Are minimum nurse-to-patient staffing ratios needed in hospitals? An observational study in British Columbia, Canada

ObjectiveTo evaluate staffing conditions, patient outcomes, quality of care, patient safety and nurse job outcomes in British Columbia (BC), Canada hospitals.DesignCross-sectional study of 58 hospitals in BC with surveys of nurses and independent measures of patient outcomes.Setting58 hospitals in B...

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Vydáno v:BMJ open Ročník 15; číslo 7; s. e099358
Hlavní autoři: Lasater, Karen B, Brom, Heather, Aiken, Linda H, McHugh, Matthew D
Médium: Journal Article
Jazyk:angličtina
Vydáno: England British Medical Journal Publishing Group 30.07.2025
BMJ Publishing Group LTD
BMJ Publishing Group
Témata:
Adult
British Columbia
Burnout
Burnout, Professional - epidemiology
Clinical outcomes
Cross-Sectional Studies
Female
Health & safety
Health policy
Health Workforce
Hospital Mortality
Hospitals
Humans
Intensive care
Job Satisfaction
Likert scale
Male
Medical personnel
Mortality
Nurses
Nursing
Nursing care
Nursing Staff, Hospital - supply & distribution
Observational studies
Patient Readmission - statistics & numerical data
Patient Safety
Personnel Staffing and Scheduling - standards
Personnel Staffing and Scheduling - statistics & numerical data
Polls & surveys
Quality in health care
Quality of Health Care
Ratios
Retention
Shift work
Well being
Workforce planning
British Columbia
British Columbia Canada
Canada
United States > US
Health Workforce
Health & safety
Health policy
Hospitals
Nurses
Quality in health care
ISSN:2044-6055, 2044-6055
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Shrnutí:ObjectiveTo evaluate staffing conditions, patient outcomes, quality of care, patient safety and nurse job outcomes in British Columbia (BC), Canada hospitals.DesignCross-sectional study of 58 hospitals in BC with surveys of nurses and independent measures of patient outcomes.Setting58 hospitals in BC.Participants6685 hospital-based nurses working in a direct patient care role.ExposuresHospital-wide and unit-specific patient-to-nurse staffing ratios derived from registered nurse reports of how many patients and how many nurses were on their unit during their last shift worked.Main outcomes and measuresObjective patient outcome measures included the Hospital Standardized Mortality Ratio (HSMR) and 30-day Readmission Rate, from 2022 to 2023 Canadian Institute for Health Information data. Nurses4All@BC provided data from 2024 using validated items on multiple measures (eg, nurse burnout, missed health breaks, intentions to leave, quality and safety measures such as culture of patient safety, quality of nursing care, missed nursing care).ResultsBurnout (59.4%), missed health breaks (41.7%), job dissatisfaction (36.0%), intentions to leave (19.3%) and patient outcomes (HSMR mean 95.4, median 96.0, range 26–180; readmission rate mean 10.0%, median 9.5%, range 7.9%–13.8%) were high and varied across hospitals. 68.3% of nurses reported there were not enough staff, and 77.3% reported their workloads were unsafe for patients. 60.6% of nurses gave their hospital an unfavourable patient safety rating. More patients per nurse were associated with poorer hospital mortality and readmission rates, poorer job outcomes for nurses, more adverse events for patients, less favourable ratings of quality of care and patient safety, more missed nursing care and poorer ratings of staffing adequacy and management.ConclusionsGiven the variability in staffing, quality and patient outcomes across BC hospitals, the implementation of a minimum nurse-to-patient ratio policy has the potential to improve patient care safety and retention of nurses.
Bibliografie:Original research
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SourceType-Scholarly Journals-1
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ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2025-099358