PROVIDING QUALITY CARE

Nurse staffing, quality of nursing care and nurse job outcomes in intensive care units
Sung-Hyun Cho, Kyung Ja June, Yun Mi Kim, Yong Ae Cho, Cheong Suk Yoo, Sung-Cheol Yun and
Young Hee Sung

Aim. To examine the relationship between nurse staffing and nurse-rated quality of nursing care and job outcomes.
Background. Nurse staffing has been reported to influence patient and nurse outcomes.
Design. A cross-sectional study with a survey conducted August–October 2007.
Methods. The survey included 1365 nurses from 65 intensive care units in 22 hospitals in Korea. Staffing was measured using two indicators: the number of patients per nurse measured at the unit level and perception of staffing adequacy at the nurse level. Quality of care and job dissatisfaction were measured with a four-point scale and burnout measured by the Maslach
Burnout Inventory. Multilevel logistic regression models were used to determine the relationships between staffing and quality of care and job outcomes.
Results. The average patient-to-nurse ratio was 2Æ8 patients per nurse. A fifth of nurses perceived that there were enough nurses to provide quality care, one third were dissatisfied, half were highly burnt out and a quarter planned to leave in the next year.
Nurses were more likely to rate quality of care as high when they cared for two or fewer patients (odds ratio, 3Æ26; 95% confidence interval, 1Æ14–9Æ31) or 2Æ0–2Æ5 patients (odds ratio, 2Æ44; 95% confidence interval, 1Æ32–4Æ52), compared with having more than three patients. Perceived adequate staffing was related to a threefold increase (odds ratio, 2Æ97; 95% confidence interval, 2Æ22–3Æ97) in the odds of nurses’ rating high quality and decreases in the odds of dissatisfaction (odds ratio,
0Æ30; 95% confidence interval, 0Æ23–0Æ40), burnout (odds ratio, 0Æ50; 95% confidence interval, 0Æ34–0Æ73) and plan to leave
(odds ratio, 0Æ40; 95% confidence interval, 0Æ28–0Æ56).
Conclusions. Nurse staffing was associated with quality of care and job outcomes in the context of Korean intensive care units.
Relevance to clinical practice. Adequate staffing must be assured to achieve better quality of care and job outcomes.
Key words: burnout, intensive care unit, intention to leave, job dissatisfaction, nurse staffing, quality
Accepted for publication: 30 September 2008

Providing adequate nurse staffing has been discussed as a key working condition of hospital nurses. However, nurses in many countries have continuously reported that hospitals are

not staffed with enough nurses. Aiken et al. (2001a) pointed out that the proportion of nurses reporting that there were enough registered nurses on staff to provide quality patient care decreased from 98% in 1986 to 51% in 1998. In an international comparison of five developed countries, only

Authors: Sung-Hyun Cho, PhD, RN, Department of Nursing,
Hanyang University, Seoul, Korea; Kyung Ja June, PhD, RN,
Department of Nursing, Soonchunhyang University, Chonan,
Korea; Yun Mi Kim, PhD, RN, Department of Nursing, Eulji
University, Seongnam, Korea; Yong Ae Cho, MSN, RN, Department of Clinical Nursing Science, Samsung Medical Center,
Sungkyunkwan University, School of Medicine, Seoul, Korea;
Cheong Suk Yoo, MSN, RN, Department of Nursing, Seoul
National University Hospital, Seoul, Korea; Sung-Cheol Yun, PhD,

Department of Preventive Medicine, College of Medicine, University of Ulsan, Seoul, Korea; Young Hee Sung, PhD, RN, Department of
Clinical Nursing Science, Samsung Medical Center, Sungkyunkwan
University, School of Medicine, Seoul, Korea
Correspondence: Young Hee Sung, Department of Clinical Nursing
Science, Samsung Medical Center, Sungkyunkwan University, School of Medicine, #50 Ilwon-dong Kangnam-gu, Seoul, Korea 135-710.
Telephone: 82 2 3410 2901.
E-mail: yhee.sung@samsung.com

Introduction

Ó 2009 The Authors. Journal compilation Ó 2009 Blackwell Publishing Ltd, Journal of Clinical Nursing, 18,