relationship more plausible. None tested an intervention that changed staffing, which leaves open what happens when policy forces ratios down.
Conclusion
Synthesized, the three studies tell one story: when nurses care for more patients, more patients die, and the effect appears in the United States and Europe and on the level of individual shifts. The next question, whether mandating staffing changes outcomes, is the subject of my argument essay.
References
Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA, 288(16), 1987-1993. https://doi.org/10.1001/jama.288.16.1987
Aiken, L. H., Sloane, D. M., Bruyneel, L., Van den Heede, K., Griffiths, P., Busse, R., Diomidous, M., Kinnunen, J., Kózka, M., Lesaffre, E., McHugh, M. D., Moreno-Casbas, M. T., Rafferty, A. M., Schwendimann, R., Scott, P. A., Tishelman, C., van Achterberg, T., & Sermeus, W. (2014). Nurse staffing and education and hospital mortality in nine European countries: A retrospective observational study. The Lancet, 383(9931), 1824-1830. https://doi.org/10.1016/S0140-6736(13)62631-8
Needleman, J., Buerhaus, P., Pankratz, V. S., Leibson, C. L., Stevens, S. R., & Harris, M. (2011). Nurse staffing and inpatient hospital mortality. New England Journal of Medicine, 364(11), 1037-1045. https://doi.org/10.1056/NEJMsa1001025
Reading the DNP 703 Module 4 assignment instructions
The posted syllabus grades Paper 3, the Synthesis Essay, at 100 points and 20% of the course. It falls in Module 4, Weeks 10 to 11, whose lessons cover using synthesis in scholarly writing, health sciences database searching, developing and documenting a search strategy, and synthesizing research articles. Expect to search library databases on a topic, document the strategy, select research articles, and write an essay that combines their findings by theme rather than summarizing each in turn. The topic may be assigned or open, so check Canvas. Paper 4 builds an argument on this synthesis, so choose a topic you can take a position on later. Keep a log of each search, including the date, database, terms and number of results, so you can write the strategy section accurately.
Inside the DNP 703 Module 4 example
The essay opens with a question that the synthesis answers. A short section documents the search: databases, terms, limits and why each study was chosen. The body is organized by three themes, and each theme draws on more than one study where possible, which is what separates synthesis from a string of summaries. Numbers are reported precisely with their sources. A section on agreements, differences and gaps evaluates the studies together, noting design limitations. The conclusion states the combined finding in one sentence and points to the next paper. Transitions between themes connect the evidence rather than listing it. Each theme paragraph begins with the writer's own claim and then brings in the studies, keeping the writer in control of the argument.
Where the marks sit in the DNP 703 Module 4 rubric
Synthesis essays are usually graded on a clear focus or question, a documented and appropriate search strategy, organization by themes rather than by source, accurate reporting of findings, critical comparison of studies including limitations, a conclusion that integrates the evidence, and correct APA style. Faculty look for paragraphs that cite two or more sources in conversation. Recognizing design limits, such as observational data, shows critical reading. A search strategy described clearly enough to repeat shows information literacy. Using the course's writing moves, such as metacommentary that tells the reader where the argument is going, also earns credit. Faculty also notice whether students report each study's design and setting, since those details shape how much weight a finding deserves.
DNP 703 Module 4 help from the desk
The most frequent weakness is one paragraph per article. Build a matrix first: articles across the top, themes down the side, then write by row. Another is citing findings with no figures and no word about study design. Document your search as you go, including dates and limits. Keep your own voice in topic sentences and let sources support them. For help with your synthesis essay or search strategy, send your topic and the articles you have found to the desk. Ask a librarian to review your search terms before you finalize them, since a weak search limits the synthesis. Limit yourself to studies you have read in full, not only abstracts.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Arizona State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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DNP 703 Module 4 questions, answered
Where can I find a free DNP 703 Module 4 sample paper?
The synthesis essay above is complete: a documented search and three nurse staffing studies synthesized by theme, with agreements, differences and gaps.
How many points is DNP 703 Paper 3?
The Synthesis Essay is worth 100 points, 20% of the course grade.
What is the difference between a summary and a synthesis?
A summary reports one source; a synthesis combines several sources by theme to show what they say together.
Do I need to document my search strategy in DNP 703?
Yes. Module 4 covers developing and documenting a search strategy alongside the synthesis essay.
What databases should DNP students search?
CINAHL and PubMed are standard for nursing, with others such as PsycINFO or Cochrane depending on the topic.