Evidence of Nurse Working Conditions: A Global Perspective

There is a global nursing shortage. Few health services decision makers have made the critical link between the number of human resources, the characteristics of the work environment and the impact on patients, nurses, and the system as a whole. The purpose of this article is to review evidence about nurse workload, staffing, skill mix, turnover, and organizational characteristics' effect on outcomes; discuss methodological considerations in this research; discuss research initiatives currently under way; review policy initiatives in different countries; and make recommendations where more research is needed. Overall, an understanding of the relationships among nurse staffing and organizational climate to patient safety and health outcomes is beginning to emerge in the literature. Little is known about nursing turnover and more evidence is needed with consistent definitions and control of underlying patient characteristics. Research and policy initiatives in Australia, Canada, New Zealand, and the United States are summarized.

[1]  S M Shortell,et al.  The Performance of Intensive Care Units: Does Good Management Make a Difference? , 1994, Medical care.

[2]  A. Baumann.  Commitment and Care: The benefits of a healthy workplace for nurses , 2001 .

[3]  Jack Needleman,et al.  Strengthening hospital nursing. , 2002, Health affairs.

[4]  P H Mitchell,et al.  Adverse outcomes and variations in organization of care delivery. , 1997, Medical care.

[5]  M. Blegen,et al.  Adverse patient occurrences as a measure of nursing care quality. , 1998, The Journal of nursing administration.

[6]  A I Mushlin,et al.  Nurse-physician collaboration and satisfaction with the decision-making process in three critical care units. , 1997, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[7]  Sean P Clarke,et al.  Effects of hospital staffing and organizational climate on needlestick injuries to nurses. , 2002, American journal of public health.

[8]  S. Fridkin,et al.  The Influence of the Composition of the Nursing Staff on Primary Bloodstream Infection Rates in a Surgical Intensive Care Unit , 2000, Infection Control & Hospital Epidemiology.

[9]  C Kovner,et al.  Nurse staffing levels and adverse events following surgery in U.S. hospitals. , 1998, Image--the journal of nursing scholarship.

[10]  Joanne Ritter-Teitel.  The Impact of Restructuring on Professional Nursing Practice , 2002, The Journal of nursing administration.

[11]  J. Sochalski.  Nursing's valued resources: critical issues in economics and nursing care. , 2001, The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmieres.

[12]  C E Phelps,et al.  The association between interdisciplinary collaboration and patient outcomes in a medical intensive care unit. , 1992, Heart & lung : the journal of critical care.

[13]  A A Rimm,et al.  Hospital characteristics and mortality rates. , 1989, The New England journal of medicine.

[14]  D. Farley,et al.  Volume-Outcome Relationships and Inhospital Mortality: The Effect of Changes in Volume Over Time , 1992, Medical care.

[15]  C. B. Jones.  Staff nurse turnover costs: Part II, Measurements and results. , 1990, The Journal of nursing administration.

[16]  L. Aiken,et al.  Hospital staffing, organization, and quality of care: Cross-national findings. , 2002, Nursing outlook.

[17]  C. Kovner,et al.  CMS study: correlation between staffing and quality. , 2002, The American journal of nursing.

[18]  J. Spetz,et al.  Measuring Shortages of Hospital Nurses: How do you Know a Hospital with a Nursing Shortage When you See One? , 2001, Medical care research and review : MCRR.

[19]  R. Gaynes,et al.  Accuracy of Reporting Nosocomial Infections In Intensive-Care–Unit Patients to the National Nosocomial Infections Surveillance System: A Pilot Study , 1998, Infection Control & Hospital Epidemiology.

[20]  S. Bakken,et al.  Economic evidence for evidence-based practice. , 2002, Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing.

[21]  C. Kovner.  State regulation of RN-to-patient ratios. , 2000, The American journal of nursing.

[22]  R. Haley,et al.  Eradication of endemic methicillin-resistant Staphylococcus aureus infections from a neonatal intensive care unit. , 1995, The Journal of infectious diseases.

[23]  D. J. Dwyer,et al.  Decision-Making Autonomy in Nursing , 1992, The Journal of nursing administration.

[24]  L. O'Brien-Pallas,et al.  The economic impact of nurse staffing decisions: time to turn down another road? , 2001, Hospital quarterly.

[25]  S. Sidani,et al.  Evaluation of a client care delivery model, Part 2: Variability in client outcomes in community home nursing. , 2002, Nursing economic$.

[26]  L. Aiken,et al.  Organization and outcomes of inpatient AIDS care. , 1999, LDI issue brief.

[27]  P Giovannetti,et al.  Nursing-related determinants of 30-day mortality for hospitalized patients. , 2011, The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmieres.

[28]  J. Buchan.  The 'greying' of the United Kingdom nursing workforce: implications for employment policy and practice. , 1999, Journal of advanced nursing.

[29]  J. A. N. Eedleman,et al.  Nurse-Staffing Levels and the Quality of Care in Hospitals , 2002 .

[30]  R. Gaynes,et al.  Improving hospital-acquired infection rates: the CDC experience. , 1996, The Joint Commission journal on quality improvement.

[31]  S. Shortell,et al.  Regional variation in Medicare hospital mortality. , 1992, Inquiry : a journal of medical care organization, provision and financing.

[32]  A. Baumann,et al.  Toward evidence‐based policy decisions: a case study of nursing health human resources in Ontario, Canada , 2000 .

[33]  R. Bartlett,et al.  Control of methicillin-resistant Staphylococcus aureus in a burn unit: role of nurse staffing. , 1982, The Journal of trauma.

[34]  Wendy Armstrong,et al.  Building on Values: The Future of Health Care in Canada , 2005 .

[35]  P Leatt,et al.  A comparison of workload estimates using three methods of patient classification. , 1989, Canadian journal of nursing administration.

[36]  C. L. Johnston.  Sources of Work Satisfaction/Dissatisfaction for Hospital Registered Nurses , 1991, Western journal of nursing research.

[37]  A. Vicca.  Nursing staff workload as a determinant of methicillin-resistant Staphylococcus aureus spread in an adult intensive therapy unit. , 1999, The Journal of hospital infection.

[38]  T. Porter-O’Grady,et al.  Shared Governance within the market-oriented health care system of New Zealand. , 2000, International nursing review.

[39]  T A Brennan,et al.  Factors associated with unplanned hospital readmission among patients 65 years of age and older in a Medicare managed care plan. , 1999, The American journal of medicine.

[40]  Sean P Clarke,et al.  Organizational climate, staffing, and safety equipment as predictors of needlestick injuries and near-misses in hospital nurses. , 2002, American journal of infection control.

[41]  M. Naylor,et al.  Nurses' effect on changing patient outcomes. , 1995, Image--the journal of nursing scholarship.

[42]  T. Wan,et al.  Modeling organizational determinants of hospital mortality. , 1991, Health services research.

[43]  L O'Brien-Pallas,et al.  Different systems, different costs? An examination of the comparability of workload measurement systems. , 1992, The Journal of nursing administration.

[44]  Lichtig Lk,et al.  Some impacts of nursing on acute care hospital outcomes. , 1999 .

[45]  L. Archibald,et al.  Patient density, nurse-to-patient ratio and nosocomial infection risk in a pediatric cardiac intensive care unit. , 1997, The Pediatric infectious disease journal.

[46]  L. Lichtig,et al.  Some impacts of nursing on acute care hospital outcomes. , 1999, The Journal of nursing administration.

[47]  T W Tai,et al.  Review of nursing turnover research, 1977-1996. , 1998, Social science & medicine.

[48]  Robert P. Steel,et al.  Turnover theory at the empirical interface: Problems of fit and function. , 2002 .

[49]  P. Mitchell,et al.  American Association of Critical-Care Nurses Demonstration Project: profile of excellence in critical care nursing. , 1989, Heart & lung : the journal of critical care.

[50]  L. Aiken,et al.  Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. , 2002, JAMA.

[51]  A. Mushlin,et al.  Association between nurse-physician collaboration and patient outcomes in three intensive care units. , 1999, Critical care medicine.

[52]  S. Shortell,et al.  The effects of regulation, competition, and ownership on mortality rates among hospital inpatients. , 1988, The New England journal of medicine.

[53]  L. Kohn,et al.  To Err Is Human : Building a Safer Health System , 2007 .

[54]  W. Knaus,et al.  An evaluation of outcome from intensive care in major medical centers. , 1987, Canadian critical care nursing journal.

[55]  Chunliu Zhan,et al.  Nurse staffing and postsurgical adverse events: an analysis of administrative data from a sample of U.S. hospitals, 1990-1996. , 2002, Health services research.

[56]  H. L. Smith,et al.  Lower Medicare Mortality Among a Set of Hospitals Known for Good Nursing Care , 1994, Medical care.

[57]  C. Duffield,et al.  The nursing workforce in Canada and Australia: two sides of the same coin. , 2002, Australian health review : a publication of the Australian Hospital Association.