The Impact of Patient to Nurse Ratio on Quality of Care and Patient Safety in the Medical and Surgical Wards in Malaysian Private Hospitals: A Cross-sectional Study

Abstract

Background and objective: Nursing shortage and inadequate hospital nursing jeopardized quality of care andpatient safety. This study aims to predict the impact of patient to nurse ratio on quality of care and patient safetyin medical and surgical wards in Malaysian private hospitals.Methods: Cross-sectional data collected by questionnaire from 652 nurses working in the medical and surgicalwards in 12 private hospitals participated in the study. Stratified simple random sampling performed to invitesmall size (less than 100 beds), medium size (100-199 beds) and large size (over than 200) hospitals’ nurse toparticipate in the study, which allow also nurses from all shift to participate in the study from the participatedhospitals.Results: Nurses with higher ratio of patients have greater negative association on quality of care and patientsafety. However, this negative association significantly associated with patient safety, whereas insignificantlyassociated with quality of care.Conclusions: Staffing level inconsistently associated with quality of care and patient safety, so there is at leastone intervening process factor mitigate the negative impact of nursing shortage on quality of care in Malaysianhospitals. However, nurses delivering care for 11-15 patients and nurses delivering care for more than 15patients had significant negative impact on both quality of care and patient safety at a p<0.05 significance levelcompared with those caring for less than 5 patients.