Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction

• Published in: JAMA : the journal of the American Medical Association Vol. 288; no. 16; pp. 1987 - 1993
• Main Authors: Aiken, Linda H, Clarke, Sean P, Sloane, Douglas M, Sochalski, Julie, Silber, Jeffrey H
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 23.10.2002
• Subjects: Adult; Aged; Biological and medical sciences; Burnout; Burnout, Professional - epidemiology; Cross-Sectional Studies; Female; Health participants; Health Services Research; Hospital Bed Capacity, 100 to 299; Hospital Mortality; Hospitals; Hospitals, General - standards; Humans; Job Satisfaction; Male; Medical sciences; Middle Aged; Mortality; Nurses; Nursing Research; Nursing Service, Hospital - standards; Nursing Staff, Hospital - psychology; Nursing Staff, Hospital - supply & distribution; Odds Ratio; Outcome and Process Assessment (Health Care); Pennsylvania; Personnel Staffing and Scheduling - standards; Public health. Hygiene; Public health. Hygiene-occupational medicine; Shortages; Surgical Procedures, Operative - mortality; Surgical Procedures, Operative - nursing; Surgical Procedures, Operative - standards; United States; Workforce; Workload - psychology; United States; North America; America; Human; Statistical analysis; Surgery; Treatment efficiency; Mortality; Health care staff; Hospital ward; Complication; Hospital; Public health; Nurse
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.288.16.1987

CONTEXT The worsening hospital nurse shortage and recent California legislation mandating minimum hospital patient-to-nurse ratios demand an understanding of how nurse staffing levels affect patient outcomes and nurse retention in hospital practice. OBJECTIVE To determine the association between the patient-to-nurse ratio and patient mortality, failure-to-rescue (deaths following complications) among surgical patients, and factors related to nurse retention. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analyses of linked data from 10 184 staff nurses surveyed, 232 342 general, orthopedic, and vascular surgery patients discharged from the hospital between April 1, 1998, and November 30, 1999, and administrative data from 168 nonfederal adult general hospitals in Pennsylvania. MAIN OUTCOME MEASURES Risk-adjusted patient mortality and failure-to-rescue within 30 days of admission, and nurse-reported job dissatisfaction and job-related burnout. RESULTS After adjusting for patient and hospital characteristics (size, teaching status, and technology), each additional patient per nurse was associated with a 7% (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.03-1.12) increase in the likelihood of dying within 30 days of admission and a 7% (OR, 1.07; 95% CI, 1.02-1.11) increase in the odds of failure-to-rescue. After adjusting for nurse and hospital characteristics, each additional patient per nurse was associated with a 23% (OR, 1.23; 95% CI, 1.13-1.34) increase in the odds of burnout and a 15% (OR, 1.15; 95% CI, 1.07-1.25) increase in the odds of job dissatisfaction. CONCLUSIONS In hospitals with high patient-to-nurse ratios, surgical patients experience higher risk-adjusted 30-day mortality and failure-to-rescue rates, and nurses are more likely to experience burnout and job dissatisfaction.