Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction… 1 answer below »

Context The worsening hospital nurse shortage and recent California legislation mandating minimum hospital patient-to-nurse ratios demand an understanding of how nurse staffing levels affect patient outcomes and nurse retention in hospital practice. Objective To determine the association between the patient-to-nurse ratio and patient mortality, failure-to-rescue (deaths following complications) among surgical patients, and factors related to nurse retention. Design, Setting, and Participants Cross-sectional analyses of linked data from 10184 staff nurses surveyed, 232342 general, orthopedic, and vascular surgery patients discharged from the hospital between April 1, 1998, and November 30, 1999, and administrative data from 168 nonfederal adult general hospitals in Pennsylvania. Main Outcome Measures Risk-adjusted patient mortality and failure-to-rescue within 30 days of admission, and nurse-reported job dissatisfaction and job-related burnout. Results After adjusting for patient and hospital characteristics (size, teaching status, and technology), each additional patient per nurse was associated with a 7% (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.03-1.12) increase in the likelihood of dying within 30 days of admission and a 7% (OR, 1.07; 95% CI, 1.02-1.11) increase in the odds of failure-to-rescue. After adjusting for nurse and hospital characteristics, each additional patient per nurse was associated with a 23% (OR, 1.23; 95% CI, 1.13-1.34) increase in the odds of burnout and a 15% (OR, 1.15; 95% CI, 1.07- 1.25) increase in the odds of job dissatisfaction. Conclusions In hospitals with high patient-to-nurse ratios, surgical patients experience higher risk-adjusted 30-day mortality and failure-to-rescue rates, and nurses are more likely to experience burnout and job dissatisfaction.

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Hospital Nurse Staffing and Patient Mortality, Nurse
Burnout, and Job Dissatisfaction

 
 
Linda H. Aiken; Sean P. Clarke; Douglas M. Sloane; et al.
Online article and related content
 
current as of July 21, 2010. JAMA. 2002;288(16):1987-1993 (doi:10.1001/jama.288.16.1987)
   
http://jama.ama-assn.org/cgi/content/full/288/16/1987
 
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Downloaded from www.jama.com at Emory University on July 21, 2010ORIGINAL CONTRIBUTION
Hospital Nurse Staffing and
Patient Mortality, Nurse Burnout,
and Job Dissatisfaction
Linda H. Aiken, PhD, RN
Context The worsening hospital nurse shortage and recent California legislation
Sean P. Clarke, PhD, RN mandating minimum hospital patient-to-nurse ratios demand an understanding of
how nurse staffing levels affect patient outcomes and nurse retention in hospital
Douglas M. Sloane, PhD
practice.
Julie Sochalski, PhD, RN
Objective To determine the association between the patient-to-nurse ratio and pa-
Jeffrey H. Silber, MD, PhD tient mortality, failure-to-rescue (deaths following complications) among surgical pa-
tients, and factors related to nurse retention.
HE PAST DECADE…

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