Hospital Staffing, Organization, and Quality of Care

Hospitals are facing great challenges today; among them are budget troubles, changing clinical care requirements and organizational restructuring. Recent studies showing consumer dissatisfaction with hospital stays and publicized evidence that quality of care is threatened by the nursing shortage add to concerns about hospital care.

The International Hospital Outcomes Study was conducted in response to these issues. It seeks to determine the effects of hospital organizational support and nurse staffing on nurses' dissatisfaction with their jobs, nurse burnout and nurse reports of quality of patient care. It is a multi-site cross-sectional survey of 10,319 nurses working in 303 adult acute-care hospitals across five jurisdictions: the United States, Canada (Ontario and British Columbia), England and Scotland.

Results show that dissatisfaction, burnout and concerns about quality of care were common among hospitals in all five sites. Organizational and managerial support for nursing had a pronounced effect on nurse dissatisfaction and burnout, and both organizational support and staffing were directly and independently related to nurse-assessed quality of care. A limitation to the analysis is the potential bias created by the use of the same nurses' reports to provide data for both the independent measures and the nurse-rated quality of care outcomes for hospitals. Nevertheless, results indicate that the current state of affairs suggests poor prospects for recruiting adequate numbers of nurses for future health care needs and holds the potential for a worsening international nursing shortage.