Systematic Review: Patient-Nurse Ratio and Nurse Outcomes in Acute Care Hospitals

Abstract

Aims: To evaluate the current evidence base and provide a systematic overview of this evidence on the relationship between the patient-nurse ratio and nurse employee outcomes. Background: The ongoing shortage of qualified nursing staff has resulted in the introduction of different staff-related interventions. As a consequence, evidence-based decision-making linking nurse staffing with staff-related outcomes is a much needed research area. Although multiple studies have investigated this phenomenon, the evidence is mixed and fragmented. Evaluation: Thirty studies were identified, analysing the following outcomes: job (dis)satisfaction, emotional exhaustion, job stress, intent to leave, needle stick injuries, nurses’ perception of quality of care, safety of patients and care left undone. Key issue(s): Several studies confirm that a higher patient-nurse ratio can be associated to adverse nurse outcomes. Future research should incorporate other methodologies (e.g. longitudinal designs) and unit-level data. Conclusion: A relationship between the patient-nurse ratio and specific staff-related outcomes is confirmed by various studies. Implications for Nursing Management: Staffing alone is not enough to ensure quality of care. Other variables have to be taken into consideration (e.g. skill mix and the work environment). Hospital management should systematically start tracking data on the work environment and convert this information into policy guidelines.