Nurse staffing levels in critical care: The impact of patient characteristics.

BACKGROUND: Intensive care is one of the most resource-intensive forms of care because seriously ill patients are cared for in units with high staffing levels. Studies show that the number of registered nurses (RNs) per patient and nurse education level affects patient outcome. However, there is a lack of studies that consider how nurses/patient ratio with an advanced educational level of specialized nurses in intensive care, affect the intensive care performed in different patient populations. AIM: To investigate if differences in patient characteristics and nurse-patient ratio have an impact on the quality of care. STUDY DESIGN: This is a retrospective observational study with a review of all patients >15 years receiving care at two general intensive care units with different nurse/patient ratio (unit A, 1:1 nurse/patient ratio and unit B, 0.5:1 nurse/patient ratio). RESULTS: There was no significant difference in the initial severity of illness between the units. However, younger patients, male patients and patients requiring surgery entailed a higher workload and a longer intensive care unit (ICU) stay despite a 1:1 critical care nurse/patient ratio. A small difference, but not significant, with more unplanned re-intubations occurred at unit A compared with unit B. CONCLUSION: The differences in the nurse/patient ratio did not reflect a difference in the severity of illness among admitted patients but might be explained by patient characteristics with different needs. RELEVANCE TO CLINICAL PRACTICE: Health care managers should consider not only the number of nurses but also their educational level, specific competencies and skills mix and nursing-sensitive measures to provide high-quality ICU care in settings with different patient characteristics. Nursing-sensitive patient outcomes should be considered in relation to nurse/patient ratio, as important to measure to ensure a high quality of patient care in the ICU.

Learning from COVID-19: Cross-sectional e-survey of critical care nurses' satisfaction and experiences of their role in the pandemic response across the United Kingdom.

BACKGROUND: Since the start of the global COVID-19 pandemic in 2019, critical care nurses across the world have been working under extreme levels of pressure. AIM: To understand critical care nurses' experiences of and satisfaction with their role in the pandemic response across the United Kingdom (UK). STUDY DESIGN: A cross-sectional electronic survey of critical care nurses (n = 339) registered as members of the British Association of Critical Care Nurses. Anonymous quantitative and open-ended question data were collected in March and April 2021 during the height of the second surge of COVID-19 in the UK via an online questionnaire. Quantitative data were analysed using descriptive statistics and free text responses were collated and analysed thematically. RESULTS: There was a response rate of 17.5%. Critical care nurses derived great satisfaction from making a difference during this global crisis and greatly valued teamwork and support from senior nurses. However, nurses consistently expressed concern over the quality of safe patient care, which they perceived to be suboptimal due to staff shortages and a dilution of the specialist skill mix. Together with the high volume of patient deaths, critical care nurses reported that these stressors influenced their personalwell-being. CONCLUSIONS: This study provides insights into the key lessons health care leaders must consider when managing the response to the demands and challenges of the ongoing COVID-19 pandemic. COVID-19 is unpredictable in its course, and what future variants might mean in terms of transmissibility, severity and resultant pressures to critical care remains unknown. RELEVANCE TO CLINICAL PRACTICE: Future responses to the challenges that critical care faces must consider nurses' experiences and create an environment that engenders supportive teamwork, facilitates excellent nursing practice and effective safe patient care where critical care nursing may thrive.

Staffing critical care with nurses amid the COVID-19 crisis: Strategies and plans.

AIM: To describe a nursing staffing surge model in critical care units that can be used during a pandemic or crisis. This model may give useful guidance for hospitals or centers that must immediately react in response to the devastating challenges introduced by disease outbreaks. BACKGROUND: During the COVID-19 pandemic, many hospitals were challenged to maintain the quality of care and safe practice in critical care units while accommodating the daily rapidly increasing number of infected cases that needed critical care. The nursing staffing shortage in critical care units and its consequences were among the top issues to deal with. METHOD: This is a descriptive study about our experience in preparing for nursing staffing in critical care as a part of the COVID-19 surge plan. We have used evidence-based strategies to design our team-based model for staffing during the COVID-19 pandemic. RESULTS: The team-based model for staffing during the COVID-19 pandemic had shown success in dealing with the acute shortage of nursing staff in critical care units. We had implemented other additional supportive strategies to help enhance this staffing. CONCLUSION: With the support of available evidence-based resources and on-the-fly preparation and training, we were able to augment the tremendous increase in patient influx during the pandemic using the team-based model. IMPLICATIONS FOR NURSING MANAGEMENT: The team-based approach and other strategies included in this article can help support critical care units with staff during crises. However, we strongly recommend developing a nursing deployment policy that makes staff redeployment and re-allocation smoother, whenever needed.

Intensive care nurse staffing and nurse outcomes: A systematic review.

BACKGROUND: Intensive care units (ICU) are associated with significant work stress and exert continuous physical and emotional demand upon health care providers. The health and well-being of care providers, including ICU nurses, is a matter of great concern. However, to the researcher's knowledge, there have been no reviews synthesizing the evidence about the relationship between nurse staffing and nurse outcomes in the ICU. PURPOSE: The purpose of this systematic review was to examine nurse staffing in the ICU and synthesize literature to examine the relationship with nurse outcomes such as job satisfaction, burnout, fatigue, and intent to leave. METHODS: This review was reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Peer-reviewed articles published between January 2000 and September 2019 were identified via eight electronic bibliographic databases. Articles were included and reviewed if they were correlational studies examining the relationships between nurse staffing and nurse outcomes in the ICU, and were published in peer-reviewed journals written in either English or Korean. The Quality Assessment and Validity Tool for Correlation Studies was used for quality appraisal. RESULTS: From 5086 articles, eight published between 2006 and 2019 were included in this review. Three studies found expected relationships between worse nurse staffing and adverse nurse outcomes (high burnout, fatigue state, emotional exhaustion, depersonalization, and stress). However, the relationships between nurse staffing and other adverse nurse outcomes were not significant. Perceived adequate staffing was negatively related to adverse nurse outcomes. However, a non-significant relationship also was found. CONCLUSION: This study found limited evidence on relationships between nurse staffing and nurse outcomes in the ICU. More studies are needed to conduct to find a conclusive relationship. RELEVANCE TO CLINICAL PRACTICE: Given high demands and workload in the ICU, nurse staffing levels should be closely monitored to prevent adverse nurse outcomes.

The relationship between work-related musculoskeletal disorders, chronic occupational fatigue, and work organization: A multi-hospital cross-sectional study.

AIMS: To identify the prevalence of work-related musculoskeletal disorders, levels of chronic occupational fatigue, and how they vary with individual and work organization factors. DESIGN: A multi-hospital cross-sectional survey. METHODS: Nurses from 39 hospitals completed self-reported questionnaires from June to September 2015. Descriptive statistics were used to summarize hospitals and nurses' characteristics, fatigue levels and prevalence, and type of musculoskeletal disorders. Linear and logistic regression analyses were used to identify correlational factors. RESULTS: The results revealed that 71.3% of participants reported a work-related musculoskeletal disorder in the previous 12 months, mainly back pain. The reported musculoskeletal disorders were significantly correlated with years of experience, nurse to patient ratios, and chronic occupational fatigue. Higher chronic occupational fatigue levels were associated with education, age, years of experience, nurse to patient ratio, and model of care. CONCLUSION: Preventive work organization strategies are needed to ensure healthier occupational environment for nurses.

Predicting the effect of nurse-patient ratio on nurse workload and care quality using discrete event simulation.

AIM: A novel nurse-focused discrete event simulation modelling approach was tested to predict nurse workload and care quality. BACKGROUND: It can be challenging for hospital managers to quantify the impact of changing operational policy and technical design such as nurse-patient ratios on nurse workload and care quality. Planning tools are needed-discrete event simulation is a potential solution. METHOD: Using discrete event simulation, a demonstrator "Simulated Care Delivery Unit" model was created to predict the effects of varying nurse-patient ratios. Modelling inputs included the following: patient care data (GRASP systems data), inpatient unit floor plan and operating logic. Model outputs included the following: nurse workload in terms of task-in-queue, cumulative distance walked and Care quality in terms of task in queue time, missed care. RESULTS: The model demonstrated that as NPR increases, care quality deteriorated (120% missed care; 20% task-in-queue time) and nursing workload increased (120% task-in-queue; 110% cumulative walking distance). CONCLUSIONS: DES has the potential to be used to inform operational policy and technical design decisions, in terms of impacts on nurse workload and care quality. IMPLICATIONS FOR NURSING MANAGEMENT: This research offers the ability to quantify the impacts of proposed policy changes and technical design decisions, and provide a more cost-effective and safe alternative to the current trial and error methodologies.

A causal model for the quality of nursing care in Thailand.

BACKGROUND: A growing global nursing shortage has affected the quality of care (QOC) provision. AIM: To test the structure-process-outcome model for quality of nursing care in regional medical centres in Thailand. METHODS: A cross-sectional study with multi-stage, proportional stratified random sampling. The sample comprised 136 units, 916 nurses and 943 patients from nine regional medical centres. Data were collected from six instruments in February-June 2016 and analysed with structural equation modelling. RESULTS: The modified model fitted the empirical data. The nurse practice environment (NPE) had a negative direct effect on pressure ulcer prevalence and a positive direct effect on patient satisfaction, perceived QOC and interpersonal processes of care (IPC). Increasing the patient-to-nurse ratio had a positive direct effect on catheter-associated urinary tract infections and pressure ulcer prevalence and had negative direct effects on patient satisfaction and perceived QOC. Skill mix had negative direct effects on the two former conditions but had a positive direct effect on patient satisfaction. The patient-to-nurse ratio and skill mix also had indirect effect on four outcomes via NPE. LIMITATIONS: The generalizability of findings may be limited to settings similar to this study. CONCLUSION: We empirically demonstrated that NPE, patient-to-nurse- ratio and skill mix had direct effects on unfinished nursing care and four outcomes. Also, the IPC had significant influence on patient satisfaction. IMPLICATIONS FOR NURSING AND HEALTH POLICY: The findings add to increasing international evidence that favourable nurse working conditions, low nurse-to-patient ratio and richer skill mix result in positive patient outcomes. Health systems can foster nurses to perform high-quality care by improving work conditions, and providing sufficient nurses and resources.

Nurses' implementation of ventilator-associated pneumonia prevention guidelines: an observational study in Jordan.

BACKGROUND: Ventilator-associated pneumonia prevention guidelines from the Center for Disease Control and Prevention, the American Thoracic Society, and the Institute for Health Care and Improvement have been published to reduce the rate of ventilator-associated pneumonia in the clinical settings; however, nurses' compliance with these guidelines is still questionable. AIMS: The purpose of this study was to assess nurses' compliance with ventilator-associated pneumonia prevention guidelines and the factors that influence their compliance. DESIGN: A structured observational design with a non-participant approach. METHOD: One hundred nurses were observed during their care for patients on mechanical ventilator. The observers documented nurses' implementation of ventilator-associated pneumonia prevention guidelines using a structured observational sheet. RESULTS: Compliance of nurses was found to be unsatisfactory. Of the participants, 63% showed 'insufficient compliance'. Nurses working in units with a 1:1 nurse:patient ratio and lower beds' capacity demonstrated higher compliance and their intensive care units had a lower rate of ventilator-associated pneumonia and shorter intensive care unit stay in comparison with their counterparts working with a 1:2 nurse:patient ratio and higher beds' capacity. CONCLUSION: Nurses' compliance with ventilator-associated pneumonia prevention guidelines was insufficient. Low nurse-patient ratio and large intensive care unit beds capacity were found to affect nurses' compliance and patients' outcomes. This study expanded knowledge about important aspects of nursing care; nurses' compliance with ventilator-associated pneumonia prevention guidelines and the factors that affect their compliance. This knowledge can be used by health professional to guide the clinical practice and to improve the quality of care.

Impact of teamwork on missed care in four Australian hospitals.

AIMS AND OBJECTIVES: Investigate effects of teamwork on missed nursing care across a healthcare network in Australia. BACKGROUND: Missed care is universally used as an indicator of quality nursing care, however, little is known about mitigating effects of teamwork on these events. DESIGN: A descriptive exploratory study. METHODS: Missed Care and Team Work surveys were completed by 334 nurses. Using Stata software, nursing staff demographic information and components of missed care and teamwork were compared across the healthcare network. Statistical tests were performed to identify predicting factors for missed care. RESULTS: The most commonly reported components of missed care were as follows: ambulation three times per day (43·3%), turning patient every two hours (29%) and mouth care (27·7%). The commonest reasons mentioned for missed care were as follows: inadequate labour resources (range 69·8-52·7%), followed by material resources (range 59·3-33·3%) and communication (range 39·3-27·2%). There were significant differences in missed care scores across units. Using the mean scores in regression correlation matrix, the negative relationship of missed care and teamwork was supported (r = -0·34, p < 0·001). Controlling for occupation of the staff member and staff characteristics in multiple regression models, teamwork alone accounted for about 9% of missed nursing care. CONCLUSION: Similar to previous international research findings, our results showed nursing teamwork significantly impacted on missed nursing care. Teamwork may be a mitigating factor to address missed care and future research is needed. RELEVANCE TO CLINICAL PRACTICE: These results may provide administrators, educators and clinicians with information to develop practices and policies to improve patient care internationally.

Patient acuity and nurse staffing challenges in Norwegian neonatal intensive care units.

AIM: To describe fluctuations in patient numbers, patient acuity and the need for nurses in neonatal intensive care units based on population data. BACKGROUND: Neonatal intensive care units are difficult to staff appropriately due to fluctuations in patient volume and acuity. Staffing guidelines have been developed and applied in some countries to offer the neonatal population safe patient care. METHOD: National data were used to describe patient load and acuity for two consecutive years. The need for nurses was calculated by combining these data with guidelines for nurse staffing. RESULTS: A total of 11.3% of all neonatal patients in Norway were categorised as intensive care patients. There were no differences in the need for nurses in weekends vs. weekdays or during summer holidays vs. days in the rest of the year. Small units have increased variability in staffing needs, and sufficient staffing is more challenging compared to that of larger units. CONCLUSION AND IMPLICATIONS FOR NURSING MANAGEMENT: Planning for reduced staffing for weekends and summer seasons is ineffective. Staffing planned for most of the days in a year instead of the median need for nurses will result in a greater increase in the need for nurses in small units compared to larger units.

[Concept for Planning the Nurse-Patient Ratio and Nursing Fee Payment Linkage System].

This article describes the current situation in Taiwan with regard to the nurse-patient ratio and nursing fee payments, reviews the related policies and results in developed countries, and then proposes a plan for improving the domestic situation. Direct relationships exist between patient nursing quality and patient safety and the nurse-patient ratio as well as between nursing fee payments and the nurse-patient ratio. Therefore, in order to enhance the quality and safety of nursing care, it will be necessary to develop and institute a payment linkage system that links nursing fee payments to the nurse-patient ratio. This process requires public consensus and planning in order to institute an equitable and effective payment linkage system in the future.

Effect of nurse staffing variation and hospital resource utilization.

In this study, we examined the effect of variations in nurse staffing levels on the length of stay and medical expenses of patients who underwent hip or knee surgeries. A cross-sectional study was conducted using the National Health Insurance database and hospital surveys from 2010. Patient length of stay and medical expenses by nurse staffing level and skill mix were compared after adjusting for hospital and patient characteristics. Nurse staffing was measured based on staffing grade, the bed-to-registered nurse/nurse aid ratio, the bed-to-nursing personnel ratio, and the RN proportion. Generalized estimation models were used to analyze the associations. Decreased nurse staffing was consistently associated with increased length of stay, regardless of nurse staffing measures. The medical expenses associated with the lowest staffing level were approximately $US 1142.2 more than those associated with the highest staffing level. The study results suggest that maintaining a high nurse staffing level could be a cost-effective strategy for government and insurers, as well as for patients. We propose that policy makers implement more efficient nurse staffing strategies.

Staff Developed PACU Acuity Scoring Grid.

PURPOSE: The goal of this project was to design a tool to classify patients in the postanesthesia care unit (PACU) for acuity as defined by nursing interventions. DESIGN: An instrument development and validation approach was used. METHODS: A PACU acuity scoring grid was developed using the American Society of PeriAnesthesia Nurses (ASPAN) professional guidelines and Rothman Index concepts to help classify patients by acuity and determine PACU acuity class. The appropriate ASPAN nurse-patient ratio was assigned to the classification. PACU staff were educated on use of the PACU acuity scoring grid. Staff piloted the grid on patients in PACU and then refined the grid. Validity and reliability of the grid were also evaluated. FINDINGS: Data evaluation showed that 54% of patients fell into classification II, with a ratio of one nurse to two patients. Classification III is the second highest category with 38%, with a ratio of one nurse to one patient. The tool demonstrated validity and the Cronbach alpha measure of reliability for the PACU acuity scoring grid was 0.695 on 73 of the 92 variables on the grid. CONCLUSIONS: The PACU acuity scoring grid is a tool that can be used to identify patient acuity by assigning acuity points to nursing interventions in five categories. The acuity points can be used to assign a patient to a PACU class, which can then converted to a nurse-patient ratio to allow for the provision of safe and efficient nursing care.

Nurse Staffing in Neonatal Intensive Care Units in the United States.

The neonatal intensive care unit (NICU) is a setting with high nurse-to-patient ratios. Little is known about the factors that determine nurse workload and assignment. The goals of this study were to (1) develop a measure of NICU infant acuity; (2) describe the acuity distribution of NICU infants; (3) describe the nurse/infant ratio at each acuity level, and examine the factors other than acuity, including nurse qualifications and the availability of physicians and other providers, that determined staffing ratios; and (4) explore whether nurse qualifications were related to the acuity of assigned infants. In a two-stage cohort study, data were collected in 104 NICUs in 2008 by nurse survey (6,038 nurses and 15,191 infants assigned to them) and administrators reported on unit-level staffing of non-nurse providers; in a subset of 70 NICUs in 2009-2010, census data were collected on four selected shifts (3,871 nurses and 9,276 infants assigned to them). Most NICU infants (62%) were low-acuity (Levels 1 and 2); 12% of infants were high-acuity (Levels 4 and 5). The nurse-to-infant ratio ranged from 0.33 for the lowest-acuity infants to 0.95 for the highest-acuity infants. The staffing ratio was significantly related to the acuity of assigned infants but not to nurse education, experience, certification, or availability of other providers. There was a significant but small difference in the percentage of high-acuity (Levels 4 and 5) infants assigned to nurses with specialty certification (15% vs. 12% for nurses without certification). These staffing patterns may not optimize patient outcomes in this highly intensive pediatric care setting.

Changes in Nurse Staffing Grades of Korean Hospitals during COVID-19 Pandemic.

The global COVID-19 pandemic is creating challenges to manage staff ratios in clinical units. Nurse staffing level is an important indicator of the quality of care. This study aimed to identify any changes in the nurse staffing levels in the general wards of hospitals in Korea during the COVID-19 pandemic. The unit of analysis was the hospitals. This longitudinal study observed the quarterly change of the nurse staffing grades in 969 hospitals in 2020. The nurse staffing grades ranged from 1 to 7 according to the nurse-patient ratio measured by the number of patients (or beds) per nurse. The major dependent and independent variables were the change of nurse staffing grades and three quarterly observation points being compared with those during the 1st quarter (1Q) of 2020, respectively. A generalized linear model was used. Unexpectedly, the nurse staffing grades significantly improved (2Q: RR, 27.2%; 95% confidence interval (CI), 15.1-27.6; p < 0.001; 3Q: RR, 95% CI, 20.2%; 16.9-21.6; p < 0.001; 4Q: RR, 26.6%; 95% CI, 17.8-39.6; p < 0.001) quarterly, indicating that the nurse staffing levels increased. In the comparison of grades at 2Q, 3Q, and 4Q with those at 1Q, most figures improved in tertiary, general, and small hospitals (p < 0.05), except at 3Q and 4Q of general hospitals. In conclusion, the nurse staffing levels did not decrease, but nursing shortage might occur.

Important factors for planning nurse staffing in the emergency department: A consensus study.

INTRODUCTION: Planning adequate nurse staffing in the emergency department (ED) is challenging. Although there are models to determine nurse staffing in EDs, these models do not consider all the factors. Inadequate nurse staffing causes overcrowding, poor quality of patient care, increased hospital costs, poor patient outcomes and high levels of burnout amongst nurses. In this paper, we report stakeholders' perceptions of important factors to be considered when planning ED nursing ratios. METHODS: We applied a consensus research design. The data was generated from modified nominal group techniques followed by an e-Delphi with two rounds. The factors were generated during two nominal groups by 19 stakeholders which included management and healthcare professionals working in EDs. The generated factors were then put on a survey format for use in an e-Delphi. Using purposive and snowball sampling the survey was distributed to 74 national and international experts for consensus. RESULTS: Ultimately, 43 experts agreed (a validity index of ≥ 80%) on four categories namely: hospital, staff, patient and additional categories which included 17 related factors. CONCLUSION: Ideal nurse staffing ratios are influenced by the complexity of the environment and interactions between multiple factors. The categories and factors identified emphasised the need for extensive further research to ensure a financially viable model that will be accepted by both staff and patient, and thus promote optimal outcomes.

The effects of market concentration on health care price and quality in hospital markets in Ibadan, Nigeria.

Evidence about the Nigerian health indicators show that the quality of health care in Nigeria is low and inflation of health care prices also persists. Theoretically, by observing the market concentration, inferences can be drawn as to how hospitals conduct themselves, which allows the evaluation of the market performance. Therefore, the effects of market concentration on the health care price and quality were examined. Market concentration was measured by Herfindahl Hirschman Index (HHI) and four hospital concentration ratios (CR4). The values of HHI were disaggregated into the less and more concentrated markets. Quality of health care was measured by the staff-nurse-patient ratio. Ordinary Least Square (OLS) was used to estimate the effects of market concentration on price and quality of health care. The price of health care was found to be 13.4% lower in the less concentrated markets than in the more concentrated market. Income significantly and positively influenced health care prices by 17.8%. Also, a low HHI lead to 33.4% increase in Staff-nurse Patient Ratio (SPR) indicating that the quality of health care was higher in less concentrated markets as hospitals increased the treatment intensity via staff-nurse patient ratio. A less concentrated market is linked with higher health care quality and lower health care prices. Therefore, a strategy that will reduce market concentration so as to enhance consumer welfare in terms of price and quality is recommended.

Workload scoring systems in the Intensive Care and their ability to quantify the need for nursing time: A systematic literature review.

INTRODUCTION: The Intensive Care Unit is a resource intense service with a high nursing workload per patient resulting in a low ratio of patients per nurse. This review aims to identify existing scoring systems for measuring nursing workload on the Intensive Care and assess their validity and reliability to quantify the needed nursing time. METHODS: We conducted a systematic review of the literature indexed before 01/Mar/2018 in the bibliographic databases MEDLINE, Embase, and Cinahl. Full-text articles were selected and data on systems measuring nursing workload on the Intensive Care and translation of this workload into the amount of nursing time needed was extracted. RESULTS: We included 71 articles identifying 34 different scoring systems of which 27 were included for further analysis as these described a translation of workload into nursing time needed. Almost all systems were developed with nurses. The validity of most scoring systems was evaluated by comparing them with another system (59%) or by using time measurements (26%). The most common way to translate workload-scores into nursing time needed was by categorizing the Nurse:Patient-ratios. Validation of the Nurse:Patient-ratios was mostly evaluated by comparing the results with other systems or with the actual planning and not with objective time measurements. CONCLUSION: Despite the large attention given to nursing workload systems for Intensive Care, only a few systems objectively evaluated the validity and reliability of measuring nursing workload with moderate results. The Nursing Activity Score system performed best. Poor methodology for the translation of workload scores into Nurse:Patient-ratio weakens the value of nursing workload scoring systems in daily Intensive Care practice.

Nurse-to-patient ratio and nurse staffing norms for hospitals in India: A critical analysis of national benchmarks.

Optimum nurse-to-patient ratio is the concern of most of the nurse leaders globally. It has benefits both for nurses and patients; which is essential for patient's safety and quality of care. Some parts of the world such as California, USA, and Queensland, Australia has passed the law for the minimum nurse-to-patient ratio, which has scientifically found to be beneficial for the patients and healthcare system. Indian nurse staffing norms given by the Staff Inspection Unit, Indian Nursing Council, and Medical Council of India are developed through professional judgement models and are not updated. Five electronic databases were considered for literature search; in addition, grey literature and books were also searched. The primary outcome was to summarise exiting national nurse-to-patient norms and to find out the ideal nurse-to-patient ratio and nurse staffing norms as per Indian resources. It is concluded that nurse staffing norms must be immediately revised in the light of international norms and research evidence available in this regard. Further, there is a need for workload analysis based research evidence to have true nurse-to-patient ratio estimation for hospitals in India.

Associations of understaffing and cardiovascular health of hospital care providers: A multi-source study.

BACKGROUND: Understaffing in hospitals is a serious problem in healthcare work since it jeopardizes efficiency, reliability and quality of care as well as the work life of the healthcare professionals. However, estimates on the associations of understaffing and cardiovascular health in healthcare professionals are lacking. Further shortcomings refer to the problem, that determinant and outcome measures are often assessed via self-reports what increases the risk of spurious estimates due to common source bias. OBJECTIVE: We sought to reliably identify associations between understaffing and cardiovascular health in hospital nurses. METHODS: Multi-source and cross-sectional study. N = 273 nurses of a large academic hospital were surveyed. All filled out a standardized questionnaire to report psychosocial work conditions and underwent a standardized medical examination. Cardiovascular health outcomes were blood pressure and blood cholesterol (total cholesterol level, LDL-cholesterol) as well as the SCORE classification. Logistic regression analyses were applied to calculate risk estimates for the understaffing and cardiovascular health relationship, adjusted for individual and life-style factors (e.g., sex, age, BMI, alcohol consumption, smoking) and work related characteristics (i.e., shift work, leadership position, work load, autonomy, social support at work). RESULTS: Multivariate associations revealed significant relationships of perceived understaffing with increased blood pressure [OR = 1.60, 95% CI: 1.05, 2.43] and increased total cholesterol [OR = 1.42, 95 CI: 1.04, 1.95]. LDL cholesterol level was associated with understaffing. We furthermore observed associations of high autonomy and high cholesterol levels. CONCLUSIONS: Nurses in hospital units with lower staffing ratios had an increased risk for adverse cardiovascular health, irrespective of workload and social support. We discuss implications for future research on potential mechanisms of understaffing and nurses' health outcomes. The associated risks of poor nurse-patient-ratios for provider health need to be addressed through work and organizational design efforts.