Elsevier

Nursing Outlook

Volume 50, Issue 5, September–October 2002, Pages 187-194
Nursing Outlook

Research-health services delivery
Hospital staffing, organization, and quality of care: Cross-national findings*,**,*

https://doi.org/10.1067/mno.2002.126696Get rights and content

Abstract

Objective: To examine the effects of nurse staffing and organizational support for nursing care on nurses' dissatisfaction with their jobs, nurse burnout, and nurse reports of quality of patient care in an international sample of hospitals. Design: Multisite cross-sectional survey Setting: Adult acute-care hospitals in the U.S. (Pennsylvania), Canada (Ontario and British Columbia), England and Scotland. Study Participants: 10319 nurses working on medical and surgical units in 303 hospitals across the five jurisdictions. Interventions: None Main outcome measures: Nurse job dissatisfaction, burnout, and nurse-rated quality of care. Results: Dissatisfaction, burnout and concerns about quality of care were common among hospital nurses in all five sites. Organizational/managerial support for nursing had a pronounced effect on nurse dissatisfaction and burnout, and both organizational support for nursing and nurse staffing were directly, and independently, related to nurse-assessed quality of care. Multivariate results imply that nurse reports of low quality care were three times as likely in hospitals with low staffing and support for nurses as in hospitals with high staffing and support. Conclusion: Adequate nurse staffing and organizational/managerial support for nursing are key to improving the quality of patient care, to diminishing nurse job dissatisfaction and burnout and, ultimately, to improving the nurse retention problem in hospital settings.

Nurs Outlook 2002;50:187-94.

Section snippets

Study background

The International Hospital Outcomes Study Consortium consists of seven interdisciplinary research teams headed by the University of Pennsylvania's Center for Health Outcomes and Policy Research. The study includes over 700 hospitals located in the United States (Pennsylvania), three provinces in Canada (Ontario, Alberta, British Columbia), England, Scotland, and Germany. The conceptual framework and design of the study derive from more than a decade of research on U.S. hospitals conducted by

Study design

The International Hospital Outcomes Study includes three primary linked and overlapping sources of data. These sources include surveys of nurses, patient discharge data, and secondary data on hospital characteristics. We sought to study hospitals in comparable countries but with differently organized and financed health care systems and selected the U.S. (Pennsylvania), Canada, the U.K. (England and Scotland), and Germany. Where feasible, our design called for the inclusion of all hospitals in

Results

We begin by describing some key variables in the sample of medical-surgical nurses we used in these exploratory analyses. Table 2 provides mean scores by jurisdiction for staffing, organizational support, and burnout.Staffing levels vary by country and site and may reflect differences in average length of stay and severity of illness between countries. The U.S. has the shortest average patient length of stay and Pennsylvania nurses also have the smallest numbers of assigned patients.

Discussion and conclusions

Consumers' and health professionals' concerns about adverse consequences of health system change on quality of hospital care are consistent with the findings of the International Hospital Outcomes Study. Deficiencies in hospital care were found in the five jurisdictions included in the present analysis representing the United States, Canada, and the United Kingdom. In addition to uneven quality of care, high levels of nurse job dissatisfaction and burnout signal the potential for a worsening

Acknowledgements

This research has been supported by: National Institute of Nursing Research, National Institutes of Health (NR04513); Commonwealth Fund of New York; Agency for Healthcare Quality and Research; Alberta Heritage Foundation for Medical Research; British Columbia Health Research Foundation; Federal Ministry of Education and Research (Germany); Nuffield Provincial Hospital Trust, London; and the Baxter Foundation. The authors represent the International Hospital Outcomes Research Consortium, which

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    *

    Reprinted from International Journal for Quality in Health Care; 14, Copyright 2002, Oxford Press. All rights reserved. For the International Hospital Outcomes Research Consortium.

    **

    Forthcoming, International Journal for Quality in Health Care, 2002: 14(1) Do Not Reproduce or Cite Without Authors' Permission Based on Dr. Aiken's Plenary Address to the 17th International Conference of the International Society for Quality in Health Care, Dublin, Ireland, September 15, 2000.

    *

    Reprint requests: Professor Linda Aiken, Center for Health Outcomes and Policy Research, University of Pennsylvania, 420 Guardian Drive, Philadelphia, PA, 19104-6096. Tel: (215) 898-9759, Fax: (215) 573-2062, E-mail: [email protected]

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