Hospital staffing, organization, and quality of care: Cross-national findings.
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 U.S. (Pennsylvania), Canada (Ontario and British Columbia), England and Scotland.


METHODS
10319 nurses working on medical and surgical units in 303 hospitals across the five jurisdictions.


METHODS
None Main outcome measures: 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.
Aiken
Linda H
LH
Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Department of Sociology, University of Pennsylvania, Philadelphia 19104, USA. laiken@nursing.upenn.edu
Clarke
Sean P
SP
Sloane
Douglas M
DM
D002055:Burnout, Professional; D003430:Cross-Sectional Studies; D006801:Humans; D007588:Job Satisfaction; D009739:Nursing Services / Q000592:standards; D009741:Nursing Staff, Hospital; D015279:Organizational Culture; D010561:Personnel Staffing and Scheduling; D011787:Quality of Health Care; D014481:United States