Staffing, skill mix and the model of care

Succession Planning Leadership Model for Nurse Managers in Hospitals: A Narrative Review

The high number of nursing staff in Indonesia requires optimal management skills, one of which comes from the leadership domain. The succession planning program can be an option to prepare nurses who have leadership potential to carry out a management function. This study aims to identify the nurse succession planning model and its application in clinical practice. This study uses a narrative review of the literature approach. Article searches were carried out using electronic databases (PubMed and Science Direct). Researchers obtained 18 articles. Three main themes emerged: (1) the factors that influence the efficient implementation of succession planning, (2) the benefits of succession planning, and (3) the implementation of succession planning in clinical practice. Training and mentoring related to leadership, support from human resources, and adequate funding are the main factors in implementing effective succession planning. Succession planning also can help nurses find competent leaders. However, in its application in clinical practice, the process of recruitment and planning for nurse managers that occurs in the field is not optimal so that succession planning must exist and be integrated with organizational needs and provide guidance and assistance for the younger generation who will become leaders in the future.

Workforce management and patient outcomes in the intensive care unit during the COVID-19 pandemic and beyond: a discursive paper

AIMS

To highlight the need for the development of effective and realistic workforce strategies for critical care nurses, in both a steady state and pandemic.

BACKGROUND

In acute care settings, there is an inverse relationship between nurse staffing and iatrogenesis, including mortality. Despite this, there remains a lack of consensus on how to determine safe staffing levels. Intensive care units (ICU) provide highly specialised complex healthcare treatments. In developed countries, mortality rates in the ICU setting are high and significantly varied after adjustment for diagnosis. The variability has been attributed to systems, patient and provider issues including the workload of critical care nurses.

DESIGN

Discursive paper.

FINDINGS

Nursing workforce is the single most influential mediating variable on ICU patient outcomes. Numerous systematic reviews have been undertaken in an effort to quantify the effect of critical care nurses on mortality and morbidity, invariably leading to the conclusion that the association is similar to that reported in acute care studies. This is a consequence of methodological limitations, inconsistent operational definitions and variability in endpoint measures. We evaluated the impact inadequate measurement has had on capturing relevant critical care data, and we argue for the need to develop effective and realistic ICU workforce measures.

CONCLUSION

COVID-19 has placed an unprecedented demand on providing health care in the ICU. Mortality associated with ICU admission has been startling during the pandemic. While ICU systems have largely remained static, the context in which care is provided is profoundly dynamic and the role and impact of the critical care nurse needs to be measured accordingly. Often, nurses are passive recipients of unplanned and under-resourced changes to workload, and this has been brought into stark visibility with the current COVID-19 situation. Unless critical care nurses are engaged in systems management, achieving consistently optimal ICU patient outcomes will remain elusive.

RELEVANCE TO CLINICAL PRACTICE

Objective measures commonly fail to capture the complexity of the critical care nurses' role despite evidence to indicate that as workload increases so does risk of patient mortality, job stress and attrition. Critical care nurses must lead system change to develop and evaluate valid and reliable workforce measures.

An aged life has less value: A qualitative analysis of moral disengagement and care failures evident in Royal Commission oral testimony

AIMS AND OBJECTIVES

To identify common themes about care failures in residential aged care as described from the perspectives of older people and their families in transcripts from hearings and submission to the Australian Royal Commission. These failures are explored through the lens of moral disengagement.

BACKGROUND

Previous inquiries into care failures have highlighted widespread harm from inhumane care, caused by staff carelessness, indifference and callousness. In health care, limited consideration has been given to the moral engagement or disengagement of staff and the relationship of moral engagement with care failures.

METHOD

Qualitative latent content analysis of 22 transcripts from the Royal Commission between March 2020-August 2020. Methods are reported using the SRQR.

RESULTS

This paper presents one theme, Dehumanisation of the care process: An aged life has less value, from a larger study. Care failures relating to morally disengaged staff were found to be widespread and influenced by the environments created by organisations.

CONCLUSION

This study highlights the need for further research to identify indicators of moral disengagement among staff and explore strategies to reduce or prevent moral disengagement within organisations trusted with providing care to older people.

RELEVANCE TO CLINICAL PRACTICE

Caregiving is necessarily associated with, and shaped by, moral dimensions. The erosion or disengagement of these moral dimensions among care staff reveals important aspects of residential aged care's lived experience. Studying dynamics within aged care facilities can provide a useful analytic lens for illuminating ways that residents and their family or those close to them, experience or are impacted by moral dimensions and behaviours.

Facilitators and barriers to the provision of type 1 diabetes inpatient care: An interpretive phenomenological analysis

AIM

The aim and objective of this study was to understand how non-specialized nurses understand the possible barriers and facilitators of inpatient care for type 1 diabetes.

DESIGN

An interpretative phenomenology approach was conducted.

METHODS

The sample consisted of non-specialized nurses (N = 24) working in medical, surgical and nephrology wards in the state hospitals in Cyprus. The data were collected during 2016-2018 from one focus group with nurses (N = 6) and individual semi-structured interviews with nurses (N = 18) conducted. The Standards for Reporting Qualitative Research checklist used to ensure the quality of the study.

RESULTS

It is evident from the study findings that nurses experience several barriers in diabetes inpatient care reported which are of great concern since this could have adverse effects on patients' outcomes. Only one facilitator has been reported by few nurses.

Models of generalist and specialist care in smaller hospitals in England: a mixed-methods study

Background

The increasing number of older, complex patients who require emergency admission to hospital has prompted calls for better models of medical generalist care, especially for smaller hospitals, whose size constrains resources and staffing.

Objective

To investigate the strengths and weaknesses of the current models of medical generalism used in smaller hospitals from patient, professional and service perspectives.

Methods

The design was a mixed-methods study. Phase 1 was a scoping and mapping exercise to create a typology of models of care, which was then explored further through 11 case studies. Phase 2 created a classification using the Hospital Episode Statistics of acute medical ‘generalist’ and ‘specialist’ work and described differences in workload and explored the links between case mix, typology and length of stay and between case mix and skill mix. Phase 3 analysed the relationships between models of care and patient-level costs. Phase 4 examined the strengths and weaknesses of the models of care through focus groups, a discrete choice experiment and an exploration of the impact of typology on other outcomes.

Results

In total, 50 models of care were explored through 48 interviews. A typology was constructed around generalist versus specialist patterns of consultant working. Twenty-five models were deployed by 48 hospitals, and no more than four hospitals used any one model of care. From the patient perspective, analysis of Hospital Episode Statistics data of 1.9 million care episodes found that the differences in case mix between hospitals were relatively small, with 65–70% of episodes accounted for by 20 case types. The skill mix of hospital staff varied widely; there were no relationships with case mix. Patients exhibited a preference for specialist care in the discrete choice experiment but indicated in focus groups that overall hospital quality was more important. From a service perspective, qualitative work found that models of care were contingent on complex constellations of factors, including staffing, the local hospital environment and policy imperatives. Neither the model of care nor the case mix accounted for variability in the length of stay (no associations were significant at p < 0.05). No significant differences were found in the costs of the models. Professionally, the preferences of doctors for specialist versus generalist work depended on their experiences of providing care and were associated with a healthy organisational culture and a co-operative approach to managing emergency work. Concepts of medical generalism were found to be complex and difficult to define, with theoretical models differing markedly from models in action.

Limitations

Smaller hospitals in multisite trusts were excluded, potentially leading to sample bias. The rapidly changing nature of the models limited the analysis of typology against outcomes.

Conclusions

The case mix of smaller hospitals was dominated by patients with presentations amenable to generalist approaches to care; however, there was no evidence to support any particular pattern of consultant working. Matching hospital staff to better meet local need and the creation of more collaborative working environments appear more likely to improve care in smaller hospitals than changing models.

Future work

The exploration of the relationships between workforce, measures of hospital culture, models of care, costs and outcomes in both smaller and larger hospitals is urgently required to underpin service reforms.

Study registration

This study is registered as Integrated Research Application System project ID 191393.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 4. See the NIHR Journals Library website for further project information.

Nursing Skills Video Selfies: An Innovative Teaching and Learning Strategy for Undergraduate Nursing Students to Master Psychomotor Skills

Introduction

The quality of care for patients is linked to the performance and competence of nurses. Nurse educators are challenged to prepare graduates to deliver safe, competent, patient-centered care. Nursing skills video "selfie" is an innovative teaching and learning strategy in which nursing students use technology to create videos of themselves (video selfie) performing psychomotor skills.

Method

The instructional exercise of creating the video selfie was administered to a group of nursing students in a medical-surgical class. The laboratory instructors identified three psychomotor nursing skills. In the skills lab, the instructors showed videos to demonstrate how the skills were performed. The students returned demonstration in the lab and were asked to return to the lab independently to practice the skills and to create a video selfie.

Results

The exercise encouraged students to increase the quality and length of practice and master the skill. Students demonstrated confidence to perform the skills and to accurately list each step required to perform the skills. The video selfie was used as a peer evaluation tool and as a faculty assessment tool to guide individual students' instruction, learning, and remediation.

Conclusion

The exercise had some shortcomings. Future quantitative research using survey instruments to collect data from a larger group of nursing students is needed to validate the utility of this innovative teaching and learning strategy in nursing programs.

Effect of Nursing Care Delivery Models on Registered Nurse Outcomes

The two key components of models of nursing care delivery are mode of nursing care delivery and skill mix. While mode of nursing care delivery refers to the independent or collaborative work of nurses to provide care to a group of patients, skill mix is defined as direct care nurse classifications. Previous research has typically focused on only one component at a time (mode or skill mix). There exists little research that investigates both components simultaneously. This study examined the effect of mode of nursing care delivery and skill mix on nurse emotional exhaustion and job satisfaction after controlling for nurse demographics, workload factors, and work environment factors. A secondary analysis was done with survey data from 416 British Columbia medical–surgical registered nurses. Data were analyzed using hierarchical multiple regression and moderated regression. Registered nurses in a skill mix with licensed practical nurses reported lower emotional exhaustion when caring for more acute patients compared with those in a skill mix without licensed practical nurses. While mode of nursing care delivery was not related to nurse outcomes, work environment factors were the strongest predictors of both nurse outcomes. Skill mix moderated the relationship between patient acuity and emotional exhaustion. Nurse managers should invest in nurses’ conditions of work environments.

Care delivery models: Challenge to change

AIM

The purpose of this project was to evaluate a partnership model of care delivery on nurse and patient satisfaction and clinical outcomes.

BACKGROUND

Care delivery models result in practical staff assignment decisions based on perceived fairness. The division of labour lies in social interaction of participants. Research notes that partnership team models require effective communication skills and delegation abilities to sustain.

METHOD

This project used multiple methods in two study sites. A convenience sample was used to assess measures. Institutional Review Board approval obtained.

RESULTS

Nurse satisfaction statistically increased in one setting and statistically decreased in the other setting. One statistically significant difference in a clinical outcome was noted. Patient satisfaction, nurse turnover and vacancy rates failed to reveal anything of statistical significance. Observed operational care components improved in both settings.

CONCLUSIONS

Care delivery models are determined by a variety of factors of resource availability, unit culture, and quality and patient safety priorities. Identification of preferential structural approaches to guide nursing workflow is needed.

IMPLICATIONS FOR NURSING MANAGEMENT

Innovative models of care delivery must be predicated on new role skills of delegation and negotiation for nurses, purposeful oversight and mentoring for sustainable success. Staffing can influence the integrity of care delivery models.

The effect of nursing care delivery models on quality and safety outcomes of care: A cross-sectional survey study of medical-surgical nurses

AIMS

This study examined the effect of two components of a model of nursing care delivery, the mode of nursing care delivery, and skill-mix on: (a) quality of nursing care; and (b) patient adverse events, after controlling for nurse demographics, work environment, and workload factors.

DESIGN

A cross-sectional exploratory correlational study that drew on secondary data was conducted.

METHODS

Survey data from 416 direct care registered nurses from medical-surgical settings across British Columbia were analysed using hierarchical multiple regression. Larger study data were collected in 2015.

RESULTS

Nurses working in a team-based mode reported a greater number of nursing tasks left undone compared with those working in a total patient care. Nurses working in a skill-mix with licensed practical nurses reported a higher frequency of patient adverse events compared with those working in a skill-mix without licensed practical nurses. At higher levels of acuity, nurses in a team-based mode reported a higher frequency of patient adverse events than did nurses in a total patient care.

CONCLUSION

Models of nursing care delivery components, mode and skill-mix, influenced quality and safety outcomes. Some of the team-based medical-surgical nurses in British Columbia are not functioning as effective teams. Team building strategies should be used to enhance collaboration among them.

IMPACT

Research into redesigning care delivery has typically focused on only one care delivery component at a time. The study findings could have implications for nurses and patients, nursing leadership and policymakers particularly in medical-surgical settings in British Columbia.

Nurses' needs for care robots in integrated nursing care services

AIMS

To determine the need for care robots among nurses and to suggest how robotic care should be prioritized in integrated nursing care services.

BACKGROUND

Korea is expected to be a super-aged society by 2030. To solve care issues with elderly inpatient caused by informal caregivers, the government introduced "integrated nursing care services"; these are comprehensive care systems staffed by professionally trained nurses. To assist them, a care robot development project has been launched.

DESIGN

The study applied a cross-sectional survey.

METHODS

In 2016, we conducted a multicentre survey involving 302 Registered Nurses in five hospitals including three tertiary and two secondary hospitals in Korea. The questionnaire consisted of general characteristics of nurses and their views on and extents of agreement about issues associated with robotic care.

RESULTS

Trial centre nurses and those with ≥10 years of experience reported positively on the prospects for robotic care. The top-three desired primary roles for care robots were "measuring/monitoring", "mobility/activity" and "safety care". "Reduction in workload", especially in terms of "other nursing services" which were categorized as nonvalue-added nursing activities, was the most valued feature. The nurses approved of the aid by care robots but were concerned about device malfunction and interruption of rapport with patients.

CONCLUSION

Care robots are expected to be effective in integrated nursing care services, particularly in "measuring/monitoring". Such robots should decrease nurses' workload and minimize nonvalue-added nursing activities efficiently. No matter how excellent care robots are, they must cooperate with and be controlled by nurses.

Revisiting task orientated care: Oral histories of former student nurses in Ireland (1960-2001)

The apprenticeship model of nurse training was in place in Ireland up to the end of the twentieth century. Task orientated care was a feature of this model. It is important to examine task allocation from the student's perspective, in light of current and on-going debates regarding student nurses' supernumerary status. Both approaches influence the status of the student; as a worker with task allocation and as a learner with supernumerary status. Oral history interviews were undertaken with twelve former student nurses (1960-2001) to explore their experiences of clinical learning and task allocation. Task allocation consisted of household tasks and tasks involving patient care. Students' experiences were influenced more by issues surrounding the task, particularly the 'task-person', than the task itself. Therefore, a learning environment that is inclusive, supportive and understanding of students' learning is recommended, regardless of the model of nurse training or education that might be in place. These findings can inform current debate on supernumerary status and task allocation for the student nurse within their clinical learning environment, but also on the history of nurse education in Ireland in the twentieth century.

ENsCOPE: Scoping the Practice of Enrolled Nurses in an Australian Community Health Setting

INTRODUCTION

A continuing shift of healthcare delivery from hospital to the community has increased the acuity and complexity of care provided in the home. Global financial crises and nursing shortages have prompted policies supporting two tiers of nursing and expansion of the licensed practical nurse, second level or enrolled nurse role and evoked debate surrounding roles traditionally undertaken by registered nurses. Community nursing offers unique challenges for enrolled nurses wanting to enact their full scope of practice.

AIM

To compare and describe registered and enrolled nurse opinions of their current and potential enrolled nurse scope of practice in the community health setting.

METHODS

A cross-sectional survey of 136 nurses (115 registered and 21 enrolled nurses) was undertaken within a large community nursing team in Australia. Participants reported their opinions of enrolled nurse scope of practice based on 27 core community nursing skills.

RESULTS

Although substantial agreement was evident, there were statistically significant differences between registered nurse and enrolled nurse opinions in core skill areas; 'Patient Education' and 'Clinical Observation'. Registered nurses identified some specialized skills-catheter and gastrostomy care-that could be undertaken by enrolled nurses with further education.

CONCLUSION

We confirm that registered nurses do agree with extending the skills of enrolled nurses. Education approaches that build shared confidence in enrolled nurse advanced skills are recommended.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

The future supply of nurses is at risk. There are limited resources and increasing demand for quality health care where people live and work. While there may be opportunities internationally to improve productivity through advanced nursing roles, these policies should prioritize efficiency by firstly promoting the full enactment of nursing skills in these settings.

Perceptions of a Primary Nursing Care Model in a Pediatric Hematology/Oncology Unit

The primary nursing care model optimizes relationship-based care. Despite using a primary nursing model on a pediatric hematology/oncology inpatient unit, it was hypothesized patients and nurses were dissatisfied with the structure of primary care teams and inconsistency of primary assignments. The purpose of this study was to evaluate patient/family and nurse perceptions of our current care model through assessing gaps in its operationalization and satisfaction. This study used a descriptive cross-sectional design featuring patient/family and nurse surveys. Of the 59 patient/family respondents, 93.2% prefer to have a primary nurse care for them and 85% are satisfied with how often they are assigned a primary care team member. Similarly, 63% of the 57 nurse respondents are satisfied with the current implementation of our primary nursing model and 61% state the model reflects good continuity of care. Yet 80.7% of nurses believe safety would improve for a patient whose nurse works shifts consecutively even if not a primary nurse. Overall, patients, families, and nurses value care continuity and meaningful nurse-patient relationships, which is fundamental to primary nursing.

Using workload measurement tools in diverse care contexts: the experience of staff in mental health and learning disability inpatient settings

ACCESSIBLE SUMMARY

What is known on the subject? Difficulties with the recruitment and retention of qualified nursing staff have resulted in nursing shortages worldwide with a consequential impact on the quality of care. It is increasingly recommended that evidence-based staffing levels are central to the development of workforce plans. Due to a paucity of empirical research in mental health and learning disability services the staffing needs and requirements for these settings are undefined and the availability of tools to aid staffing decisions is limited. What this paper adds to existing knowledge? This paper provides a valuable insight into the practical uses of these tools as perceived by staff members with day-to-day experience of the requirements of mental health and learning disability wards. It reveals that while workload measurement tools are considered a valuable aid for the development of workforce plans, they are limited in their ability to capture all aspects of care provision in these settings. It further emphasizes the inapplicability of a one-shoe-fits-all approach for determining nurse staffing levels and the need for individual and customized workforce plans. What are the implications for practice? This study demonstrates that the development of tools for use in mental health and learning disability services is in its infancy, yet no tool that has been validated as such. It highlights the potential for workload measurement tools to aid staffing decisions; however, a more holistic approach that considers additional factors is needed to ensure robust workforce planning models are developed for these services.

INTRODUCTION

The critical challenge of determining the correct level and skill mix of nursing staff required to deliver safe and effective health care has become an international concern. It is recommended that evidence-based staffing decisions are central to the development of future workforce plans. Workforce planning in mental health and learning disability nursing is largely under-researched with few tools available to aid the development of evidence-based staffing levels in these environments.

AIM

It was the aim of this study to explore the experience of staff using the Safer Nursing Care Tool and the Mental Health and Learning Disability Workload Tool in mental health and learning disability environments.

METHOD

Following a 4-week trial period of both tools, a survey was distributed via Qualtrics online survey software to staff members who used the tools during this time.

RESULTS

The results of the survey revealed that the tools were considered a useful resource to aid staffing decisions; however, specific criticisms were highlighted regarding their suitability to psychiatric intensive care units and learning disability wards.

DISCUSSION

This study highlights that further development of workload measurement tools is required to support the implementation of effective workforce planning strategies within mental health and learning disability services.

IMPLICATIONS FOR PRACTICE

With increasing fiscal pressures, the need to provide cost-effective care is paramount within the services of the National Health Service. Evidence-based workforce planning is therefore necessary to ensure that appropriate levels of staff are determined. This is of particular importance within mental health and learning disability services due to the reduction in the number of available beds and an increasing focus on purposeful admission and discharge.

Letting go: How newly graduated registered nurses in Western Canada decide to exit the nursing profession

BACKGROUND

The Canadian Nurses Association (CNA) estimates a nursing shortage in Canada will rise to 60,000 registered nurses by 2022. Further compounding this crisis is the approximate 14-61% of new nursing graduates who will change nursing roles or exit the profession.

AIM

To explore the factors and basic psychosocial process involved in the decisions of newly graduated registered nurses in Western Canada who permanently exit the nursing profession within five years.

DESIGN

Data was collected through unstructured and semi-structured interviews using the Glaserian grounded theory method.

FINDINGS

Participants were found to be in a process of letting go of nursing that commenced as students and continued as they entered practice as registered nurses. Four major themes were identified. 1) Navigating constraints of the healthcare system and workplace: participants encountered difficulties adjusting to shiftwork and workload. 2) Negotiating social relationships, hierarchies, and troublesome behaviors; specifically hierarchal and horizontal violence. 3) Facing fears, traumas and challenges. 4) Weighing competing rewards and tensions which resulted in leaving the nursing profession.

CONCLUSION

Students and subsequently new nursing graduates require a variety of supports to establish a nursing identity and remain in the profession. These supports include a manageable workload; meaningful orientation; interprofessional teamwork; and engagement within transformational and authentic leadership constructs. New nurses require a sense of being welcomed, valued, respected and accepted into the workplace environment, as well as constructive feedback, emotional support and debriefing to face workplace challenges.

Models of care choices in today’s nursing workplace: where does team nursing sit?

This paper provides an overview of the developmental history of models of care (MOC) in nursing since Florence Nightingale introduced nurse training programs in a drive to make nursing a discipline-based career option. The four principal choices of models of nursing care delivery (primary nursing, individual patient allocation, team nursing and functional nursing) are outlined and discussed, and recent MOC literature reviewed. The paper suggests that, given the ways work is being rapidly reconfigured in healthcare services and the pressures on the nursing workforce projected into the future, team nursing seems to offer the best solutions.

The Use of Unregulated Staff: Time for Regulation?

Internationally, shortages in the nursing workforce, escalating patient demands, and financial constraints within the health system have led to the growth of unlicensed nursing support workers. Recently, in relation to the largest publicly funded health system (National Health Service), it was reported that extensive substitution of registered nurses with unskilled nursing support workers resulted in inadequate patient care, increased morbidity and mortality rates, and negative nurse outcomes. We argue that it is timely to consider regulation of nursing support workers with their role and scope of practice clearly defined. Further, the addition of these workers in a complementary model of care (rather than substitutive model) should also be explored in future research, in terms of impact on patient and nurse outcomes.

Addressing the mental health nurse shortage: undergraduate nursing students working as assistants in nursing in inpatient mental health settings

The population of mental health nurses is ageing and in the next few years we can expect many to retire. This paper makes an argument for the employment of undergraduate nursing students as Assistants in Nursing (AINs) in mental health settings as a strategy to encourage them to consider a career in mental health nursing. Skill mix in nursing has been debated since at least the 1980s. It appears that the use of AINs in general nursing is established and will continue. The research suggests that with the right skill mix, nursing outcomes and safety are not compromised. It seems inevitable that assistants in nursing will increasingly be part of the mental health nursing workforce; it is timely for mental health nurses to lead these changes so nursing care and the future mental health nursing workforce stay in control of nursing.

Building emotional intelligence: a strategy for emerging nurse leaders to reduce workplace bullying

Bullying is one of the most concerning forms of aggression in health care organizations. Conceptualized as an emotion-based response, bullying is often triggered by today's workplace challenges. Unfortunately, workplace bullying is an escalating problem in nursing. Bullying contributes to unhealthy and toxic environments, which in turn contribute to ineffective patient care, increased stress, and decreased job satisfaction among health care providers. These equate to a poor workforce environment, which in turn increases hospital costs when nurses choose to leave. Nurse managers are in positions of power to recognize and address negative workplace behaviors, such as bullying. However, emerging leaders in particular may not be equipped with the tools to deal with bullying and consequently may choose to overlook it. Substantive evidence from other disciplines supports the contention that individuals with greater emotional intelligence are better equipped to recognize early signs of negative behavior, such as bullying. Therefore, fostering emotional intelligence in emerging nurse leaders may lead to less bullying and more positive workplace environments for nurses in the future.

Nursing activities, nurse staffing and adverse patient outcomes as perceived by hospital nurses

AIM

To investigate the relationships between nursing activities, nurse staffing and adverse patient outcomes in hospital settings as perceived by registered nurses in Finland and the Netherlands and to compare the results obtained in the two countries.

BACKGROUND

Previous research indicates that a higher proportion of registered nurses in the staff mix results in better patient outcomes. Knowledge of the relationship between nurse staffing and adverse patient outcomes is crucial to optimise the management of professional nursing resources and patient care.

DESIGN

A cross-sectional, descriptive questionnaire survey.

METHODS

Registered nurses employed in hospitals in Finland (n = 535) and the Netherlands (n = 334), with overall response rates of 44·9% and 33·4%, respectively, participated.

RESULTS

The patient-to-nurse ratio was on average 8·74:1 and did not vary significantly between the countries. However, there were fewer registered nurses and significantly more licensed practical nurses among the Dutch hospital staff than the Finnish staff. In addition, Finnish nurses performed non-nursing and administrative activities more frequently than the Dutch nurses and reported more dissatisfaction with the availability of support services. Frequencies of patient falls were related to the patient-to-nurse ratio in both countries. Finnish participants reported the occurrence of adverse patient outcomes more frequently.

CONCLUSIONS

Significant associations were found between nurse staffing and adverse patient outcomes in hospital settings. Compared with the Netherlands, in Finland, nurses appear to have higher workloads, there are higher patient-to-nurse ratios, and these adverse staffing conditions are associated with higher rates of adverse patient outcomes.

RELEVANCE TO CLINICAL PRACTICE

The findings provide valuable insights into the potential effects of major changes or reductions in nursing staff on the occurrence of adverse patient outcomes in hospital settings.