Search Results (25)

Workplace violence (WPV) is a major occupational hazard for nurses in Thailand, negatively affecting psychological well-being, professional confidence, and patient care. In this quantitative cross-sectional analytic study involving 415 nurses, 43.61% reported experiencing at least one incident of WPV during the previous 12 months. Verbal abuse (41.20%) and physical violence (13.25%) were the most frequently reported forms, with a higher prevalence observed in urban hospitals than in rural hospitals (53.66% vs. 33.81%). Higher WPV risk was associated with working in medical wards (adjusted incidence rate ratio [Adj IRR] 3.33) and emergency departments (Adj IRR 2.47), caring for male-only patients (Adj IRR 1.87), younger age (Adj IRR 3.31), divorced or separated status (Adj IRR 3.05), rotating day and night shifts (Adj IRR 2.03), and extreme concern about WPV (Adj IRR 4.57). The psychological impact was considerable. Hypervigilance was the most common response (66.30%), especially following physical violence (76.36%). More than 41% of affected nurses reported intentions to resign or transfer and reduced professional confidence. Reporting incidents was often perceived as ineffective, contributing to underreporting. Nurses identified clear disciplinary measures, increased staffing, improved workplace environments, stronger security systems, and organizational support as key prevention priorities. These findings highlight the urgent need for context-specific interventions, targeted staff training, and organizational strategies to protect nurse well-being, strengthen workforce resilience, and maintain quality patient care. Full article

Background/Objectives: ICU nurse staffing Standard Operating Procedures (SOPs) govern nurse-to-patient assignment and escalation rules, yet their robustness under demand variability and workforce disruption has not been quantitatively evaluated. Methods: A Discrete Event Simulation model of a 20-bed ICU was parameterized from 20,419 MICU stays extracted from MIMIC-IV v3.1. Three SOPs—Fixed Ratio, Acuity-Adjusted, and Dynamic Escalation—were evaluated across four scenarios (baseline, census surge, nurse shortage, combined disruption), each with 100 replications, using Kruskal–Wallis and Dunn’s post hoc tests. Results: Dynamic Escalation achieved the lowest adverse event rate at baseline (4.25 per 100 patient days), a 16.8% reduction relative to Fixed Ratio (5.11). However, a resource-constrained comparison equalizing total nurse hours across protocols reversed this ranking: Dynamic Escalation performed significantly worse than both static protocols (p < 0.0001), which were themselves statistically indistinguishable, indicating that its primary advantage stems from greater staffing capacity rather than superior decision logic. Conclusions: Apparent differences between ICU staffing SOPs are largely driven by total available nurse hours rather than allocation logic. Investment in staffing capacity, rather than a specific allocation rule, may be the primary lever for improving ICU patient safety outcomes. Full article

This study explores how hospital location (rural/non-rural) may moderate the nurse staffing ratio’s impact on three hospital-acquired infections. This study used data from 2022 to 2024 on nurse staffing and hospital characteristics from the American Hospital Association Annual Survey and data on hospital-acquired infection rates from the Medicare Care Compare dataset provided by the Centers for Medicare and Medicaid Services. After removing missing values, the final dataset included 7997 hospital-year observations across the US. Independent variables include rural hospital designation, nursing hours per patient day, and RN FTE per adjusted day. The dependent variables included infection rates of Central Line-Associated Bloodstream Infection, Catheter-Associated Urinary Tract Infection, and Methicillin-Resistant Staphylococcus aureus. Multiple regression was performed in Stata 18. Our research found that across all three infection types, an increase in nursing hours per patient day is significantly associated with a decrease in the infection rate, and that impact was not moderated by hospital rurality. Extra time spent with patients in either a rural or non-rural hospital decreased hospital-acquired infection rates. While RN FTEs were included in the model, total nursing hours per patient day emerged as the more consistent predictor of lower hospital-acquired infection rates. Full article

Background: Unsafe care remains a major global health challenge, contributing to millions of preventable deaths and ranking among the top ten causes of mortality and disability worldwide. The World Health Organization’s Global Patient Safety Action Plan 2021–2030 emphasizes the need for strong leadership and system-wide engagement to eliminate avoidable harm. As the largest component of the global healthcare workforce, nurses—especially those in management roles—are essential to achieving these goals. Objective: This narrative review synthesizes global evidence on how nursing management practices, particularly leadership, staffing, and safety culture, influence patient safety outcomes across diverse health systems. Methods: A purposive narrative review was conducted using PubMed, CINAHL, Scopus, and Web of Science databases. Peer-reviewed studies and organizational reports published between 2020 and 2025 were evaluated. A thematic synthesis approach was used to identify patterns related to leadership style, staffing ratios, workplace conditions, and organizational resilience. Quality appraisal followed adapted Critical Appraisal Skills Programme (CASP) and Joanna Briggs Institute (JBI) guidance. Results: A total of 37 peer-reviewed empirical studies were included in the narrative synthesis, along with key global policy and foundational framework documents used to contextualize findings. Evidence consistently demonstrated that transformational leadership, adequate nurse staffing, positive safety culture, and organizational learning structures are strongly associated with improved patient outcomes, reduced errors, and enhanced workforce well-being. Most studies exhibited moderate to high methodological rigor. Conclusions: Nursing management plays a decisive role in advancing global patient safety. Policies that strengthen leadership capacity, ensure safe staffing, promote just culture, and support nurse well-being are critical to achieving WHO’s 2030 safety objectives. Empowering nurse leaders across all regions is essential for building safer, more resilient health systems. Full article

Latvia faces one of the lowest nurse-to-population ratios in the EU, resulting in critical staff shortages in intensive care units (ICUs). Nurses frequently care for more patients than recommended, which not only compromises patient safety but also places heavy psycho-emotional burdens on staff. The aim of this study was to examine organizational-level relationships between objectively measured ICU nursing workload and subjectively reported psycho-emotional outcomes, including moral distress, burnout, and intention to leave one’s job. A secondary analysis combined data from two cross-sectional studies conducted in 2025. Workload was measured using 3420 Nursing Activities Score (NAS) protocols from three hospitals, while 155 ICU nurses from 16 units completed validated instruments assessing moral distress, burnout, and turnover intentions. The findings revealed persistent nurse shortages, with one ICU showing deficits exceeding 70% and mean NASs above 100 points per nurse per shift. Nurses reported moderate moral distress, particularly in situations of unsafe patient ratios and aggressive treatment, while burnout levels were moderate to high, especially in personal and work-related dimensions. About one-quarter of respondents were actively considering leaving their jobs. Moral distress significantly correlated with burnout (r = 0.357, p < 0.001), and organizational-level comparison indicated that higher workload was associated with greater emotional strain. These results not only highlight urgent national challenges but also resonate with international evidence on the link between unsafe staffing, moral distress, and workforce sustainability. Implementing systematic workload monitoring, safe staffing ratios, and structured support mechanisms is essential to safeguard ICU nurses’ well-being, reduce turnover, and protect patient safety in both Latvian and global contexts. Full article

Background: Falls are common adverse events among hospitalized patients, affecting outcomes and placing a financial burden on patients and hospitals. This study investigated the relationship between nurse staffing/workload and patient falls during hospitalization. Methods: The patients studied were hospitalized in the general wards (excluding pediatrics and obstetrics/gynecology) of 11 National Hospital Organization institutions between April 2019 and March 2020. The data were obtained from the Diagnosis Procedure Combination Work Record and institutional fall reports. The variables used in the analyses included patient conditions, number of hospitalization cases, emergency hospitalizations, surgeries/examinations, disease composition ratio, patient attributes, hospital stay duration, hospital bed size, and nursing time per patient (day and night) on a ward-day basis. Multivariate analysis was performed to determine the effects of these factors on fall events. Results: A total of 36,209 ward days were analyzed, with falls reported on 2866 days (fall event rate of 9.0%). The mean nursing times per patient were 1.99 h (day) and 1.47 h (night). The nursing time per patient in the fall group compared to the non-fall group showed an odds ratio of 1.19 (p < 0.01) during day shifts and 0.17 (p < 0.02) during night shifts. An increase in nursing time per patient during the night was associated with fewer fall events, whereas during the day, increased nursing time appeared to contribute to more falls. Common background factors that increased nurse staffing and patient falls simultaneously could be suggested to exist during the day. Conclusions: Increased nursing time was correlated with reduced fall incidence, indicating the need for policy improvements in nurse staffing practices in Japan to enhance patient safety and outcomes. Further research is needed to accumulate evidence reflecting policies regarding nurse staffing. Full article

Background: Medication errors cause adverse events; however, studies have yet to examine medication errors related to nursing hours while considering ward characteristics in Japan. Purpose: This study investigated medication errors caused by nurses to quantitatively assess ward activity as busyness in nursing duties. Methods: This study considered patients hospitalized in the general wards of 10 National Hospital Organization institutions between April 2019 and March 2020. The study data were obtained from the Diagnosis Procedure Combination system, incident report system, and reports on nurse staffing and work hours. Data for 27,629 ward days with 88,475 patients were analyzed. Multivariate analysis was performed to determine the impact of factors on medication errors. Results: The mean patient age was 71.43 years (SD = 15.08). The medication error rate in nursing wards was 13.71%. The mean nursing time per patient during day shift was 1.95 h (SD = 0.58) in the non-medication error group and 2.06 h (SD = 0.58) in the medication error group (p < 0.01). The nursing time per patient in the medication error group compared to that in the non-medication error group had an odds ratio of 1.31 (p < 0.01) during day shifts. Conclusions/Implications for practice: Contrary to evidence, the results showed that medication errors caused by nurses related to increased nurse time with patients during day shifts. Further investigation is needed on the relationship of busyness with nursing duties to ensure an adequate nurse–patient ratio, nursing time, and improved patient safety. Full article

Studies have indicated that higher numbers of nurses regarding staffing ensure patient safety and a better practice environment. Using citation analysis, this study visualizes the landscape of nurse staffing research over the last two decades to show the overall publication trends, major contributors, and main research topics. We extracted bibliometric information from PubMed from January 2000 to September 2022. After clustering the network, we analyzed each cluster’s characteristics by keyword. A total of 2167 papers were considered for analysis, and 14 clusters were created. The analysis showed that the number of papers published per year has been increasing. Researchers from the US, the UK, Canada, Australia, and Belgium have led this field. As the main clusters in nurse staffing research during the past two decades, the following five research settings were identified: nurse outcome and patient outcome research in acute care hospitals, nurse staffing mandate evaluation research, nursing home research, and school nurse research. The first three clusters accounted for more than 80% of the total number of published papers, and this ratio has not changed in the past 20 years. To further develop nurse staffing research globally, evidence from other geographic areas, such as African and Asian countries, and from long-term care or community settings is necessary. Full article

This study examined the associations of nurse and physician staffing in intensive care units (ICUs) with hospital-acquired pneumonia (HAP) incidence and in-hospital mortality in postoperative patients on ventilators. National Health Insurance claims data and death statistics were used to investigate the nurse staffing level and the presence or absence of a dedicated resident and specialist in each ICU. The participants were patients aged 20–85 who underwent any of 13 surgical procedures and were placed on a ventilator in the ICU after the procedure. Of 11,693 patients, 307 (2.6%) experienced HAP and 1280 (10.9%) died during hospitalization. Compared to hospitals with lower nurse-to-patient ratios, patients in hospitals with higher ratios had statistically significantly higher risks of HAP and in-hospital mortality. The presence of a dedicated resident in the ICU did not statistically significantly affect HAP incidence or in-hospital mortality. The presence of an ICU specialist was statistically significantly associated with in-hospital mortality but not HAP incidence. Our findings suggest that a higher level of nursing staff in the ICU is inversely associated with HAP incidence. The legal standards for nurse staffing in the ICU should be strengthened in order to improve the quality of care and patient safety. Full article

Background and objectives: As is well known, cancer patients require extensive medical attention as they undergo surgery, chemotherapy, radiotherapy, and supportive care. The importance of high-quality cancer-directed nursing, combined with precision medicine, to maximize their survival outcomes and help them achieve a better quality of life cannot be overemphasized. In this context, we offered a new cancer-oriented comprehensive nursing system to our inpatients and reviewed its clinical outcomes in comparison with those from the preexisting general cancer ward. Materials and Methods: From March 2019 to February 2020, a total of 102 cancer patients and 42 nurses were enrolled in this pilot study. We aimed to analyze their performance in three main categories: structure, process, and patient/nurse outcomes. Results: First, structural (nurse staffing and environment) upgrades were installed in the cancer-oriented comprehensive nursing ward, including an improved nurse-patient ratio (1:8 in the comprehensive ward as compared with 1:14 in the general ward), wider space between beds (1.5 m versus 1.0 m), fully automatic beds with fall prevention sensors, etc. Second, the nursing process was improved (missed care 0.1 event/month vs. 1.3 event/month). Third, both patient and nurse outcomes showed preferable results in the comprehensive ward. The patient satisfaction level was higher in the comprehensive nursing ward than in the general ward (willing to revisit: 91.7% and 78.4%, respectively; willing to recommend to others: 95.0% and 76.8%, respectively). Pressure ulcers, as a patient safety indicator, were also decreased (0.3 events/month vs. 0.8 events/month). However, the fall incidence was similar in both groups (1.6 events/month vs. 1.5 events/month). In terms of nurse outcomes, turnover intention was stabilized and nurses’ job satisfaction in the comprehensive ward was superior to that of their counterparts. Conclusions: Our study was a pilot study to demonstrate that cancer patient-oriented comprehensive nursing services can be helpful in improving the quality of cancer treatment and nurses’ job satisfaction. Continued interest in and efforts to improve nursing care delivery are also crucial in achieving and maintaining the best possible cancer patient care. Full article

Background: Time series analyses on the relationship between nurse staffing and inpatient care quality are rare due to inconsistent frequencies of data between common observations of nurse-staffing (e.g., monthly) and inpatient care quality indicators (e.g., quarterly). Methods: In order to deal with the issue of mixed frequency data, this research adopted the MF-VAR model to explore causal relationships among nurse staffing, inpatient care quality, and hospital competition under the global budget payment scheme of Taiwan’s healthcare system. Results: Our results identified bi-directional causation between nurse staffing and patient outcomes and one-way Granger causality running between nurse staffing and reimbursement payments for inpatient care services. Impulse-response analyses found positive (negative) effects of the patient-to-nurse ratio on adverse patient outcomes (reimbursement payments) in all types of hospitals and detrimental effects of adverse patient outcomes on the patient-to-nurse ratio in medical centers and regional hospitals across a 12-month period. Conclusions: These findings suggest that nurse staffing is an essential determinant of both patient outcomes and reimbursement payments. Strategic policies such as direct subsidy and hospital accreditation for appropriate nurse staffing levels should be implemented for medical centers and regional hospitals to mitigate the harmful effects of adverse patient outcomes on nurse staffing. Full article

Information on the readiness of Irish general practice to participate in structured chronic disease management (CDM) care is limited. This study explores the logistic, staffing, and organizational preparedness of Irish general practice to do so, stratified by their size, location, and training status; implementation challenges were also explored. An anonymous, paper-based random survey was performed. A chi-square test was applied to compare practices by location (urban/rural), post-graduate training status (with/without), and numbers of GMS patient (≥1500/>1500 patients) and prevalence ratio and Poisson regression analysis to examine the relationship of staffing with key variables. Overall, 125/243 practices participated, 22% were rural, 56.6% were post-graduate training practices, and 53.9% had ≥1500 GMS patients. The rural, non-training practices and those with <1500 GMS patients had substantially lower staffing levels. The average number of GPs was significantly less in rural practices; however, the difference was insignificant for nurses. Salary costs for practice nurses in all practices and staff IT training and clinical equipment in smaller practices were important barriers. Most practices reported ‘inadequate’ waiting times for access to almost all referral and paramedical services. The study recommends addressing the staffing, funding, and training challenges within Irish general practice to effectively implement a structured CDM program. Full article

We aimed to summarize the evidence of an association between nurse staffing and nursing sensitivity outcomes in Japanese hospitals. A scoping review was conducted and reported following the PRISMA-SR 2020 statement. The ICHUSHI and CiNii databases were searched for published articles written in Japanese and PubMed and CINAHL for those written in English. Out of the 15 included studies, all observational studies, 3 were written in Japanese and the others in English. The nurse staffing level measures were grouped into three categories: patient-to-nurse ratio, nursing hours per patient day, and nurse-to-bed ratio. The outcome measures were grouped into three categories: patient outcome, nursing care quality reported by nurses, and nurse outcome/nursing care quality. Some studies reported that the nursing staff increasingly favored positive patient outcome. Conversely, the findings regarding failure to rescue, in-hospital fracture, and post-operative complications were inconsistent. Although some studies indicated that more nurse staffing was favored toward better patient and nurse outcomes, due to the sparse accumulation of studies and heterogeneity among the findings, it is difficult to draw robust conclusions between nurse staffing level and outcomes in Japanese acute care hospitals. Full article

Background: Patient safety involves identifying, assessing, and managing patient-related risks and occurrences to improve patient care and reduce patient harm. In Nigeria, there is a lack of studies on patient safety culture, especially in the northern part of the country. This study aimed to determine the levels and factors that contribute to nurses’ negative perceptions of patient safety culture in public health facilities. Methodology: A total of 460 nurses were surveyed across 21 secondary health facilities using the Hospital Survey on Patient Safety Culture, and the response rate was 93.5%. Descriptive statistics and multiple logistic regression were used to analyze the data. Results: The results showed that 59.8% of the respondents were female, and 42.6% were within the age range of 30–39 years old. Most of them (48.3%) had spent 1–5 years working in the hospital. Three out of 12 composite measures had higher negative responses (staffing—30.5%, non-punitive response to error—42.8%, and frequency of events reported—43.1%). A multiple logistic regression analysis affirmed that all three variables, in addition to organizational learning, were significant associated with overall negative perceptions of patient safety culture, with 3.15, 1.84, 2.26, and 2.39 odds ratios, respectively. Conclusion: The results revealed that four critical areas of patient safety required improvement; therefore, intervention is recommended to minimize unnecessary patient harm and medical expenses. Full article

Background: Poorly organized health systems with inadequate leadership limit the development of the robust safety cultures capable of preventing consequential adverse events. Although safety culture has been studied in hospitals worldwide, the relationship between clinician perceptions about patient safety and their actual clinical practices has received little attention. Despite the need for mixed methods studies to achieve a deeper understanding of safety culture, there are few studies providing comparisons of hospitals in different countries. Purpose: This study compared the safety culture of hospitals from the perspective of nurses in four European countries, including Croatia, Hungary, Spain, and Sweden. Design: A comparative mixed methods study with a convergent parallel design. Methods: Data collection included a survey, participant interviews, and workplace observations. The sample was nurses working in the internal medicine, surgical, and emergency departments of two public hospitals from each country. Survey data (n = 538) was collected with the Hospital Survey on Patient Safety Culture (HSOPSC) and qualitative date was collected through 24 in-depth interviews and 147 h of non-participant observation. Survey data was analyzed descriptively and inferentially, and content analysis was used to analyze the qualitative data. Results: The overall perception of safety culture for most dimensions was ‘adequate’ in Sweden and ‘adequate’ to ‘poor’ in the other countries with inconsistencies identified between survey and qualitative data. Although teamwork within units was the most positive dimension across countries, the qualitative data did not consistently demonstrate support, respect, and teamwork as normative attributes in Croatia and Hungary. Staffing and workload were identified as major areas for improvement across countries, although the nurse-to-patient ratios were the highest in Sweden, followed by Spain, Hungary, and Croatia. Conclusions: Despite all countries being part of the European Union, most safety culture dimensions require improvement, with few measured as good, and most deemed to be adequate to poor. Dimension level perceptions were at times incongruent across countries, as observed patient safety practices or interview perspectives were inconsistent with a positive safety culture. Differences between countries may be related to national culture or variability in health system structures permitted by the prevailing European Union health policy. Full article