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Learning Objective 1: The learner will able to identify which characteristics of the nurse work environment are important in order to improve nursing quality
Learning Objective 2: The learner will able to get quantitative insight in the relationship between characteristics of nurse staffing and nurse-sensitive patient outcomes
Methods: Included were peer-reviewed quantitative studies published between 2004 and 2012. The search was performed in Medline (PubMed), Cochrane, Embase, and CINAHL. Thirty studies were selected, using previously defined inclusion criteria and the Dutch version of Cochrane’s critical appraisal instrument to assess methodological quality. Cohen’s d was used to calculate effect sizes for three measures of nurse staffing.
Results: The review shows that evidence on associations between nurse work environment and nurse-sensitive outcomes is limited and often does not provide clear-cut conclusions. The meta-analysis showed small effect sizes; for pressure ulcers d= +0.21 and for patient falls d= -0.20. Increasing the hours of care performed by registered nurses and higher proportions of registered nurses were associated with less fall incidents with effect sizes of respectively d= -0.31 and d = -0.25. In contrast, increasing the total nursing hours of care was associated with higher pressure ulcers rates (d= +0.35). Characteristics of nurse work environment other than nurse staffing which showed significant effects were: i) workload; higher workload increased rates of falls and pressure ulcers, ii) teamwork; positive communication between nurses and physicians were associated with less patient falls and lower rates of pressure ulcers, and iii) experience; lower levels of experience related to more patient falls and higher rates of pressure ulcers.
Conclusion: In this review only limited evidence was found for associations between nurse-sensitive patient outcomes and staffing and other characteristics of the nurse-work environment. Fundamental methodological issues (e.g. unclear samples), major contribution of cross-sectional designs and the large diversity on outcome measures may be explanatory for these results. Future longitudinal research is necessary to find more strong and causal evidence.