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Purpose: This study was done to develop and validate a scale for assessing nursing needs on comprehensive nursing care units and to derive a patient classification system based on nursing needs.Methods: In this methodological study, the initial items were identified through a review of the literature and surveys from nursing staff regarding the nursing needs on comprehensive nursing care units. Content validity was evaluated by nine nursing staff members from comprehensive nursing care units. To evaluate the concurrent validity and derive a patient classification system, nursing needs scores, perceived nursing needs and perceived patient severity for 216 patient cases were evaluated by five nurses. These data were analyzed using Pearson‘s correlation coefficients, one-way ANOVA with Scheffépost hoc tests and K-means clustering.Results: After evaluating content validity, the developed scale contained 64 activities in two domains: nursing intervention and assistance of daily living. Concurrent validity was verified by analyzing the differences in the nursing needs scores according to each group of perceived nursing needs and severity (p

Aims To review the comprehensive characteristics of adverse nurse work schedules and to synthesise the evidence of their relationships with adverse patient outcomes. Background To manage nurse shortages and fluctuations in patient censuses, nurses often work overtime. This increases nurses' work hours and causes them to have fewer breaks. Such extended work schedules, long shift length, long weekly work hours and insufficient beaks can be considered as adverse nurse work schedules. Understanding how these adverse nurse work schedules affect patient outcomes is important to ensure patient safety. Design A systematic review of nursing and healthcare literature was conducted in this study. Methods Eight electronic bibliographic databases (CINAHL, Cochrane Library, DBpia, EBSCO, PubMed, PsycINFO, RISS and Web of Science) were used to search research articles published from 2000 to 2019. The study selection process followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Results From the search, 2,366 articles were identified, 22 of which were included in this review. Working more than 12 hours in a day had an adverse effect on patient outcomes, as was working more than 40 hours per week. There were mixed findings in the relationship between nurse overtime and adverse patient outcomes. Conclusions This study found a conclusive relationship between excessive nurse work hours and adverse patient outcomes. This review highlights the importance of managing adverse nurse schedules such as long daily and weekly work hours to improve patient safety and prevent adverse patient outcomes. Relevance to clinical practice Study findings support the importance of monitoring and regulating nurse work schedules and adverse scheduling practices to improve nurse well-being and health and to prevent adverse patient outcomes.

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

Purpose: Comprehensive nursing care services are provided for patient-centered nursing care in Korea. This study was conducted to compare differences in the frequency and elapsed time of nursing activities between comprehensive nursing care units and general medical-surgical units. Methods: This is a descriptive study design using direct observation of nursing care activities. A time and motion study on the frequency and elapsed time of nursing activities provided by nurses was conducted in the comprehensive nursing care units and general units of two small-to-medium sized hospitals. Data were collected for 64 hours in each hospital, through a two-way method using a checklist and a camera recorder. Results: The total number of nursing activities, activities provided per patient and patient safety care including clinical assessment and treatment were higher in the comprehensive nursing care units compared to general units. We found similar findings regarding the duration of nursing activities. Conclusion: Comprehensive nursing care units provide patient-centered nursing care and have a broader range of nursing activities for patient safety than general units. Assessments conducted to meet nursing needs and to promote safe nurse staffing should reflect the characteristics of the nursing tasks performed in comprehensive nursing care units.

Aim To examine the nature and prevalence of Cambodian nurses' work hours and overtime and related factors BACKGROUND: The chronic shortage of nursing workforce is a major cause of overtime among nurses. Introduction Nursing shortage and working overtime among nurses negatively affect nurse and patient outcomes, but nurses' work hours and overtime in Cambodia have not been comprehensively examined. Methods A multicenter cross-sectional study was conducted in four Cambodian hospitals. Data were collected from 253 nurses providing direct nursing care using a questionnaire. The STROBE checklist was used for reporting this study. Results More than a fifth of staff nurses worked more than 48 h, which is the legal work hour limit in Cambodia. Two major reasons for working mandatory or voluntary overtime, on-call or 24-h on-call were (a) not wanting to let down colleagues and (b) able to get all work done. The number of patients cared for was related to whether or not nurses worked 48 h or more. Conclusion Overtime work and adverse nurse scheduling are common in Cambodia. Implications for nursing and health policy Nurse managers and healthcare institutes in Cambodia need to monitor Cambodian nurses' work hours, which are often beyond the legal work hour limit. Moreover, it is important to understand why nurses work overtime and develop health policies, strategies, and programs that can help promote patient and nurse safety and retain qualified nursing staff. The 24-h on-call practice needs to be regulated according to the labor policy in healthcare institutes to prevent adverse nurse and patient outcomes.

Background As the shortage of qualified nurses is one of the primary healthcare issues in Cambodia, a two-year Nurse Bridging Program which grants bachelor's degrees to nurses with associate degrees was introduced. Objectives This study explores the challenges and achievements that the graduates experienced during and after the Nurse Bridging Program. Design A qualitative approach was used in this study. Setting The Nurse Bridging Program was conducted in a university in Cambodia from 2015 to 2016. This study was conducted 1 year after the Nurse Bridging Program. Participants A group of 38 graduates participated in the online survey and 3 graduates participated in a focus group interview. Methods Sequential data collection for explanatory follow-up design was used in this study. The data obtained were analyzed using content and thematic analyses. Results Participants reported challenges such as unfamiliarity with research, difficulty with a foreign language, and shortage of time. They tried to overcome these challenges, and this experience improved their nursing and research competencies, which improved their job prospects and aspirations of further studies. Conclusions The Nurse Bridging Program helped the nurses improve the quality of their work and develop their potential as nursing leaders.

This cross-sectional study used quantitative survey data collected from registered nurses (RNs) who worked as staff nurses in medium-sized (300 beds or less) Korean hospitals. Data from 290 RNs were analyzed to examine the nature and prevalence of staff nurses’ work hours, overtime, breaks, and related work conditions. The results showed that staff nurses working in medium-sized Korean hospitals worked 9.6 hours a day on average and had 1.5 breaks daily, including mealtime. The average number of days the nurses skipped a meal due to work during the last month was 6.1. With respect to skipping bathroom breaks due to work, staff nurses reported that they could not visit the bathroom 7.3 times during the last month. Regarding work conditions, staff nurses working in intensive care units reported having longer daily work hours and were more likely to work 10 hours or more per shift. Nurses with less than 3 years of experience reported longer daily work hours and fewer breaks.

Aims To examine the nature and characteristics of both received and provided mutual support in a social network within an acute care hospital unit. Background Current evidence regarding the social network in the health care workforce reveals the nature of social ties. Most studies of social network-related support that measured the characteristics of social support used self-reported perception from workers receiving support. There is a gap in studies that focus on back-up behaviour. Methods The evaluation included a social network analysis of a nursing unit employing 54 staff members. A 12 item electronic survey was administered. Descriptive statistics were calculated using the Statistical Package for the Social Sciences. Social network analyses were carried out using ucinet, r 3.2.3 and gephi. Results Based on the study findings, as providers of mutual support the nursing staff claimed to give their peers more help than these peers gave them credit for. Those who worked overtime provided more mutual support. Conclusion Mutual support is a key teamwork characteristic, essential to quality and safety in hospital nursing teams that can be evaluated using social network analysis. Implications for nursing management Because of a discrepancy regarding receiving and providing help, examining both receiver and provider networks is a superior approach to understanding mutual support.

This integrative review synthesized evidence on the consequences of the Centers for Medicare & Medicaid Services (CMS) nonpayment policy on quality improvement initiatives and hospital-acquired conditions. Fourteen articles were included. This review presents strong evidence that the CMS policy has spurred quality improvement initiatives; however, the relationships between the CMS policy and hospital-acquired conditions are inconclusive. In future research, a comprehensive model of implementation of the CMS nonpayment policy would help us understand the effectiveness of this policy.

The purpose of this study was to examine nurse staffing in comprehensive nursing care units in Korea and examine the corresponding nurse outcomes, including intent to leave, job satisfaction, and occupational injuries. A total of 356 nurses working in comprehensive nursing care units at eight small-medium sized Korean hospitals participated in this cross-sectional study. In the day, evening, and night shifts, nurse staffing ranged from 9.00 to 24.82, 9.04 to 24.26, and 9.02 to 25.80, respectively. The nurse staffing on each shift did not have a significant impact on nurses' intent to leave, job satisfaction, and occupational injuries. However, workload had a strong relationship with intent to leave and job satisfaction. Voluntary overtime was related to occupational injuries. These findings demonstrate that workload is an important factor for intent to leave and job satisfaction among nurses working in comprehensive nursing care units. Improvements of the work environment, as well as rearrangement of nurse workload to account for patient acuity and nursing needs, are required for the future expansion of comprehensive nursing care services.

Purpose The purpose of this study is to examine the nature of nurse practitioners’ (NPs) job satisfaction and its relationship to work conditions in rural versus nonrural areas. Data sources A secondary analysis of data extracted from the 2012 National Sample Survey of Nurse Practitioners. NPs in active practice in clinical settings were included in this study. The final analytic sample consisted of 9010 NPs. Conclusions and implications for practice Overall, NPs were satisfied with their positions (satisfied to very satisfied). Both rural and nonrural NPs were most satisfied with the proportion of their time spent in patient care, their level of autonomy, and the respect that they received from other colleagues. Nonrural NPs who said or stated that they performed to the fullest extent of their states’ legal scope of practice were more satisfied than nonrural NPs who did not. When nonrural NPs fully utilized their NP skills, their job satisfaction increased. For rural NPs, a similar pattern was found regarding full use of their NP skills. The evidence found in this study reminds us that given the increasing demands for NPs’ healthcare services, continuous effort should be made to recruit and retain rural NPs.

To explore the nature and prevalence of nurse practitioner (NP) overtime, work hours, and their relationship to practice within NP work conditions.A secondary analysis of data extracted from the 2012 National Sample Survey of Nurse Practitioners. The focus in this study was on data from NPs in active practice in clinical settings. The final analytic sample consisted of 9010 NPs.NPs working in hospitals and long-term care settings tended to work more than 40 h/week (p.001). When healthcare facilities used electronic health records (p.001) or had recently adopted electronic health records (p = .002), NPs were found to work more hours per week than those who did not. Regarding the type of relationships with physicians, NPs who worked more than 40 h/week either had hierarchical relationships with them (p0.001), or relationships in which the physician examined and signed off on patients whom the NP had examined (p.001). These analyses provide a preliminary description of the nature and prevalence of NP work hours/overtime and work conditions related to longer work hours. Further study is indicated to assess the potential impact of work hours/overtime on NP roles and patient outcomes.

Objectives Although considerable progress has been made in understanding networks, their structure, and their development, little has been known about their effectiveness in the health care setting and their contributions to quality of care and patient safety.The purpose of this study was to examine studies using social network analysis (SNA) in the health care workforce and assess factors contributing to social network and their relationships with care processes and patient outcomes. Methods We identified all published peer-reviewed SNA articles in CINAHL, PubMed, PsycINFO, JSTOR, Medline (OVID), and Web of Science databases up to April 2013. Results Twenty-nine published articles met the inclusion criteria. Current evidence of the health care workforce's social networks reveals the nature of social ties are related to personal characteristics, practice setting, and types of patients. A few studies also revealed the social network effects adoption and the use of a health information system, patient outcomes, and coordination. Conclusions Current studies on the social ties of health care workforce professionals include several assessments of inefficiencies. The level of technical sophistication in these studies tended to be low. Future study using enhanced sophistication in study design, analysis, and patient outcome testing are warranted to fully leverage the potential of SNA in health care studies.

This article describes the evolution of mandated nurse staffing committees in Texas from 2002 to 2009 and presents a study that analyzed nurse staffing trends in Texas using a secondary analysis of hospital staffing data ( N = 313 hospitals) from 2000 to 2012 obtained from the American Hospital Association Annual Survey. Nurse staffing patterns based on three staffing variables for registered nurses (RNs), licensed vocational nurses (LVNs), and total licensed nurses were identified: full-time equivalents per 1,000 adjusted patient days, productive hours per adjusted patient day, and RN skill mix. Similar to national trends between 2000 and 2012, most Texas hospitals experienced an increase in RN and total nurse staffing, decrease in LVN staffing, and an increase in RN skill mix. The magnitude of total nurse staffing changes in Texas (5% increase) was smaller than national trends (13.6% increase). Texas's small, rural, government hospitals and those with the highest preregulation staffing levels experienced the least change in staffing between 2000 and 2012: median change of 0 to .13 full-time equivalents per 1,000 adjusted patient days and median change in productive hours per patient day of 0 to .23. The varying effects of staffing committees in different organizational contexts should be considered in future staffing legislative proposals and other policy initiatives.

Background A great number of studies have been conducted to examine the relationship between nurse staffing and patient outcomes. However, none of the reviews have rigorously assessed the evidence about the effect of nurse staffing on nurse outcomes through meta-analysis. Purpose The purpose of this review was to systematically assess empirical studies on the relationship between nurse staffing and nurse outcomes through meta-analysis. Methods Published peer-reviewed articles published between January 2000 and November 2016 were identified in CINAHL, PubMed, PsycINFO, Cochrane Library, EBSCO, RISS, and DBpia databases. Findings This meta-analysis showed that greater nurse-to-patient ratio was consistently associated with higher degree of burnout among nurses (odds ratio: 1.07; 95% confidence interval [CI]: 1.04–1.11), increased job dissatisfaction (odds ratio: 1.08; 95% CI: 1.04–1.11), and higher intent to leave (odds ratio: 1.05; 95% CI: 1.02–1.07). With respect to needlestick injury, the overall effect size was 1.33 without statistical significance. Discussion The study findings demonstrate that higher nurse-to-patient ratio is related to negative nurse outcomes. Future studies assessing the optimal nurse-to-patient ratio level in relation to nurse outcomes are needed to reduce adverse nurse outcomes and to help retain nursing staff in hospital settings.

When nurses work on-call hours, they have limited ability to control the hours they work. Nurses may be required to work extra hours and, if they are unable to detach from work during break time, can experience fatigue and sleep disturbances. Previous studies have not examined factors associated with on-call work. In this pilot study, the authors examined state regulatory, organizational, and personal factors related to nurse on-call hours. Data were collected from registered nurses working in hospitals in two states; the final analytic sample consisted of 219 nurses. The authors found that four variables (teaching hospital employment, patient-to-nurse ratio, race/ethnicity of the nurse, and living with children) were significantly related to working on-call hours. Additional research is needed to understand nurse on-call hours and develop agency policies to promote nurses' health and well-being.

BAE S.H. (2011) Organizational socialization of international nurses in the New York metropolitan area. International Nursing Review59, 81–87 Background: The global migration of nurses has been ongoing in an effort to alleviate the worldwide nursing shortage. Although international nurses have unique needs in adapting to a new host culture and workplace, little is known about the process of organizational socialization faced by different groups of international nurses, such as child immigrant registered nurses (RNs), adult immigrant RNs, and foreign-educated RNs, compared with native nurses. Objectives: This study examined international nurses' perceptions of their organizational socialization and its association with intent to leave in both the international and the American nurses. Methods: Data from a hospital RN survey was used for secondary data analysis, with the final dataset consisting of 752 RNs. Organizational socialization was measured to assess the quality of the orientation programme and support from supervisors and peers. Nurse retention was measured by nurses' intent to leave within 3 years. Findings: The level of organizational socialization of foreign-educated RNs was higher than that of any of other nurse groups. Lower proportions of foreign-educated RNs and adult immigrant RNs had plans to leave within 3 years compared with American RNs and child immigrant RNs. Good supervisor and peer support were negatively associated with nurses' intent to leave (i.e. these nurses were less likely to leave within 3 years). Conclusions: This study found that the orientation programme and support from peers and supervisors played an important role in the international nurse's organizational socialization process. This process should be the subject of continued research to provide frontline nurse managers with practical information addressing the challenges of international nurses' organizational socialization.

bae s.-h. (2011) Journal of Nursing Management19, 700–713 Assessing the relationships between nurse working conditions and patient outcomes: systematic literature review Aim The purpose of the study was to systematically evaluate nurse working conditions and to review the literature dealing with their association with patient outcomes. Background Improving nurse working conditions is essential to address nursing shortages. Although general reviews of the literature support the positive link between working conditions and patient outcomes, definitive evidence has been lacking. Evaluation A search of six electronic bibliographic databases was conducted for the primary research published in English, from January 2000 to October 2009. Key issues The concepts of working conditions were categorized into 10 groups of working conditions. A total of 69 relationships between working conditions and patient outcomes were examined. Conclusions Increased attention has been drawn to nurse working conditions resulting from nursing shortages. The findings of this review suggested that the evidence supporting positive relationships between working conditions and patient outcomes is inconclusive. Further studies of a longitudinal and interventional nature in various settings are needed to advance knowledge of the complex contextual and multivariate influences among nurse working conditions and patient outcomes. Implications for nursing management Efforts to improve working conditions should be made in various health-care work settings to ensure patient safety and improve patient quality of outcomes.

Background To deal with nursing shortages and inadequate hospital nurse staffing, many solutions have been tried, including utilizing temporary nurses. Relatively little attention has been given to use of temporary nurses and its association with both nurse and patients outcomes. Purpose : The purpose of this study is to investigate the association between use of temporary nurses and nurse (needlesticks and back injuries) and patient (patient falls and medication errors) safety outcomes at the nursing unit level. Methodology/approach Data came from a large organizational study which investigated the relationship between registered nurse (RN) staffing adequacy, work environments, organizational, and patient outcomes. The sample for this study was 4,954 RNs on 277 nursing units in 142 hospitals. Findings Nurses working on nursing units with high levels (more than 15%) of external temporary RN hours were more likely to report back injuries than nurses working on nursing units that did not use external temporary RNs. Nurses working on these nursing units also reported greater levels of patient falls compared with those who did not use temporary RNs. This study found that nurses working on nursing units with moderate levels (5-15%) of external temporary RN hours reported fewer medication errors than those without using any external temporary RNs. Practice implications Hospitals need to monitor the levels of temporary nurse use and maintain a level of approximately 15% to ensure both nurse and patient safety outcomes. The temporary nurse use to manage nursing shortfall may provide both benefit and harm to nurse and patient safety depending on the level of the use.

A descriptive study used data from the 2004 National Sample Survey of Registered Nurses to examine the nature and occurrence of RN mandatory, voluntary overtime, paid on-call, and total work hours and their association with mandatory overtime regulations in United States. About half of the nurses worked more than 40 hrs per week. Nurses working in states regulating mandatory overtime reported lower levels of mandatory overtime hours than states without regulations or states restricting total work hours. The percent of RNs working 61 hrs and over per week in states without regulations was lower than that in states with regulations. Nurses working in nursing homes reported higher levels of the percentage of mandatory overtime hours worked than those working in hospitals. This suggested that governments need to continuously supervise healthcare institutions, including both hospitals and nursing homes, to ensure adherence to mandatory overtime regulations.

Aims and objectives To examine the nature and prevalence of the use of temporary nursing staff in intensive care units and relationships between the use of temporary nursing staff and the occurrence of nosocomial infections (central line-associated blood stream infections and ventilator-associated pneumonia). Background Hiring temporary nurses raises controversial issues with respect to nurse staffing, care processes and patient outcomes, yet empirical findings regarding the use of temporary nurses are mixed. Whether adverse patient outcomes in intensive care units are related to the use of temporary nursing staff remains unexamined. Design A retrospective longitudinal design was used. Methods Data were collected monthly from 12 intensive care units at six hospitals; 144 ICU-month data points were used for the analysis. Chi-square, anova and logit regression models were used to examine the research questions. Results The intensive care units used higher levels of temporary nursing staff, but the use of temporary nursing staff was not significantly associated with nosocomial infections. Nurses' perceptions regarding staffing and resource adequacy were significantly associated with nosocomial infections. Conclusions No evidence was found to link the use of temporary nursing staff and nosocomial infections. Instead, nurses' perceptions of staffing adequacy were related to nosocomial infections. Relevance to clinical practice Given the greater use of temporary nursing staff in intensive care units, nurse managers in intensive care units need to monitor the levels of temporary nurse staffing and develop a systematic approach for hospitals to assist in these nurses' adjustment, which can reduce the burden of both temporary and permanent intensive care unit nurses. In addition to quantitative measures of nurse staffing, nurses' perceptions regarding staffing adequacy can be used to measure nurse staffing in relation to adverse patient outcomes.

Objectives To examine the degree to which states' work hour regulations for nurses—policies regarding mandatory overtime and consecutive work hours—decrease mandatory overtime practice and hours of work among registered nurses. Methods We analyzed a nationally representative sample of registered nurses from the National Sample Survey of Registered Nurses for years 2004 and 2008. We obtained difference-in-differences estimates of the effect of the nurse work hour policies on the likelihood of working mandatory overtime, working more than 40 hours per week, and working more than 60 hours per week for all staff nurses working in hospitals and nursing homes. Principal Findings The mandatory overtime and consecutive work hour regulations were significantly associated with 3.9 percentage-point decreases in the likelihood of working overtime mandatorily and 11.5 percentage-point decreases in the likelihood of working more than 40 hours per week, respectively. Conclusions State mandatory overtime and consecutive work hour policies are effective in reducing nurse work hours. The consecutive work hour policy appears to be a better regulatory tool for reducing long work hours for nurses.

Associations between comprehensive nurse staffing characteristics and patient falls and pressure ulcers were examined using negative binomial regression modeling with hospital- and time-fixed effects. A convenience sample was collected from 35 nursing units in 3 hospitals. Rates of patient falls and injury falls were found to be greater with higher temporary registered nurse staffing levels but decreased with greater levels of licensed practical nursing care hours per patient day. Pressure ulcers were not related to any staffing characteristics.

Background The effects of work hours/overtime on nurse and patient outcomes and specific components of work hours (per shift and per week) and overtime on these effects have not been systematically examined. Purpose The purpose of this review was to systematically evaluate the effect of nurse overtime and long work hours on nurse and patient outcomes. Methods An online search of six electronic bibliographic databases was conducted for research published from 2000 to 2013. Discussion Twenty-one nurse outcome measures and 19 patient outcome measures were found in relationships with work hours and overtime. A total of 67 relationships to nurse outcomes and 41 relationships to patient outcomes were examined. Conclusions The findings of this review suggested that evidence supporting positive relationships between working long hours and adverse outcomes to the nurses is strong. However, to make a conclusion of the positive relationship between long work hours and adverse patient outcomes, more evidence is needed.

The purpose of this study was to complete an integrated literature review of the relationship between staffing and quality outcomes in nursing homes. The majority of the reviewed studies showed better outcomes with higher nursing staff but depended heavily on cross-sectional observational studies and failed to differentiate RNs from other nursing staff. A total of 28 articles relating nurse staffing and quality outcomes were systematically reviewed and synthesized. However, each study examined different aspects of staffing and different resident or organizational outcomes, making determination of appropriate staffing levels difficult. The reviewed studies have not clearly defined the relationship between differing levels of nurse-staffing skill mix and specific structure, process, outcome, and composite indicators of quality. The inconsistent findings suggest that further research is needed in this area.

Although more states have regulated mandatory nurse overtime, limited research has examined the impact of these regulations on the actual time nurses work and their working conditions. The purpose of this study was to compare nurse overtime and working conditions between states with and states without regulations limiting mandatory nurse overtime. Data were collected from registered nurses working in hospitals located in states with and without mandatory nurse overtime regulations; the final sample consisted of 219 nurses. No difference was found in overtime worked between nurses who worked in states with regulations or without. Those nurses working in states with regulations cared for more patients per shift and experienced more chronic nursing shortages on their nursing units than those working in states without regulation. Continuous efforts are needed to improve the implementation of regulations to reduce nurse mandatory overtime and long work hours.

Purpose: The aim of this study was to examine how nursing unit turnover affects key workgroup processes and how these processes mediate the impact of nursing turnover on patient outcomes. Methods: A secondary data analysis was used to test the hypothesized model. This study used registered nurse and patient data from 268 nursing units at 141 hospitals collected as part of the Outcomes Research in Nursing Administration (ORNA II) project. Nursing units provided monthly nursing unit turnover rates for 6 consecutive months, and registered nurses completed questionnaires measuring workgroup processes (group cohesion, relational coordination, and workgroup learning). Patient outcome measures included unit-level average length of patient stay, patient falls, medication errors, and patient satisfaction scores. Results: Nursing units with moderate levels of turnover were likely to have lower levels of workgroup learning compared to those with no turnover (p