Nursing Staffing and Hospital Outcomes
Julie Sochalski, Ph.D., R.N.
Center for Health Outcomes and Policy Research
University of Pennsylvania
Results of Survey of Hospital Nurses
• A survey of over 13,000 staff nurses working in 210 hospitals in Pennsylvania was done in 1999.
• Over 40% of hospital staff nurses reported being dissatisfied with their current job.
• These rates are about 3 times higher than the rates of job satisfaction for workers in general in the U.S.
• In addition, 43% of the nurses reported high levels of job burnout .
Health Affairs, May-June, 2001, 43-53
Results of Survey of Hospital Nurses (con’t)
• Over 80% of the nurses reported that the number of patients they were required to care for had increased in the past year.
• Around 45% reported that the quality of patient care at their hospital had deteriorated over the past year.
• Only about 1/3 of the nurses reported that the quality of nursing care at their hospital was excellent.
• Only 1/3 expressed confidence that their patients were able to manage their own care after being discharged from the hospital.
Health Affairs, May-June, 2001, 43-53
Relationship Between Nurse Staffing and Patient Outcomes: Mortality Rates
• Nursing workload had a significant impact on patient outcomes in hospitals.
• Patient mortality increased 7% for every additional patient that is added to the average nurse’s workload.
• Implications: A hospital with an average patient-per-nurse ratio of 8:1 has a 31% higher mortality rate than a hospital with a ratio of 4:1.
JAMA, October 23/30, 2002, 1987-1993
Relationship Between Nurse Staffing and Nurse Outcomes: Job Burnout
• Nursing workload also had a significant impact on nurse outcomes in hospitals.
• Job burnout increased 23% for every additional patient that is added to the average nurse’s workload.
• Implications: A nurse working in a hospital with an average patient-per-nurse ratio of 8:1 is more than twice as likely to show high job burnout than a nurse working in a hospital with a ratio of 4:1.
JAMA, October 23/30, 2002, 1987-1993
Relationship Between Nurse Staffing and Nurse Outcomes: Job Satisfaction
• Nursing workload had similar effects on nurse job satisfaction.
• Job dissatisfaction increased 15% for every additional patient that is added to the average nurse’s workload.
• Implications: A nurse working in a hospital with an average patient-per-nurse ratio of 8:1 is 75% more likely to be dissatisfied than a nurse working in a hospital with a ratio of 4:1.
JAMA, October 23/30, 2002, 1987-1993
Responses to Hospital Nursing Shortages: “Magnet” Hospitals
• Responding to a nursing shortage in the early 1980s, the American Academy of Nursing embarked on the “magnet hospital” project
Identify hospitals that attract and retain nurses.
• Key Magnet Hospital characteristics• nurse autonomy and control over practice• strong nursing leadership• participation in policy-making• career development opportunities
• Magnet hospitals also found to have lower patient mortality rates, higher job satisfaction, and lower nurse turnover.
McClure & Hinshaw, Magnet Hospitals Revisited, 2002