title: Nursing activities, nurse staffing and adverse patient outcomes as perceived by hospital nurses.
abstract: OBJECTIVE
  To investigate the relationships between nursing activities, nurse staffing and adverse patient outcomes in hospital settings as perceived by registered nurses in Finland and the Netherlands and to compare the results obtained in the two countries.
  
  
  BACKGROUND
  Previous research indicates that a higher proportion of registered nurses in the staff mix results in better patient outcomes. Knowledge of the relationship between nurse staffing and adverse patient outcomes is crucial to optimise the management of professional nursing resources and patient care.
  
  
  METHODS
  A cross-sectional, descriptive questionnaire survey.
  
  
  METHODS
  Registered nurses employed in hospitals in Finland (n = 535) and the Netherlands (n = 334), with overall response rates of 44·9% and 33·4%, respectively, participated.
  
  
  RESULTS
  The patient-to-nurse ratio was on average 8·74:1 and did not vary significantly between the countries. However, there were fewer registered nurses and significantly more licensed practical nurses among the Dutch hospital staff than the Finnish staff. In addition, Finnish nurses performed non-nursing and administrative activities more frequently than the Dutch nurses and reported more dissatisfaction with the availability of support services. Frequencies of patient falls were related to the patient-to-nurse ratio in both countries. Finnish participants reported the occurrence of adverse patient outcomes more frequently.
  
  
  CONCLUSIONS
  Significant associations were found between nurse staffing and adverse patient outcomes in hospital settings. Compared with the Netherlands, in Finland, nurses appear to have higher workloads, there are higher patient-to-nurse ratios, and these adverse staffing conditions are associated with higher rates of adverse patient outcomes.
  
  
  CONCLUSIONS
  The findings provide valuable insights into the potential effects of major changes or reductions in nursing staff on the occurrence of adverse patient outcomes in hospital settings.
authors.affiliation: Department of Nursing Science, University of Eastern Finland, Kuopio, Finland. hinno@student.uef.fi
authors.forename: Saima
authors.initials: S
authors.lastname: Hinno
authors.forename: Pirjo
authors.initials: P
authors.lastname: Partanen
authors.forename: Katri
authors.initials: K
authors.lastname: Vehviläinen-Julkunen
mesh_terms: D003430:Cross-Sectional Studies; D005387:Finland; D006801:Humans; D009426:Netherlands; D009729:Nursing; D009741:Nursing Staff, Hospital / Q000523:psychology*; D010561:Personnel Staffing and Scheduling; D015203:Reproducibility of Results; D016896:Treatment Outcome