title: Are Staffing, Work Environment, Work Stressors, and Rationing of Care Related to Care Workers' Perception of Quality of Care? A Cross-Sectional Study.
abstract: OBJECTIVE
  To describe care worker-reported quality of care and to examine its relationship with staffing variables, work environment, work stressors, and implicit rationing of nursing care.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  National, randomly selected sample of Swiss nursing homes, stratified according to language region and size.
  
  
  METHODS
  A total of 4311 care workers of all educational backgrounds (registered nurses, licensed practical nurses, nurse aides) from 402 units in 155 nursing homes completed a survey between May 2012 and April 2013.
  
  
  METHODS
  Care worker-reported quality of care was measured with a single item; predictors were assessed with established instruments (eg, Practice Environment Scale-Nurse Working Index) adapted for nursing home use. A multilevel logistic regression model was applied to assess predictors for quality of care.
  
  
  RESULTS
  Overall, 7% of care workers rated the quality of care provided as rather low or very low. Important factors related to better quality of care were higher teamwork and safety climate (odds ratio [OR] 6.19, 95% confidence interval [CI] 4.36-8.79); better staffing and resources adequacy (OR 2.94, 95% CI 2.08-4.15); less stress due to workload (OR 0.71, 95% CI 0.55-0.93); less implicit rationing of caring, rehabilitation, and monitoring (OR 0.34, 95% CI 0.24-0.49); and less rationing of social care (OR 0.80, 95% CI 0.69-0.92). Neither leadership nor staffing levels, staff mix, or turnover was significantly related to quality of care.
  
  
  CONCLUSIONS
  Work environment factors and organizational processes are vital to provide high quality of care. The improvement of work environment, support in handling work stressors, and reduction of rationing of nursing care might be intervention points to promote high quality of care in nursing homes.
authors.affiliation: Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland. Electronic address: franziska.zuniga@unibas.ch.
authors.forename: Franziska
authors.initials: F
authors.lastname: Zúñiga
authors.affiliation: Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland; University of Applied Science Claudiana, Research Department, Bozen, Italy.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Ausserhofer
authors.affiliation: CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.
authors.forename: Jan P H
authors.initials: JP
authors.lastname: Hamers
authors.affiliation: Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland; University of Pittsburgh, School of Nursing, Pittsburgh, PA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Engberg
authors.affiliation: Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland; Inselspital Bern University Hospital, Nursing and Midwifery Research Unit, Bern, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Simon
authors.affiliation: Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland.
authors.forename: René
authors.initials: R
authors.lastname: Schwendimann
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D015276:Health Care Rationing; D006801:Humans; D016015:Logistic Models; D008297:Male; D009735:Nursing Homes; D015279:Organizational Culture; D010348:Patient Care Team; D061214:Patient Safety; D010561:Personnel Staffing and Scheduling; D011787:Quality of Health Care; D013315:Stress, Psychological / Q000209:etiology / Q000517:prevention & control; D013557:Switzerland; D000078329:Workforce; D016526:Workload
keywords: Nursing homes; quality of health care; rationing of care; staffing; work environment