title: The Relationships of Nurse Staffing Level and Work Environment With Patient Adverse Events.
abstract: OBJECTIVE
  The purpose of this study was to examine the relationships of nurse staffing level and work environment with patient adverse events.
  
  
  METHODS
  This cross-sectional study used a combination of nurse survey data (N = 4,864 nurses), facility data (N = 58 hospitals), and patient hospital discharge data (N = 113,426 patients) in South Korea.
  
  
  METHODS
  The three most commonly nurse-reported adverse events included administration of the wrong medication or dose to a patient, pressure ulcers, and injury from a fall after admission. Multilevel ordinal logistic regression was employed to explore the relationships of nurse staffing level (number of patients assigned to a nurse) and work environment (Practice Environment Scale of the Nursing Work Index) with patient adverse events after controlling for nurse, hospital, and patient characteristics.
  
  
  RESULTS
  A larger number of patients per nurse was significantly associated with a greater incidence of administration of the wrong medication or dose (odds ratio [OR] = 1.01, 95% confidence interval [CI] = 1.007-1.016), pressure ulcer (OR = 1.01, 95% CI = 1.007-1.016), and patient falls with injury (OR = 1.02, 95% CI = 1.013-1.022). A better work environment had a significant inverse relationship with adverse events; the odds of reporting a higher incidence of adverse events were 45% lower for administration of the wrong medication or dose (OR = 0.55, 95% CI = 0.400-0.758), followed by 39% lower for pressure ulcer (OR = 0.61, 95% CI = 0.449-0.834) and 32% lower for falls with injury after admission (OR = 0.68, 95% CI = 0.490-0.939).
  
  
  CONCLUSIONS
  This study found that a larger number of patients per nurse and poor work environment increase the incidence of patient adverse events, such as administration of the wrong medication or dose to a patient, pressure ulcers, and injury from falling after admission. The findings suggest that South Korean hospitals could prevent patient adverse events by improving nurse staffing and work environment.
  
  
  CONCLUSIONS
  Healthcare strategies and efforts to modify adequate nurse staffing levels and better work environments for nurses are needed to improve patient outcomes.
authors.affiliation: Associate Professor, College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea.
authors.forename: Eunhee
authors.initials: E
authors.lastname: Cho
authors.affiliation: Postdoctoral Scholar, School of Nursing, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Dal Lae
authors.initials: DL
authors.lastname: Chin
authors.affiliation: Research Assistant, College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea.
authors.forename: Sinhye
authors.initials: S
authors.lastname: Kim
authors.affiliation: Professor, School of Nursing, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: OiSaeng
authors.initials: O
authors.lastname: Hong
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D055361:Multilevel Analysis; D009741:Nursing Staff, Hospital / Q000706:statistics & numerical data / Q000600:supply & distribution*; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data*; D003668:Pressure Ulcer / Q000453:epidemiology*; D056910:Republic of Korea / Q000453:epidemiology; D011795:Surveys and Questionnaires; D017132:Workplace; D014947:Wounds and Injuries / Q000453:epidemiology*
keywords: Korea; nurse staffing; patient adverse events; patient outcomes; work environment