Abstract
In healthcare settings, nurses’ workload, burnout, and job satisfaction are associated to the patient–nurse ratio. Whether this ratio also affects their intention to leave the nursing profession, along with the underlying stress pathway, remains unclear. This study aimed to investigate the effects of the patient–nurse ratio on nurses’ intention to leave and considering the mediating roles of burnout and job dissatisfaction. The study analyzed the data of two pooled cross-sectional surveys collected in 2013 and 2014. Measures were obtained by a structure questionnaire, which queried the average daily patient–nurse ratio (ADPNR), nurses’ personal burnout, client-related burnout, job dissatisfaction, intention to leave, and other demographics. ADPNRs were standardized according to hospital levels. Multiple regression models examined mediation hypotheses, and a percentile bootstrap confidence interval was applied to determine the significance of indirect effects. A total of 1409 full-time registered nurses in medical and surgical wards of 24 secondary or tertiary hospitals in Taiwan completed self-administered questionnaires. Most of the participants were female (97.2%), and the mean age was 29.9 years. The association between the standardized ADPNR and intention to leave their job was significantly mediated by personal burnout, client-related burnout, and job dissatisfaction. Higher standardized ADPNRs predicted higher levels of personal burnout, client-related burnout, and job dissatisfaction, each of which resulted in higher levels of intention to leave the current job. The results highlight that appropriate patient–nurse ratio standards may be further discussed by selecting personal burnout, client-related burnout, and job dissatisfaction as indicators.
Highlights
Given that direct labor costs are the major budget items, hospitals face the dilemma between reducing or limiting direct labor costs and providing better care quality [1]
Client-related burnout positively mediates the relationship between average daily patient–nurse ratio (ADPNR) and intention to leave
The results showed that the association between standardized ADPNR and intention to leave was significantly mediated by personal burnout as the 95% bootstrap confidence precise intervalsgoal (CIs) of the indirect effects did not include 0
Summary
Given that direct labor costs are the major budget items, hospitals face the dilemma between reducing or limiting direct labor costs and providing better care quality [1]. Studies show that hospitals with better nurse staffing can alleviate nurses’ workload [1,6], attract nurses to practice [7], and diminish workplace injury and illness rates [8]. Some governments use a direct patient–nurse ratio (PNR) to represent the total number of patients taken care of by each nurse in each shift [11,13]. Japan offers a fee schedule for hospitals with different levels of nurse staffing: More sufficient staffing, more reimbursement [10]. In Taiwan, the standards, average daily PNRs (ADPNRs), are set in accordance with hospital levels, and have been effective since 1 May 2019 for medical and surgical wards. The ADPNR is calculated by the total number of beds*bed occupancy rate per month*3
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