Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction.
BACKGROUND
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.


METHODS
Cross-sectional analyses of linked data from 10 184 staff nurses surveyed, 232 342 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.


METHODS
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.
Aiken
Linda H
LH
Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, 420 Guardian Dr, Philadelphia, PA 19104-6096, USA. laiken@nursing.upenn.edu
Clarke
Sean P
SP
Sloane
Douglas M
DM
Sochalski
Julie
J
Silber
Jeffrey H
JH
D000328:Adult; D000368:Aged; D002055:Burnout, Professional / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006302:Health Services Research; D006744:Hospital Bed Capacity, 100 to 299; D017052:Hospital Mortality; D006769:Hospitals, General / Q000592:standards; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D015399:Nursing Research; D009738:Nursing Service, Hospital / Q000592:standards*; D009741:Nursing Staff, Hospital / Q000523:psychology* / Q000600:supply & distribution*; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D010414:Pennsylvania; D010561:Personnel Staffing and Scheduling / Q000592:standards; D013514:Surgical Procedures, Operative / Q000401:mortality* / Q000451:nursing* / Q000592:standards; D014481:United States; D000078329:Workforce; D016526:Workload / Q000523:psychology