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My personal experience with nursing school can be best described as floating in the middle of the ocean with a life vest while kicking and paddling to keep my head above the water. I spent countless hours studying for examinations, rewriting care plans, and practicing skills. In addition to my own efforts to survive, I also had my life vest in the form of my instructors, preceptors, and fellow classmates, who I give credit for my success.

Aim: To report a concept analysis of nursing overtime., Background: Economic constraints have resulted in hospital restructuring with the aim of reducing costs. These processes often target nurse staffing (the largest organizational expense) by increasing usage of alternative staffing strategies including overtime hours. Overtime is a multifaceted, poorly defined, and indiscriminately used concept. Analysis of nursing overtime is an important step towards development and propagation of appropriate staffing strategies and rigorous research., Design: Concept analysis., Data Sources: The search of electronic literature included indexes, grey literature, dictionaries, policy statements, contracts, glossaries and ancestry searching. Sources included were published between 1993-2012; dates were chosen in relation to increases in overtime hours used as a result of the healthcare structuring in the early 1990s. Approximately 65 documents met the inclusion criteria., Review Methods: Walker and Avant's methodology guided the analysis., Discussion: Nursing overtime can be defined by four attributes: perception of choice or control over overtime hours worked; rewards or lack thereof; time off duty counts equally as much as time on duty; and disruption due to a lack of preparation. Antecedents of overtime arise from societal, organizational, and individual levels. The consequences of nursing overtime can be positive and negative, affecting organizations, nurses, and the patients they care for., Conclusion: This concept analysis clarifies the intricacies surrounding nursing overtime with recommendations to advance nursing research, practice, and policies. A nursing-specific middle-range theory was proposed to guide the understanding and study of nursing overtime., (© 2013 Blackwell Publishing Ltd.)

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. [ABSTRACT FROM AUTHOR]

Addressing patient experience is a priority in the health care system. Hospital Consumer Assessment of Providers and Systems (HCAHPS) survey results incentivize hospitals to elevate patient experience, a factor in patient-centered care. Although hospital nursing resources have been positively associated with better HCAHPS ratings, it is unknown how changes in nursing resources are associated with changes in HCAHPS ratings over time. This two-period longitudinal study ranked the associations between changes in nurse staffing, skill mix, nurse education, and work environment on HCAHPS ratings and found that changes in the work environment had the strongest associations (β = 2.29; p <.001) with improved HCAHPS ratings. Our findings provide hospital administrators with empirical evidence that may help make informed decisions on how to best invest limited resources to improve HCAHPS ratings, including the potential utility of improving the work environment through enhancing Nursing Quality of Care and Nurse Participation in Hospital Affairs. [ABSTRACT FROM AUTHOR]

Abstract Purpose Minimizing delays in delivering nursing care is paramount for enhancing the overall quality of care. Certain bottleneck variables restrict the workflow of nurses, resulting in extended shift times. This study is designed to pinpoint and analyze the principal factors contributing to bottleneck issues in nursing workflow, to direct improvement endeavors. This study seeks to provide insights into the key variables contributing to nurses’ extended shift times, with the ultimate goal of prioritizing efforts for improvement. Methods A descriptive multicenter cross-sectional study was conducted. A scale was developed for this study by the authors after conducting a literature review, subsequently validated, and its reliability was assessed. Results Among the 31 bottleneck variables, 29 were retained under three persistent bottleneck factors: (1) Nurse staffing— This pertains to the availability of sufficient nursing staff at all times across the continuum of care; (2) Working environment and quality of care—This refers to the availability of necessary skills and resources for nurses to perform their duties effectively and; (3) Medical devices— This factor concerns the availability of fully functional medical devices required for providing care. Conclusion Efforts aimed at enhancing the overall healthcare system should concentrate on addressing persistent bottleneck factors. This may involve the implementation of a healthcare workforce management system, the establishment of standards for a conducive and supportive working environment, and the utilization of a standardized system for the management of medical equipment. The outcomes of this study can be utilized by nurses and policymakers to devise comprehensive strategies for improvement.

Purpose: Minimizing delays in delivering nursing care is paramount for enhancing the overall quality of care. Certain bottleneck variables restrict the workflow of nurses, resulting in extended shift times. This study is designed to pinpoint and analyze the principal factors contributing to bottleneck issues in nursing workflow, to direct improvement endeavors. This study seeks to provide insights into the key variables contributing to nurses' extended shift times, with the ultimate goal of prioritizing efforts for improvement. Methods: A descriptive multicenter cross-sectional study was conducted. A scale was developed for this study by the authors after conducting a literature review, subsequently validated, and its reliability was assessed. Results: Among the 31 bottleneck variables, 29 were retained under three persistent bottleneck factors: (1) Nurse staffing— This pertains to the availability of sufficient nursing staff at all times across the continuum of care; (2) Working environment and quality of care—This refers to the availability of necessary skills and resources for nurses to perform their duties effectively and; (3) Medical devices— This factor concerns the availability of fully functional medical devices required for providing care. Conclusion: Efforts aimed at enhancing the overall healthcare system should concentrate on addressing persistent bottleneck factors. This may involve the implementation of a healthcare workforce management system, the establishment of standards for a conducive and supportive working environment, and the utilization of a standardized system for the management of medical equipment. The outcomes of this study can be utilized by nurses and policymakers to devise comprehensive strategies for improvement. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim To compare nurse work hours and nursing activities between high‐staffed and low‐staffed general wards to examine the effects of increased staffing on nurse workload and nursing care. Design A secondary analysis was conducted using cross‐sectional data collected at a tertiary teaching hospital in South Korea in January 2020. Methods Nursing activities provided by 350 nurses were observed every 10 min during their shifts for three observation days in four high‐ and four low‐staffed wards. Nurse‐to‐patient ratios, nurse work hours, nursing activities and the composition of nursing hours (direct care, indirect care and associated work) were analysed. Results After excluding non‐productive personal time, nurses in the low‐staffed wards worked 9.28 h, which indicates 1.28 h of overtime work on average, while the high‐staffed wards recorded 7.90 h of productive work time. The nurse‐to‐patient ratio in the high‐staffed wards was 1:4.73, whereas that in the low‐staffed wards was 1:8.87. The proportion of direct care hours out of nurse work hours was higher in the low‐staffed wards (30.9%) than in the high‐staffed wards (25.7%). Nurses in the low‐staffed wards provided a greater number of direct care hours, and the largest difference in direct care hours between the two groups was found on night shifts. Nurses in the high‐staffed wards spent more time communicating with patients and charting, whereas nurses in the low‐staffed wards spent more time on vital signs and medications. Conclusion Improved staffing had positive impacts on patients and nurses. Patients benefited from better staffing through increased communication with nurses. Better staffing also reduced overtime work and activities conducted during night shifts. Implications for the Profession and Patient Care Adequate staffing is essential to improve patient care quality and reduce nurse workload. Nursing activities must be prioritised and redesigned to maximise the benefits of increased staffing on patient and nurse outcomes. Reporting Method We have adhered to the STROBE reporting guidelines. No Patient or Public Contribution The aim of this study was to compare nurse work hours and nursing activities between high‐staffed and low‐staffed wards.

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.

ObjectivesAlthough many prior studies have shown that high average levels of nurse staffing in nursing homes are associated with fewer hospitalizations, some studies have not, suggesting that the average nursing level may mask a more complex relationship. This study examines this issue by investigating the associations of daily staffing patterns and daily hospitalizations and emergency department (ED) visits.DesignRetrospective analyses of national Payroll Based Journal (PBJ) staffing data merged with the Minimum Data Set.Setting and participantsA total of 15,718 nursing homes nationally reporting PBJ data during 2017-2019, their staff, and residents.MethodsWe estimated facility-day-level models as conditional facility fixed-effect Poisson regressions with robust standard errors. The dependent variables were daily numbers of hospitalization and ED visits and the independent variables of interest were the number of registered nurse (RN), licensed practical nurse (LPN), and certified nurse assistant (CNA) hours on the same and prior days.ResultsThe daily number of hospital transfers averaged 0.28 (SD 0.21). Daily total direct-care staffing hours averaged 288.7 (SD 188.2), with RNs accounting for 35.0, LPNs for 68.7, and CNAs for 185.0. Higher staffing was associated with more hospitalizations on the concurrent day. Higher staffing on the day prior was associated with fewer hospitalizations. The effect size was larger for RNs and LPNs (same day = ∼2%; prior day = approximately -0.7% to -0.9%) than for CNAs (same day

Numerous nursing roles in a variety of work environments are available to nurses specializing in nephrology nursing. This article describes the various roles and work settings available to nurses new to nephrology and experienced nephrology nurses, intending to promote awareness of the specialty and increase the number of nurses working in nephrology. The information provided can be shared with those working within the specialty, and be included in nephrology nursing recruitment and retention strategies implemented to address the current and future anticipated nephrology nursing void. [ABSTRACT FROM AUTHOR]

Background: Patients in intensive care units need full nursing care due to the high mortality rate. However, some aspects of nursing care can be forgotten. Aims: To investigate the quality of death and dying and its association with aspects of missed nursing care, alongside the overall perception of nurses in intensive care units about factors associated with missed nursing care. Methods: This cross-sectional study used a census sampling method of 105 nurses working in intensive care units. In order to collect data, the Quality of Dying and Death Questionnaire (QODD), missed nursing care (MISSCARE survey) and factors associated with missed nursing care questionnaire were used. Data analysis was performed by using SPSS 16. Findings: The quality of death and dying, as perceived by nurses, was found to be lower than the average (Range score: 0 to 100). The range of missed nursing care was average (Range of score: 24 to 96) and the most noticeable reason for this missed nursing care was the shortage of nursing staff. Conclusion: Managers should ensure that nurses provide complete nursing care for terminally ill patients in intensive care units and eliminate factors that lead to aspects of nursing care being missed, such as staffing levels, material resources and communication between staff members. [ABSTRACT FROM AUTHOR]

Background: In Italy, nursing research has paid special attention to 'missed nursing care'. The studies carried out, varying in tools and settings, describe considerable percentages of missed care. In the field of stoma care, the phenomenon has not been investigated to date. Aim: To investigate the prevalence of missed nursing care (MNC) in the Italian ostomy patient population and the most relevant causes suggested for this by stoma care nurses. Design: Cross-sectional study. Method: The Italian version of the MISSCARE survey was used with some questions related to the stoma care pathway. The survey was targeted at hospitals in the country with dedicated services and/or pathways for ostomy patients, between February and April 2023. Findings: A total of 461 questionnaires were sent out, 214 (53.3%) were analysed. The majority of the participants were female (160, 76.2%), median age of 50 years (35.0–53.8). The most common qualification was a Bachelor's degree (n=117; 54.9%) and work experience in stoma care was more than 10 years in 95 cases (50.3%). Prominent instances of MNC were identified, with hand washing (score 4.6 out of 5), compilation of nursing documentation and hygiene/skin care (score 4.5 out of 5) and patient/family education (score 4.4 out of 5) emerging as the most prevalent. The most notable omissions in the stoma care process encompassed educational facets, clinical monitoring, a comprehensive discharge plan, and diligent follow-up. Among the most frequent reasons were staff shortages (score 3.1 out of 4), unsuitable nurse–patient ratios (score of 3 out of 4) and insufficient numbers of experienced stoma care personnel (score of 3 out of 4). Conclusion: A substantial number of basic and clinically relevant nursing interventions were perceived to be missed, and this may lead to an increase in negative outcomes for ostomy patients. [ABSTRACT FROM AUTHOR]

Background: Missed care is defined as the omission or delay of necessary patient care and is internationally reported by nurses as a significant safety risk. Nurses working at night also report high levels of occupational fatigue that, coupled with inadequate staffing and practice environment support, may impede a nurse's ability to carry out the nursing process and lead to more missed care. Objective: The study's objective was to examine the interrelationships among organizational and nurse characteristics, occupational fatigue, and missed care among nurses working at night. Methods: A cross-sectional design was used. Participants included registered nurses (RNs) who worked at night in New Jersey acute care hospitals. Multiple linear regression and simple moderation analyses were performed to examine the associations. Results: Nurses reported missing necessary care at night. Unsupportive practice environments, high RN workloads, high patient–RN ratios, high chronic fatigue levels, and low intershift recovery were individually associated with missed care at night. High patient-to-RN ratios and chronic fatigue were independently associated with missed care. However, patient-to-registered-staffing levels had the most considerable effect on missed care at night. Nurses' years of experience and the number of hours of sleep between shifts were significant moderators of the relationship between occupational fatigue states and missed care. Discussion: This study is the first to examine the interrelationship between occupational fatigue levels, organizational and nurse characteristics, and missed care at night. There is an urgent need to implement strategies in hospital organizations that foster work schedules and adequate staffing patterns that lessen nurses' occupational fatigue levels to ensure our workforce's and patients' safety. [ABSTRACT FROM AUTHOR]

Despite considerable research on nursing turnover, few studies have considered turnover among nurses working in home health care. Using novel administrative data from one of the largest home health care organizations in the United States, this study examined turnover among home health nurses, focusing on the role of schedule volatility. We estimated separation rates among full-time and part-time registered nurses and licensed practical nurses and used daily visit logs to estimate schedule volatility, which was defined as the coefficient of variation of the number of daily visits in the prior four weeks. Between 2016 and 2019, the average annual separation rate of home health nurses was over 30%, with most separations occurring voluntarily. Schedule volatility and turnover were positively associated for full-time nurses, but not for part-time nurses. These results suggest that reducing schedule volatility for full-time nurses could mitigate nursing turnover in home health care.

Background: Patient safety is an important element of the quality of a health service, with the existence of a patient safety culture it is hoped that it can make patient care safer. Thus it is necessary to improve quality through several supporting aspects of patient safety. Purpose: The purpose of this study is to analyze staffing, communication and hospital management for patient safety ratings at Dr. Iskak Tulungagung Hospital. Methods: The type of research conducted in this activity is an observational study with a cross-sectional design and using logistic regression statistical tests. The sample in this study were 406 respondents. Results: Based on the characteristics of the respondents, it shows that nurses with an education level of S1 Nursing are 258 respondents and D3 Nursing are 148 respondents, with an age range > 41 years (38%), ages 31-40 years (36.7%), ages 20-30 years (25.3%), and the majority of nurses have working hours > 40 hours/week (75%) and working hours of 30-40 hours/week (25%). The results of the descriptive analysis show that the value of good category staffing is 95%, communication openness is good category is 87% and hospital management is good category is 92%. Meanwhile, based on the statistical test results, the p-value is 0.000

Objectives: There is limited literature on the experiences of internationally educated nurses (IENs) who have joined NHS trusts in England in the past 20 years. The objectives of this integrative review included exploring and analysing the experiences of IENs in the NHS in England and identifying the cultural, pastoral and training needs of IENs during their first 2 years working in England and providing research-informed recommendations to better support IENs. Design: An integrative review of primary research studies using quantitative, qualitative, and mixed methods of data collection. Data source: CINAHL, British Nursing Index and Google Scholar. Results: Nine articles met the inclusion criteria for this integrative review. All articles contributed to the findings of three main analytical themes: expectations, challenges and belongingness. Conclusion: Limited research fully met the search criteria. This was concerning since IENs have been working in the NHS for decades, yet so few primary studies have been conducted into their experiences. The findings were in line with previous studies, which found that IENs faced challenges both in the workplace and in settling into an English way of life, and often reported feeling that they were not treated equally to their English counterparts. This integrative review raises issues and increases awareness of how the NHS in England can better support IENs transitioning into their new life and ways of working, to further aid recruitment and retention of the international nursing workforce. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to propose revised inpatient nursing fee schedules that address three discrepancies between actual nurse staffing levels in general wards and the corresponding patient payment structures. Methods: A total of 45 tertiary hospitals, 329 general hospitals, and 1,379 hospitals from publicly released data for 2021-2022 were analyzed. This analysis focused on three primary discrepancies between (1) the staffing grades under which patients were hospitalized and the corresponding grades for which they were charged; (2) the staffing grades determined by bed-to-nurse and patient-to-nurse criteria; and (3) the current differentiation rates of nursing fees and the expected differentiation rates based on the number of nurses required for each grade. Results: The first discrepancy occurred in 8.9% of tertiary hospitals, 21.0% of general hospitals, and 26.0% of hospitals. The bed-to-nurse and patient-to-nurse grades differed by 2.23 and 2.29 grades on average in general hospitals and hospitals, respectively. The current differentiation rates were higher than the expected differentiation rates. New nursing fee schedules were suggested to resolve those discrepancies. Conclusion: Nursing fees should be charged to reflect the staffing levels under which patients were cared for and proportionate to the number of nurses required to provide the corresponding staffing levels. [ABSTRACT FROM AUTHOR]

Background: Safety culture is known to influence patient outcomes, but the relationship between nursing units’ safety cultures and the development of pressure injuries in acute care hospitals is unclear. Pressure injuries are a nursing-sensitive patient outcome and are widely considered preventable. Objective: To examine the impact of unit safety culture, nursing unit characteristics, and missed care on pressure injury rates in Saudi Arabian hospitals. Design: A multi-center cross-sectional study was conducted between August and November 2021 and compared to secondary data on the incidence of pressure injuries. Settings/Participants: A total of 653 nurses from 35 units in five Ministry of Health hospitals in Saudi Arabia participated in this study. Methods: The survey included validated scales of safety culture, nurse staffing, and nurses’ perceptions of quality of care, missed care, and the frequency of pressure injury. Secondary data on pressure injuries were collected from the Ministry of Health administrative database between 2018 and 2021. Descriptive analysis and Generalized Linear Models were performed. Results: Higher safety culture scores were associated with fewer pressure injuries (β = -2.000, 95% Confidence Interval [CI] -3.107, -0.893) and lower nurses’ perceptions of the frequency of pressure injuries in their unit (β = -1.224, 95% CI -2.255, -0.192). High scores on the sub-scales of hospital management (β = -2.105, 95% CI -2.835, -1.375) and safety climate (β = -1.402, 95% CI -2.383, -0.421) were the most statistically significant predictor for pressure injury prevention. Higher frequency of missed nursing care was positively associated with higher rates of pressure injuries (β = 1.606, 95% CI 0.187, 3.024) and higher nurses’ perceptions of the frequency of pressure injuries (β = 1.243, 95% CI 0.211, 2.363). There was a positive relationship between higher nurses’ perceptions of the frequency of pressure injury and higher incidence rate of pressure injury as reported in the incident management system (β = 1.183, 95% CI 0.065, 2.301). Conclusion: Nursing units with stronger safety climate and safety behavior scores, higher ratings of hospital and unit quality of care, and lower levels of missed nursing care were associated with lower incidence of pressure injury and nurses’ perceptions of the frequency of pressure injury in their units. Nurses’ perceptions of the frequency of pressure injuries are concordant with the incidence of pressure injuries and can be a valid measure to capture patient outcomes within a specific time. Tweetable abstract: High safety culture and lower missed care are linked to fewer pressure injuries in Saudi Arabian hospitals. Nurses’ perceptions of pressure injury frequency aligned with reported incidence rates, indicating a valid measure of patient outcomes.

Background: The demand for nursing care is rising in the long-term care setting. Nurse staffing is a crucial measure linked to health care quality measure outcomes. Purpose: To assess for associations between nursing hours per patient day (NHPPD) and outcome measures in the Veterans Health Administration Community Living Centers. Methods: A retrospective data review of NHPPD and quality measures for 134 community living centers was conducted. Linear regression was used to assess for linear associations between average total NHPPD and 6 quality measures. Results: A significant linear association was found between average total NHPPD and falls with major injury (P = .02) and help with activities of daily living (P = .01). No associations were found between nurse staffing and 4 other quality measures. Conclusions: This study adds to the body of literature regarding the impact of nurse staffing on quality measures. [ABSTRACT FROM AUTHOR]

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Abstract Aim The nursing associate role has created a new second‐level nursing role and provided an alternative route into registered nursing. For some, this provides a previously inaccessible opportunity for career progression. The aim of the study was to understand the factors that influence career choices of trainee nursing associates. Design A longitudinal qualitative study of trainee nursing associate motivations, experiences and career aspirations. Methods Semi‐structured interviews with trainee nursing associates from across England, UK, in February 2020 (N = 14) and March 2021 (N = 13). Diary data were also collected. Interview and diary data were analysed thematically. Reporting has followed COREQ guidelines. Results Nursing associate training was viewed by some as a bridge into registered nursing. Role ambiguity led several to seek perceived security offered by the Registered Nurse profession. Those preferring to remain as nursing associates were keen to embed the bridging role between healthcare assistants and Registered Nurses, valuing a positive workplace culture.

Background: Although work engagement and job satisfaction are two important indicators associated with care quality, their mediating effects on the relationship between perceived staffing and quality of care have not been adequately clarified. Purpose: This study was designed to determine the mechanism by which nurses' perceived staffing influences quality of care by clarifying the mediating roles of job satisfaction and work engagement. Methods: A cross-sectional questionnaire survey was implemented among 2,142 clinical nurses from 211 inpatient wards in 13 hospitals. Work engagement, job satisfaction, perceived staffing, and rated quality of care were measured. Results: Most (89.7%) of the respondents rated quality of care as good or better, and 56.1% perceived staffing in the wards as adequate. The two main findings of this study are as follows: (a) Perceived staffing influenced quality of care via one direct and three indirect pathways, with the indirect effect greater than the direct effect (βdirect = 0.09, βtotal indirect = 0.25), and (b) work engagement and job satisfaction were important mediators of the impact of staffing on quality of care. Conclusion: Quality of care may be enhanced by improving the work engagement and satisfaction of nurses in their current job, suggesting an effective approach to alleviating the current nursing shortage. [ABSTRACT FROM AUTHOR]

The article discusses recommendations on the education and training of U.S. nursing home (NH) staff to ensure a competent NH workforce in 2023. Topics covered include the academic requirements for an NH administrator, director of nursing, medical director, and social worker, the creation of national competency requirements for all licensed and unlicensed NH staff, and the preparation of the NH workforce. Also noted is the responsibility of relevant bodies to implement the recommendations.

With an increased emphasis on home dialysis therapies (HDTs), and to ensure nephrology nurses have a voice in health policy discussions and decisions, the American Nephrology Nurses Association (ANNA) initiated the Home Dialysis Therapies Task Force. ANNA fully supports the increased utilization of HDTs and wants to ensure every individual has the option of HDT and deserves an RN in their care. Careful consideration must be given to the impact of legislative initiatives aimed at the nursing shortage and increasing the use of HDTs on delivery of safe care and RN practice. The HDT Task Force implemented a Think Tank to explore and delineate the role of nephrology RNs in HDT to ensure a safe and informed transition to HDT for individuals with kidney failure. The mission was to gather and analyze information on the role of the nephrology RN in HDTs, clarify RN-specific tasks versus tasks that may be delegated to support staff, and gather and gain insight into barriers to HDTs. [ABSTRACT FROM AUTHOR]

Aim: Nursing work has historically been difficult to specify. This has led to difficulties in determining safe staffing requirements and adequately supporting safe patient care. The aim of this qualitative interview study was to explore how nurses understand their work. Design: Qualitative interview study, using the interpretive description methodology. Methods: Twenty registered nurses and nursing students completed semi-structured interviews about their work. The researcher drew on the interpretive description methodology to analyse interview data and create a model that interprets participants' experiences of their nursing work. Results: Nurses understand their work by its role in the healthcare system, rather than by the tasks or activities they complete. This understanding is significant because nurses adapt their work constantly, and rigid definitions of working would not support safe adaptation. Nurses report working across three broad roles: clinical work, which is patient-facing; managing work, which sustains the care environment; and enabling work, which provides supports like research and education that make nursing a profession. Conclusions: Clinical, managing and enabling work have different aims, but all serve the purpose of supporting safe patient care and sustaining healthcare systems. Adaptation is a constant feature of each of these roles. This model may be useful for nurses in structuring and explaining their work and informing nursing workforce policy. [ABSTRACT FROM AUTHOR]

To assess the staffing patterns of direct care nursing staff by shift in nursing homes (NHs), assisted living communities (ALCs), and their corresponding memory care units (MCUs). Observational study of the 2021 Ohio Biennial Survey of Long-Term Care Facilities and the Payroll-Based Journal data for December 2021. NHs (n = 678) and ALCs (n = 542) that reported staffing by shift in Ohio. Resident-to-staff ratios in Ohio were calculated from staffing data. The proportion of daily nursing staff assigned to each shift was based on staffing data from the Biennial Survey for NHs and ALCs. Outcomes were calculated for aides and licensed nursing staff. Ohio's NHs and ALCs had lower resident-to-staff ratios on the day shift. Lower resident-to-staff ratios mean there were more staff per resident (ie, better staffed). For both types of staff and all shifts, overall resident-to-staff ratios were lower in NHs than ALCs. However, resident-to-staff ratios for ALC MCUs were on par with NH MCUs. This was consistent with ALC and NH MCUs staffing in a more similar manner. Across all settings, the day shift had the most staff members present, while a number of ALCs had no licensed nurses on duty during the overnight shift. NHs and ALCs have different staffing patterns due to differences in resident needs. However, as ALCs provide for more residents that need NH level of care, ALCs may require additional staffing, especially on the overnight shift where some ALCs have no licensed nurses on duty. The evidence here can be used for decision making about future staffing policies, whether facility-wide policies that encompass MCUs or state-wide policies, so that care delivery aligns with care needs. [ABSTRACT FROM AUTHOR]

Aims: To describe the organization of nursing services (staffing, scope of practice, teamwork) and its association with medication errors and falls, in rehabilitation units. Background: The healthcare system is greatly impacted by the ageing population and the complexity of care associated with chronic diseases. It is therefore necessary to have enough staff who are using their full scope of practice and who are operating in a favourable working environment. However, these conditions are not always met, which can lead to threats to patient safety. Design: A correlational descriptive study. Methods: Staffing data and reported safety incidents were collected by shift from 01 October 2019 until 15 January 2020 in five rehabilitation units. In addition, a total of 75 nursing staff members responded to a missed care and teamwork survey. Descriptive analysis and logistic regression analysis were performed. Results: The mean staff hours per patient shift was 1.39 (SD = 0.60). The teams reported a global missed care score as 'rarely missed' at 1.14 (SD = 0.07) and a moderate teamwork score at 3.36 (SD = 0.58) on a five‐point scale. The safety incidents decreased 10‐fold with a predominance of bachelor compared with technician nurses and decreased by 67% when there was an increase of 1 h of care per patient shift. Conclusions: This study showed that the organization of nursing services in the observed rehabilitation units is characterized by a moderate staffing intensity, a moderate perception of teamwork level and a relatively low level of missed care. It indicated the key role of the staffing in reducing the risk of occurrence of safety incidents. Future research specific to rehabilitation hospitals are greatly needed to improve patient outcomes in this setting. Impact: Nurse Managers should consider all the aspects of the organization of nursing services (staffing, scope of practice and teamwork) in their efforts to improve patient safety in rehabilitation settings. A central finding of this study is that the staffing intensity, the proportion of bachelor prepared nurses and the proportion of agency staff were positively associated with a reduction of safety incidents. [ABSTRACT FROM AUTHOR]

We analyzed what happens to a nursing home chain when private equity takes over, with regard to strategy, financial performance, and resident well-being. We conducted a longitudinal (2000-2012) case study of a large nursing home chain that triangulated qualitative and quantitative data from 5 different data sources. Results show that private equity owners continued and reinforced several strategies that were already put in place before the takeover, including a focus on keeping staffing levels low; the new owners added restructuring, rebranding, and investment strategies such as establishing new companies, where the nursing home chain served as an essential "launch customer."

Aim: The purpose of this study was to examine the impact of nurse staffing on inpatient falls performance across a multi‐hospital system. Background: Evidence to support which staffing variables influence fall performance so that health care organizations can better allocate resources is lacking. Method: A descriptive study design was used to analyse the impact of nurse staffing and falls performance, with units dichotomized as either high or low performing based on national benchmarking data. The impact was evaluated using 10 nurse staffing variables. Results: A total of nine units were included (five high and four low performing). Higher performing units showed less use of sitters and travellers, had fewer overtime hours worked by nurses, and employed more expert‐level clinical nurses and combined nursing assistant/health unit coordinator positions, than lower performing units. Conclusion: Findings provide evidence of how staffing variables affect a unit's falls performance. While significant relationships were found, further evaluation is needed to explore the relationship of staffing variables and quality outcomes. Implications for Nursing Management: Nursing managers may consider trying to reduce use of sitters and travellers, and utilize innovative staffing models, such as using combined nursing assistant/health unit coordinator positions, to help improve their falls performance. [ABSTRACT FROM AUTHOR]

Purpose: To develop a web-based solution for patient need-driven staffing (PNDS) that automatically determines nurses' staffing requirements. Methods: Activities provided by nurses in four integrated nursing care wards (INCWs) and non-INCWs each in a tertiary hospital were observed over three days. Nursing hours per patient hour (NHPPH) were calculated by dividing nursing hours by patient stay hours per day. Patient needs were evaluated using 19 items. Results: The nurse-patient ratios in INCWs and non-INCWs were 1:4.5 and 1:8.1 (including overtime), respectively. Admitted and transferred-in patients had higher NHPPHs than those with continuing stays. The patients were classified into five groups: Group A for admissions and transfers-in, and Groups 1~4 for the remainder. In INCWs, the nurse-patient ratios ranged from 1:5.3 (Group 1) to 1:2.4 (Group 4), and Group A required 1:3.0, the secondhighest level. In non-INCWs, ratios ranged from 1:9.4 (Group 1) to 1:5.2 (Group 4 and Group A). The PNDS solution was developed to determine staffing requirements by classifying patients into five groups using the entered data on patient needs, assigning the group's NHPPH to each patient, and calculating the staffing ratio required in the unit. Conclusion: The PNDS is expected to support staffing decisions to meet patient needs. [ABSTRACT FROM AUTHOR]

Aim: To explore predictors of perceived nursing workload in relation to patients, nurses and workflow. Background: Nursing workload is important to health care organisations. It determines nurses' well‐being and quality of care. Nevertheless, its predictors are barely studied. Methods: A cross‐sectional prospective design based on the complex adaptive systems theory was used. An online survey asked nurses to describe perceived workload at the end of every shift. Data were gathered from five medical‐surgical wards over three consecutive weeks. We received 205 completed surveys and tested multivariate regression models. Results: Patient acuity, staffing resources, patient transfers, documentation, patient isolation, unscheduled activities and patient specialties were significant in predicting perceived workload. Nurse‐to‐patient ratio proved not to be a predictor of workload. Conclusions: This study significantly contributed to literature by identifying some workload predictors. Complexity of patient care, staffing adequacy and some workflow aspects were prominent in determining the shift workload among nurses. Implications for nursing management: Our findings provide valuable information for top and middle hospital management, as well as for policymakers. Identification of predictors and measurement of workload are essential for optimizing staff resources, workflow processes and work environment. Future research should focus on the appraisal of more determinants. [ABSTRACT FROM AUTHOR]

Background: The increase in COVID-19 cases in Indonesia has resulted in changes in the hospital workflow, including the staffing process and scheduling, especially in the isolation units. Nurse managers are working hard in the scheduling system to ensure high-quality care is provided with the best human resources. Objective: This study aimed to explore the experiences of nurse managers in managing staff nurses’ work schedules during the COVID-19 pandemic. Methods: A qualitative descriptive design was used in this study. Eleven nurse managers from three COVID-19 referral hospitals were selected using purposive sampling. Data were collected using online semi-structured interviews. Thematic analysis was used for data analysis, and data were presented using a thematic tree. Consolidated criteria for reporting qualitative research (COREQ) checklist was used as a reporting guideline of the study. Results: Four themes were developed: (i) Nurse shortage, (ii) Strategically looking for ways to fulfill the workforce, (iii) Change of shift schedule, and (iv) Expecting guidance from superiors and compliance from staff. Conclusion: The lack of nurse staff is a problem during a pandemic. Thus, managing personnel effectively, mobilizing and rotating, and recruiting volunteers are strategies to fulfill the workforce during the pandemic. Using a sedentary shift pattern and sufficient holidays could prevent nurses from falling ill and increase compliance with scheduling. In addition, a staffing calculation formula is needed, and top nursing managers are suggested to provide guidance or direction to the head nurses to reduce confusion in managing the work schedule during the pandemic.

We sought to evaluate if better work environments or staffing were associated with improvements in care quality, patient safety, and nurse outcomes across hospitals caring for different proportions of patients who are economically disadvantaged. Few actionable approaches for hospitals with quality and resource deficits exist. One solution may be to invest in the nurse work environment and staffing. This cross-sectional study utilized secondary data from 23,629 registered nurses in 503 hospitals from a four-state survey collected in 2005–2008. Each 10% increase in the proportion of patients who are economically disadvantaged was associated with 27% and 22% decreased odds of rating unit-level care quality as excellent and giving an "A" safety grade, respectively. Each 10% increase was also associated with 9%, 25%, and 11% increased odds of job dissatisfaction, intent to leave, and burnout, respectively. The work environment had the largest association with each outcome. Accounting for the nurse work environment lessened or eliminated the negative outcomes experienced at hospitals serving high proportions of patients who are economically disadvantaged. Leaders at hospitals serving high proportions of patients who are economically disadvantaged, as well as state and federal policymakers, should work to improve quality, safety, and nurse outcomes by strengthening nurse work environments. Improving work environments highlights the role of nursing in the health care system, and policies focused on work environments are needed to improve the experiences of patients and nurses, especially at hospitals that care for many patients who are economically disadvantaged. [ABSTRACT FROM AUTHOR]

Abstract Aim The researcher sought to understand how nurse managers describe nurses in alternative work arrangements. Design The researcher conducted this study using grounded theory. Method Semi‐structured interviews. A theoretical sample of 26 baccalaureate‐prepared nurse managers located across the United States participated in the study. Results A typology of five work arrangements provides descriptors that contribute toward greater conceptual clarity on nurses' work arrangements. The data reveal that the typology is fluid because nurses can easily switch across work arrangements. Because the rise in alternative work arrangements means that nurses can leave permanent positions—or explore different work arrangements—when circumstances permit or necessitate, nurses who do not receive continued mentoring will likely bring their deficiencies in skill and/or knowledge to facilities where they find future employment. Hence, inadequate mentoring at the unit level has practical consequences for the quality of patient care at the institutional level.

Sexual risk behavior and illicit drug use among people living with HIV/AIDS (PLWHA) contribute to poor health and onward transmission of HIV. The aim of this collaborative multi-site nursing research study was to explore the association between self-compassion and risk behaviors in PLWHA. As part of a larger project, nurse researchers in Canada, China, Namibia, Puerto Rico, Thailand and the US enrolled 1211 sexually active PLWHA using convenience sampling. The majority of the sample was male, middle-aged, and from the US. Illicit drug use was strongly associated with sexual risk behavior, but participants with higher self-compassion were less likely to report sexual risk behavior, even in the presence of illicit drug use. Self-compassion may be a novel area for behavioral intervention development for PLWHA.

Sexual risk behavior and illicit drug use among people living with HIV/AIDS (PLWHA) contribute to poor health and onward transmission of HIV. The aim of this collaborative multi-site nursing research study was to explore the association between self-compassion and risk behaviors in PLWHA. As part of a larger project, nurse researchers in Canada, China, Namibia, Puerto Rico, Thailand and the US enrolled 1211 sexually active PLWHA using convenience sampling. The majority of the sample was male, middle-aged, and from the US. Illicit drug use was strongly associated with sexual risk behavior, but participants with higher self-compassion were less likely to report sexual risk behavior, even in the presence of illicit drug use. Self-compassion may be a novel area for behavioral intervention development for PLWHA.

Background: Critical care nurses (CCNs) frequently provide end of life (EOL) care in intensive care units (ICUs). Obstacles to EOL care in ICUs exist and have been previously published along with reports from CCNs. Further data exploring obstacles faced during ICU EOL care may increase awareness of common EOL obstacles. Research focusing on obstacles related to physician behaviors and nursing issues (and others) may provide improvement of care. Objective: The aim of this study was to gather first-hand data from CCNs regarding obstacles related to EOL care. Methods: A random, geographically dispersed sample of 2000 members of the American Association of Critical-Care Nurses was surveyed. Responses from an item asking CCNs to tell us of the obstacles they experience providing EOL care to dying patients were analyzed. Results: There were 104 participants who provided 146 responses to this item reflecting EOL obstacles. These obstacles were divided into 11 themes; 6 physician-related obstacles and 5 nursing- and other related obstacles. Major EOL ICU barrier themes were inadequate physician communication, physicians giving false hope, poor nurse staffing, and inadequate EOL care education for nurses. Discussion and Conclusion: Poor physician communication was the main obstacle noted by CCNs during ICU EOL care, followed by physicians giving false hope. Heavy patient workloads with inadequate staffing were also a major barrier in CCNs providing EOL care. [ABSTRACT FROM AUTHOR]

Aims and objectives: This study aimed to identify and compare missed nursing care types and reasons between South Korea and the United States of America. Background: Patient safety has become a significant task of the healthcare delivery systems worldwide. The omission of nursing care constitutes a growing concern because it threatens both patient safety and nursing care quality. Design: This study used a cross‐sectional, descriptive and comparative design. Methods: Data were collected from registered nurses working in two university‐affiliated tertiary hospitals and a general hospital in Korea and a Midwest United States tertiary hospital. In addition, the STROBE checklist was used in this study. Results: While substantial, the level of missed nursing care reported by Korean nurses was lower than that of United States nurses. Only three nursing care activities, setting up meals, patient assessment and skin/wound care, did not significantly differed between two countries. More basic nursing care types such as ambulation, feeding and mouth care were missed more than others in both countries. The reasons for missed care differed between two countries. However, both Korean and US nurses reported labour resource problems as reasons for missed care. Conclusions: Although the types of missed nursing care differed significantly between countries, both Korean and US nurses reported labour resource problems for the top reasons for missed care. Thus, comparing missed nursing care could assist nursing administrators in developing strategies to improve care quality and patient safety. Relevance to clinical practice: The level and reasons for missed nursing care are very influential factors for patient outcomes and patient safety. Appropriate skill mix and staffing are needed to decrease extent of missed care, so that enhancing patient safety and quality of nursing care. [ABSTRACT FROM AUTHOR]

Patient safety is an important outcome for nurses who provide patient care within an environment that may increase the incidence of errors or impose them to omit care; these errors mostly happen because of staff shortage. The purpose of this study is to identify the types and reasons of "missed nursing care" among Jordanian nurses, and to examine the relationships between "missed nursing care", staffing, intent to leave, and job satisfaction. A cross‐sectional descriptive design was used. A convenience sample of 300 nurses completed the Arabic version of MISSCARE which included items to measure types and reasons for "missed nursing care", staffing adequacy, job satisfaction, and intent to leave. The results of this study indicated that Labor resources were the most common cause of "missed nursing care". The results also showed that a low number of nurses per shift were associated with a high level of "missed nursing care". Nurse managers need to tackle staffing problems that may increase the rate of missed care and result in negative outcomes on the patients, nurses, as well as organizations. Nurse administrators could conduct evidence‐based staffing plans to manage nurse to patient ratio to decrease missed care and enhance satisfaction. [ABSTRACT FROM AUTHOR]

Problem identification Patients undergoing invasive procedures are highly vulnerable to adverse outcomes. From 2012 to 2013, 5.5 per cent of all inpatient admissions reported an adverse event. Perioperative nurses play an important role in providing safe patient care and acting as the patient advocate. This review of literature aims to examine the effects of perioperative staffing and patient safety. Three common staffing themes that impact the safety and quality of patient care were identified; namely, nurse-to-patient ratios, staff training and staff fatigue. Literature search An integrative literature search to identify empirical data surrounding perioperative nursing staffing was conducted via the use of databases which included CINAHL, JBI, Medline and PubMed. Duplicates were removed, and the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines were followed. A total of 216 articles were identified. Data evaluation synthesis Scholarly literature including both qualitative and mixed methods primary research studies, that collected both qualitative and quantitative data, and some secondary research were identified for review. Articles were appraised for relevance by the researcher. Inductive thematic analysis and structured reporting was undertaken to synthesise the data. To ensure the rigor of articles Mixed Methods Appraisal Tool (MMAT) and Standard Quality Assessment Criteria for Evaluating Primary Research Papers (QualSyst) appraisals were undertaken. Out of the 216 articles, 15 research papers were identified as suitable for use within this review. Implications for practice The review demonstrated that empirical data surrounding perioperative nursing staffing is widely available. Fatigue, perioperative nurse education and nurse-to-patient ratios have a significant impact on the safety of patients undergoing invasive procedures. However, there is a lack of quantitative data surrounding these staffing factors. [ABSTRACT FROM AUTHOR]

Aim: To compare the patient acuity, nurse staffing and workforce, missed nursing care and patient outcomes among hospital unit‐clusters. Background: Relationships among acuity, nurse staffing and workforce, missed nursing care and patient outcomes are not completely understood. Method: Descriptive design with data from four unit‐clusters: medical, surgical, combined and step‐down units. Descriptive statistics were used to compare acuity, nurse staffing coverage, education and expertise, missed nursing care and selected nurse‐sensitive outcomes. Results: Patient acuity in general (medical, surgical and combined) floors is similar to step‐down units, with an average of 5.6 required RN hours per patient day. In general wards, available RN hours per patient day reach only 50% of required RN hours to meet patient needs. Workforce measures are comparable among unit‐clusters, and average missed nursing care is 21%. Patient outcomes vary among unit‐clusters. Conclusion: Patient acuity is similar among unit‐clusters, while nurse staffing coverage is halved in general wards. While RN education, expertise and missed care are comparable among unit‐clusters, mortality, skin injuries and risk of family compassion fatigue rates are higher in general wards. Implications for Nursing Management: Nurse managers play a pivotal role in hustling policymakers to address structural understaffing in general wards, to maximize patient safety outcomes. [ABSTRACT FROM AUTHOR]

Background: Evidence suggests that Magnet and non-Magnet hospitals differ with respect to quality of care. Purpose: Our study examined registered nurse (RN) staffing over time in Magnet and non-Magnet hospitals using unit-level, publicly available data in New Jersey. Methods: A secondary analysis of longitudinal RN staffing data was conducted using mandated, publicly reported data of 64 hospitals representing 12 nursing specialties across 8 years (2008-2015). Staffing ratios were trended over time to compare RN staffing changes in Magnet and non-Magnet hospitals. Results: Staffing was comparable in Magnet and non-Magnet hospitals for 9 of 12 specialties. On average, from 2008 until 2015, RN staffing slightly increased, with a greater percent increase in Magnet hospitals (6.9%) than in non-Magnet hospitals (4.7%). Conclusions: Over 8 years in New Jersey, RN staffing improved in Magnet and non-Magnet hospitals. Although there was a slight increase for Magnet hospitals, there was no meaningful difference in staffing for all 12 specialties. [ABSTRACT FROM AUTHOR]

Purpose: To compare actual versus expected nursing hours based on patients' nursing care needs. Methods: The nursing care needs of 898 inpatients in 20 wards at 11 hospitals were measured using the 14 items developed by the National Health Insurance Service (NHIS). Nursing activities from 474 nursing personnel were observed every 10 minutes for 24 hours. Actual hours indicated direct care hours per patient day provided by registered nurses according to 3 types: (1) standard hours based on staffing standards approved by the NHIS, (2) scheduled hours excluding overtime hours, and (3) observed hours including overtime. Expected hours were estimated from the linear mixed effect model including hospital type, nursing care need items and their interaction terms. Results: Standard hours ranged from 0.92 to 2.15; scheduled hours from 0.88 to 1.95; observed hours from 1.00 to 2.40; expected hours from 0.88 to 2.33. Eight hospitals had standard hours not meeting the expected hours and 2 hospitals did observed hours not meeting the expected hours due to nurses' overtime. In 3 hospitals, all types of actual hours exceeded the expected hours. Conclusion: Staffing needs to be determined based on patients' care needs and to be improved to minimize nurses' overtime work. [ABSTRACT FROM AUTHOR]

The complexity of modern burn care requires an integrated team of specialty providers working together to achieve the best possible outcome for each burn survivor. Nurses are central to many aspects of a burn survivor's care, including physiologic monitoring, fluid resuscitation, pain management, infection prevention, complex wound care, and rehabilitation. Research suggests that in general, hospital nursing resources, defined as nurse staffing and the quality of the work environment, relate to patient mortality. Still, the relationship between those resources and burn mortality has not been previously examined. This study used a multivariable risk-adjusted regression model and a linked, cross-sectional claims database of more than 14,000 adults (≥18 years) thermal burn patients admitted to 653 hospitals to evaluate these relationships. Hospital nursing resources were independently reported by more than 29,000 bedside nurses working in the study hospitals. In the high burn patient-volume hospitals (≥100/y) that care for the most severe burn injuries, each additional patient added to a nurse's workload is associated with 30% higher odds of mortality (P < .05, 95% CI: 1.02-1.94), and improving the work environment is associated with 28% lower odds of death (P < .05, 95% CI: 0.07-0.99). Nursing resources are vital in the care of burn patients and are a critical, yet previously omitted, variable in the evaluation of burn outcomes. Attention to nurse staffing and improvement to the nurse work environment is warranted to promote optimal recovery for burn survivors. Given the influence of nursing on mortality, future research evaluating burn patient outcomes should account for nursing resources. [ABSTRACT FROM AUTHOR]

Objective: To develop a nurse staffing prediction model and evaluate deviation from predicted nurse staffing as a contributor to patient outcomes.Data Sources: Secondary data collection conducted 2017-2018, using the California Office of Statewide Health Planning and Development and the California Perinatal Quality Care Collaborative databases. We included 276 054 infants born 2008-2016 and cared for in 99 California neonatal intensive care units (NICUs).Study Design: Repeated-measures observational study. We developed a nurse staffing prediction model using machine learning and hierarchical linear regression and then quantified deviation from predicted nurse staffing in relation to health care-associated infections, length of stay, and mortality using hierarchical logistic and linear regression.Data Collection Methods: We linked NICU-level nurse staffing and organizational data to patient-level risk factors and outcomes using unique identifiers for NICUs and patients.Principal Findings: An 11-factor prediction model explained 35 percent of the nurse staffing variation among NICUs. Higher-than-predicted nurse staffing was associated with decreased risk-adjusted odds of health care-associated infection (OR: 0.79, 95% CI: 0.63-0.98), but not with length of stay or mortality.Conclusions: Organizational and patient factors explain much of the variation in nurse staffing. Higher-than-predicted nurse staffing was associated with fewer infections. Prospective studies are needed to determine causality and to quantify the impact of staffing reforms on health outcomes. [ABSTRACT FROM AUTHOR]

Background and Objectives In long-term care (LTC) facilities, nursing staff are important contributors to resident care and well-being. Despite this, the relationships between nursing staff coverage, care hours, and quality of resident care in LTC facilities are not well understood and have implications for policy-makers. This systematic review summarizes current evidence on the relationship between nursing staff coverage, care hours, and quality of resident care in LTC facilities. Research Design and Methods A structured literature search was conducted using four bibliographic databases and gray literature sources. Abstracts were screened by two independent reviewers using Covidence software. Data from the included studies were summarized using a pretested extraction form. The studies were critically appraised, and their results were synthesized narratively. Results The systematic searched yielded 15,842 citations, of which 54 studies (all observational) were included for synthesis. Most studies (n = 53, 98%) investigated the effect of nursing staff time on resident care. Eleven studies addressed minimum care hours and quality of care. One study examined the association between different nursing staff coverage models and resident outcomes. Overall, the quality of the included studies was poor. Discussion and Implications Because the evidence was inconsistent and of low quality, there is uncertainty about the direction and magnitude of the association between nursing staff time and type of coverage on quality of care. More rigorously designed studies are needed to test the effects of different cutoffs of care hours and different nursing coverage models on the quality of resident care in LTC facilities. [ABSTRACT FROM AUTHOR]