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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.
Patient satisfaction with nursing care is 1 of the 21 indicators identified by the American Nurses Association (ANA) as "having a strong, established or theoretical link to the availability and quality of professional nursing services in hospital settings."1 Healthcare institutions, payers, and consumer groups frequently examine patient satisfaction levels for feedback on whether consumers are pleased with the quality of services provided. Findings from patient surveys are used to drive performance improvement and marketing strategies. To achieve quality goals, healthcare executives must be knowledgeable about factors affecting patient perceptions of services.
Growing concern about the adequacy of nurse staffing in the face of pressures on hospitals to control costs, coupled with the growing shortage of registered nurses, has led to an increased emphasis on research exploring the relationships between nurse staffing and patient outcomes. 1-5 Patient satisfaction with care was identified by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) as a potential indicator of hospital staffing adequacy in staffing standards issued in 2001. 6 In its national review of hospitals, the Advisory Board Company identified the need for further analysis of hospital service quality indicators, including patient satisfaction, with hospital structural attributes such as staffing. 7
Literature on the effects of nurse staffing levels on patient outcomes has been reviewed in detail elsewhere. 1-5 Patient satisfaction is one of several key outcome measures being examined by researchers exploring relationships among patient outcomes and hospital structural and care processes. However, until now, no studies have examined the relationship between nurse staffing and patient perceptions of nursing care in multiple hospitals using shared definitions of nurse staffing and a common survey tool. The present study analyzes prospective data collected from 40 hospitals participating in both the California Nursing Outcomes Coalition (CalNOC) and the Patients' Evaluation of Performance in California (PEP-C) projects. CalNOC and PEP-C data for each hospital were matched to explore the potential relationship among nurse staffing variables (CalNOC) and patient perceptions of care (PEP-C).
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