Nurse Staffing, Quality of Care, and Job Outcomes

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Introduction

Hospitals nurse staffing levels affect patients and nurses outcomes. Several researches have established a relationship between low nurse staffing levels and negative patient outcomes in hospitals. A study by Aiken et al, for example, presented in their article Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction, established a link between nurse patient ratio, and patients deaths. The research was conducted on 232,342 general, orthopedic, and vascular surgery patients in non-federal hospitals in Pennsylvania within thirty days. A similar study by Needleman et al (2002), published in the New England Journal of Medicine, concluded the same.

Past studies on the effects of nurse staffing levels focused on the impact of this variable on patient outcomes such as mortality, patient improvement, and secondary infections, and nurse outcomes such as job strain, job dissatisfaction, and job turnover. The impact of hospital nurse staffing is very critical as it relates to the quality of care and it will have influence on the level of future nurse workforce.

Problem Statement

Previous studies indicated that adequacy of nurse staffing in hospitals resulted in better patient and nurse outcomes. Sufficient nurse staffing was linked to reduced in-hospital and thirty-day death rate among patients. There were also claims that adequate nurse staffing affected nurse job outcomes such as job dissatisfaction and exhaustion (Cho et al, 2009).

Purpose of the Research

The aim of this research was to investigate the association between nurse staffing and nurses perception of the quality of nursing care, job satisfaction, exhaustion, and motivation to desert from ICU nursing jobs.

Research Objectives

To establish the relationship between nurse staffing and patient outcomes.
To determine the association between nurse staffing and its job outcomes.

Significance of the Study

The results of this study will be useful in advocating for adequate nurse staffing in hospitals to reduce patient mortality rate and enhance nurses job satisfaction. The findings will be important for enhancing the quality of patient care in hospitals and also for improving the working conditions of nurses.

Research Method

Quantitative vs. Qualitative

This was a quantitative study which involved collecting data from nurse managers and staff nurses. Quantitative research method was preferred to qualitative one since the fist enables the application of quantitative techniques of data analysis which are perceived as more objective and credible.

Research Design

The research was held in a form of a cross-sectional study that entailed a nurse survey, and it took place between 11 August and 26 October, 2011.

Research Sample

The survey involved nurses from the ICU units of 22 hospitals located in Seoul (the capital of South Korea) and the province of Kyeonggi that is within the vicinity of Seoul. The choice of the hospitals was explained by their location and size because of the need to make the sample homogenous and comparable.

Research Procedure

Data for the research was collected using questionnaires. The research employed two categories of questionnaires, one for nurse executives and the other for staff nurses. The nurse executives questionnaires were given to 65 ICU units of the 22 hospitals with a 100 percent response rate being achieved. The nurse questionnaires, on the other hand, were distributed to 1463 staff nurses and the response rate was 93 percent.

The measures used included hospital, ICU, and nurse attributes. The hospital features of concern were the level of care, i.e. secondary or tertiary, form of ownership (private or public), location (Seoul or Kyeonggi), and hospital size. ICU features, collected using the nurse executives questionnaires, included specialty (medical, surgical, pediatric, etc.), ICU bed capacity, and nurse staffing level. The last measure entailed collecting information from nurses such as specialty, position, perception of staffing sufficiency, quality of care and job outcomes (job satisfaction, exhaustion, and motivation to leave ICU nurse job). Questions regarding perception of staffing sufficiency, quality of care and job outcomes were evaluated using a four-point scale. Another essential measure used was the number of patients per nurse.

Results

The study found out that only 13 percent of the nurses surveyed were in charge of two patients, approximately. In fact, about 25 percent of the nurses attended to more than three patients. On the matter of nursing adequacy, 21 percent of the nurses mentioned that there were qualified nurses in their hospitals to provide quality healthcare. Moreover, 64 percent of tertiary hospital nurses perceived the quality of nursing care they provided to be high as opposed to 50 percent in secondary hospitals. Regarding job satisfaction, a third of the nurses surveyed were dissatisfied with their job, half were highly exhausted, and 25 percent were planning on leaving their current jobs the following year. Overall, secondary hospitals reflected worse job outcomes than tertiary hospitals.

Implications of the Research Results to Nursing

The above research results imply that the level of nurse staffing in hospitals has an impact on the working conditions and job satisfaction among nurses. They also suggest that nurses perception of staffing sufficiency is linked to their job outcomes, as opposed to nurse patient ratio.

Contribution of the Findings to Nursing Knowledge

The study contributed to the understanding of the association between adequate nurses staffing and quality nursing care and job outcomes, using both objective and subjective measures. The objective measures included nurse patient ratio, while the subjective measures were nurses perceptions of staffing adequacy.

Ethical Considerations

The study was well-planned to eliminate the possibility of producing misleading results. It was also approved by the Institution Review Board of the university hospital in which the author was an affiliate. Moreover, adequate measures were taken before carrying out the study, to ensure that the research did not pose any physical, mental or social risks to the respondents. The survey participants also completed a consent form before filling out the questionnaire, indicating that they had agreed to take part in the study.

Conclusion

According to this study, there is a relationship between the level of nurse staffing and the quality of nursing care and nurse job outcomes. Therefore, hospitals should make sure that they have adequate nurses to enhance the quality of nursing care and improve job outcomes.

References

Aiken, L.H. et al. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of American Medicine, 288(16), 1987-1993. Web.

Cho, S.-H. et al. (2009). Nurse staffing, quality of nursing care and nurse job outcomes in intensive care units. Journal of Clinical Nursing, 18(12), 1729-1737. Web.

Needleman, J. et al. (2002). Nurse staffing levels and quality of care in hospitals. The New England Journal of Medicine, 346, 1715-1722. Web.

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