Nurse staffing and nurse outcomes: A systematic review and meta-analysis

• Published in: Nursing outlook Vol. 66; no. 3; pp. 273 - 282
• Main Authors: Shin, Sujin, Park, Jin-Hwa, Bae, Sung-Heui
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2018
• Subjects: Humans; Meta-analysis; Nurse outcomes; Nurse staffing; Nurse-to-patient ratio; Nurses - statistics & numerical data; Nurses - supply & distribution; Nursing; Outcome Assessment (Health Care) - standards; Outcome Assessment (Health Care) - statistics & numerical data; Personnel Staffing and Scheduling - standards; Personnel Staffing and Scheduling - statistics & numerical data; Systematic review; Workforce - standards; Workforce - statistics & numerical data; Systematic review; Nurse-to-patient ratio; Nurse outcomes; Nurse staffing; Meta-analysis
• ISSN: 0029-6554; 1528-3968
• DOI: 10.1016/j.outlook.2017.12.002

•Greater nurse-to-patient ratio was consistently associated with the high degree of burnout of nurses.•An increase of one patient per RN ratio was associated with an 8% increase in odds of job dissatisfaction.•Nurses' intention to leave was increased 1.05 times when nurse-to-patient ratio was increased by 1.•Results of this meta-analysis showed that the effect size for nurse's job dissatisfaction was higher than that for nurse's burnout or intent to leave.•Findings of our study demonstrate that the greater nurse-to-patient ratio was related to negative nurse outcomes. A great number of studies have been conducted to examine the relationship between nurse staffing and patient outcomes. However, none of the reviews have rigorously assessed the evidence about the effect of nurse staffing on nurse outcomes through meta-analysis. The purpose of this review was to systematically assess empirical studies on the relationship between nurse staffing and nurse outcomes through meta-analysis. Published peer-reviewed articles published between January 2000 and November 2016 were identified in CINAHL, PubMed, PsycINFO, Cochrane Library, EBSCO, RISS, and DBpia databases. This meta-analysis showed that greater nurse-to-patient ratio was consistently associated with higher degree of burnout among nurses (odds ratio: 1.07; 95% confidence interval [CI]: 1.04–1.11), increased job dissatisfaction (odds ratio: 1.08; 95% CI: 1.04–1.11), and higher intent to leave (odds ratio: 1.05; 95% CI: 1.02–1.07). With respect to needlestick injury, the overall effect size was 1.33 without statistical significance. The study findings demonstrate that higher nurse-to-patient ratio is related to negative nurse outcomes. Future studies assessing the optimal nurse-to-patient ratio level in relation to nurse outcomes are needed to reduce adverse nurse outcomes and to help retain nursing staff in hospital settings.