title: Hospital staffing, organization, and quality of care: cross-national findings.
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.
  
  
  METHODS
  Multisite cross-sectional survey.
  
  
  METHODS
  Adult acute-care hospitals in the United States (Pennsylvania), Canada (Ontario and British Columbia), England, and Scotland.
  
  
  METHODS
  10 319 nurses working on medical and surgical units in 303 hospitals across the five jurisdictions.
  
  
  METHODS
  None.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia 19104-6069, USA. laiken@nursing.upenn.edu
authors.forename: Linda H
authors.initials: LH
authors.lastname: Aiken
authors.forename: Sean P
authors.initials: SP
authors.lastname: Clarke
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Sloane
mesh_terms: D001291:Attitude of Health Personnel; D001955:British Columbia; D002055:Burnout, Professional / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004739:England; D006302:Health Services Research; D006739:Hospital Administration / Q000379:methods*; D006801:Humans; D007588:Job Satisfaction; D015401:Nursing Administration Research; D009741:Nursing Staff, Hospital / Q000458:organization & administration / Q000523:psychology* / Q000706:statistics & numerical data / Q000600:supply & distribution; D009864:Ontario; D017063:Outcome Assessment, Health Care; D010414:Pennsylvania; D011787:Quality of Health Care / Q000145:classification*; D012606:Scotland; D011795:Surveys and Questionnaires