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JONA: Journal of Nursing Administration

November 2003, Volume 33 Number 11 , p 607 - 614


  • Linda Burnes Bolton DrPH, RN, FAAN
  • Carolyn E. Aydin PhD
  • Nancy Donaldson DNSc, RN, FAAN
  • Diane Storer Brown PhD, RN
  • Marsha S. Nelson MBA, RN
  • Dorel Harms MHA, RN, FACHE


SUMMARY: OBJECTIVE To examine the relationship between nurse staffing and patient perceptions of nursing care in a convenience sample of 40 California hospitals.BACKGROUND Growing concern about the adequacy of nurse staffing has led to an increased emphasis on research exploring the relationships between nurse staffing and patient outcomes. Patient satisfaction with nursing care is one of the 21 indicators identified by the American Nurses Association as having a strong “theoretical link to the availability and quality of professional nursing services in hospital settings.” This prospective study examined the relationship between nurse staffing and patient perceptions of nursing care in multiple hospitals using common definitions of both nurse staffing and patient perceptions of care.METHODS Nurse staffing (structural variables) and patient perceptions of nursing care (outcome variables) from hospitals participating in both the ongoing California Nursing Outcomes Coalition statewide database project and the statewide Patients' Evaluation of Performance in California project, with data available on both measures for the same time periods, were examined. Analytic methods included both descriptive and inferential statistics.RESULTS Hospitals with wide ranges of staffing levels showed similar results in patient perceptions of nursing care. Regression analysis revealed a statistically significant relationship between nursing hours per patient day, and 1 of the 6 dimensions of care measured (“respect for patient's values, preferences, and expressed needs”).CONCLUSIONS Nurse staffing alone showed a significant but weak relationship to patient perceptions of their care, indicating that staffing is likely only one of several relevant variables influencing patient perceptions of their nursing care. This research contributes data to the body of knowledge regarding nurse staffing. It is essential that nurse executives integrate results from this and other studies in developing strategic and tactical staffing plans that yield positive patient care outcomes.

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