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

TitleHospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction
Publication TypeJournal Article
Year of Publication2002
AuthorsAiken, Linda H., Sean P. Clarke, Douglas M. Sloane, Julie A. Sochalski, and Jeffrey H. Silber
JournalJournal of the American Medical Association
Volume288
Pagination1987-1993
ISBN Number0098-7484
Accession NumberPMID: 12387650
AbstractContext: 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.
URLhttp://dx.doi.org/10.1001/jama.288.16.1987