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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 examine the factors affecting actual turnover among nurses working in hospitals using the Brewer-Kovner synthesis model. Background To increase retention of nurses, it is important to understand factors contributing to actual turnover among nurses. Methods A longitudinal study design was utilized with 2,633 of 20,613 eligible female hospital nurses who participated in Korea Nurses' Health Study. We created two age groups: a younger group (20-35 years) and an older group (36-49 years). Multivariate logistic regression was used to identify the factors influencing turnover by age group. Results Pregnancy and childbirth increased young nurses' turnover. When we excluded intent to leave, depression and burnout were significant factors affecting young nurses' turnover. Salary and hospital size were factors predicting nurse turnover among nurses over 36-year age. Conclusions It is essential to develop prevention strategies of female nurse turnover based on the age group in Korea. Implications for nursing management Nurse managers and healthcare institutes need to develop new managerial and policy strategies to reduce nurse turnover in each age group.

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.

Quality and safe care requires nurses with advanced knowledge and skills. Cambodia does not have a graduate-level nursing program; therefore, nurses are required to pursue advanced degrees in other countries. However, a master's degree nursing program is being established in this country.To explore the needs of stakeholders in the master's nursing program in Cambodia to establish the curriculum.Students and graduates of Bachelor of Sciences in Nursing were surveyed, and policymakers were interviewed face-to-face.As candidates for the master's nursing program, 94 undergraduates and 37 graduates participated in the survey, and four policymakers working at the Ministry of Health and Cambodian Council of Nurses were interviewed.Descriptive statistics and frequency analyses were utilized for quantitative data and qualitative data were thematically analyzed.All 131 undergraduates and graduates were willing to apply to the master's program in nursing mainly to improve their knowledge and skills. They cited financial burden as a challenge for their study. Their educational demands were closely related to Cambodia's social situation and reflected their aspiration for advanced degrees and to become nursing leaders. The policymakers unanimously agreed on the need for the program and suggested policies and strategies to operate the course and recognize the role of graduates with this qualification. They reinforced that the curriculum should be based on the law, regulation, and policy and reflect Cambodia's current situation by identifying the needs of students and hospital officials and investigating available resources. Their perspectives revealed their expectations for graduates to plan healthcare policies and support them as their coworkers.The establishment of nursing master's course should be accompanied by a policy to support nursing students. Nursing educators and experienced senior nurses should be included in this policymaking and they must participate in the development of the curriculum. It is suggested to develop an eclectic master's program in nursing that aggregates all opinions of stakeholders.

In Morocco, there are challenges in the management of high-risk tuberculosis (TB) patients, including paper-based management and a shortage of healthcare workers related to TB. Additionally, TB management has not been accounted for in various patient types, which affects treatment adherence. This study aims to examine the delivery model of TB management and the outcomes of an integrated patient management system that uses a patient-centered and community-based approach, along with mobile health technology. A total of 3605 TB patients were enrolled in this program in Morocco’s five prefectures (Rabat, Salé, Kénitra, Khemisset, Skhirat–Témara) from January 2018 to December 2019. Patients were managed based on demographic characteristics, socioeconomic status, areas (rural or urban), health literacy levels, and distance to primary health centers. Our mobile health intervention “smart pillbox” was interposed with high-risk TB patients, along with patient education. The rate of successful treatment was 92.2%, which was higher than the national rate (88%). The “lost to follow-up” rate was 4.1%, which was significantly lower than the existing non-adherence rate of 7.9%. Therefore, integrated patient management for TB patients in Morocco is more effective than the existing conventional programs. This comprehensive approach provides an alternative method for countries with limited resources.

The purpose of this study was to determine the job satisfaction among female workers in Korea and the association between health status and job satisfaction. The Korean Longitudinal Survey of Women and Families was used for this nationwide cross-sectional study. Data from 1570 female workers were analyzed to determine job satisfaction and examine the association between health status and job satisfaction, controlling for other variables such as personal characteristics, work attributes, job opportunities, and work conditions. Analyses included descriptive statistics, independent t-tests, ANOVA, Pearson's correlation, and multivariate regression. Subjective health status was positively related, while diagnosed disease and depressive symptoms were negatively associated with job satisfaction. Monthly salary, work hours, fringe benefits, and geographical region were also significantly related to female workers' job satisfaction, and commute distance was related to job satisfaction with a small effect size. This study thus found that subjective health status, diagnosed disease, and depressive symptoms were related to female workers' job satisfaction. Health promotion and supporting mental health among female workers may be important managerial strategies for supporting increased job satisfaction in female workers.

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 Pain can have a critical negative impact on the quality of life of institutionalized older people. This study aimed to examine the characteristics of pain and associated factors among older people at nursing homes in Korea. Methods A nationwide survey was carried out on the functional status of 1444 older residents at 91 nursing homes using the interRAI Long-Term Care Facilities instrument. The frequency, intensity, severity and consistency of pain were assessed, and data on potential attributes at the resident and facility levels were collected. Multivariate and multilevel regression analysis models were developed. Results More than one-third (36.7%) of older residents had pain. Pain prevalence differed by several sociodemographic and clinical factors, including sex, depressive symptoms, cognition, or whether or not the resident was a Medical Aid beneficiary. Pain prevalence also varied according to nursing home size and location. In the multivariate, multilevel regression analyses, both having severe pain and having consistent pain were positively associated with depressive symptoms, and the pain experience was significantly lower among older residents in nursing homes that met the nursing staffing standard. Conclusions This is the most comprehensive study on pain assessment in long-term care facilities in Korea using a representative sample so far. Pain is prevalent among nursing home residents in Korea. Besides individual factors, facility characteristics - in particular, meeting the staffing standard - were important to pain control, which implies there is room for improving pain assessment and management through advancing quality of care policies. Geriatr Gerontol Int 2020; 20: 118-124.

Background: Asians accounted for 30% of all U.S. immigrants in 2014, of which 53% were women. Foreign-born Asian immigrant (FBAI) women experience difficulties in obtaining timely and need...

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.

Verbal abuse among nurses is the most prevailing type of violence encountered by nurses. A cross-sectional research design was used to identify the characteristics of verbal abuse among nurses. A self-administered questionnaire was completed by 201 nurses working in a government hospital of Nepal. Nurses were exposed to verbal abuse and yelling or raising voice in an angry fashion was the most common forms experienced by 96.5% of the respondents. Patient’s relatives were reported as the main source of verbal abuse. Frequent exposure to verbal abuse was found in Nepalese nurses, which makes nurses feel unsupported, increased stress levels, and decreased sense of relaxation/well-being in the job. There is an immediate need of monitoring and training among nursing staff in recognition and management of aggressive behavior.

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.

Supplemental material, Supplemental_Table_3 for Verbal Abuse Among Nurses Working in a Nepalese Government Hospital by Anjana Lamichhane and Sung-Heui Bae in Asia Pacific Journal of Public Health

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.

This study was a secondary analysis of cross-sectional data extracted from the 2011-2012 California Health Interview Survey. Data from 8,931 full-time (i.e., 21 hours or more per week) women workers aged 18 to 85 years were analyzed to examine the nature and prevalence of immigrant female workers’ work hours, overtime, and related factors in the United States compared to U.S.-born female workers. Results showed that foreign-born female workers did not work longer hours than U.S.-born female workers. Foreign-born female workers who reported poor health worked longer hours than did their U.S.-born counterparts. Foreign-born female workers who were self-employed or worked in family businesses tended to work longer hours than did those women who worked for private companies or nonprofit organizations.

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.

Objectives This study's objective was to explore the possible triggers of clinicians' disruptive behavior and to consider whether the type of trigger resulting in disruptive behavior differed by type of clinician, clinician characteristics, professional role, and ethnic background. Methods Using data collected from 1559 clinicians working at an urban academic medical center in the United States, we examined intrapersonal, interpersonal, and organizational triggers. In addition, we measured 3 subscales of disruptive behavior including incivility, psychological aggression, and violence. Multivariate regression and logit models were used to examine the relationship between triggers and disruptive behavior. Results We found that higher levels of intrapersonal, interpersonal, and organizational triggers related to a greater frequency of disruptive behaviors after controlling for clinician characteristics. Among nurses, all 3 types of triggers were significantly related to disruptive behaviors with the same direction and magnitude of difference. However, in the physician/affiliate group, only intrapersonal and interpersonal triggers were statistically significant factors for disruptive behavior. Conclusions In the present study, important triggers were found to contribute to clinicians' disruptive behaviors. Strategies to prevent disruptive behaviors should be multipronged and reflect intrapersonal and interpersonal features for both clinician groups. For nurses, organizational triggers should be addressed through process and system improvements. Because disruptive behavior continues to be frequent among clinicians, efforts to implement evidence-based practices to prevent disruptive behaviors must continue, and future research should evaluate them.

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.

Purpose: This study compares beneficiaries of Korean Medicaid with those under the National Health Insurance program, seeking to understand how each group utilizes their healthcare. Methods: Data were obtained from a Health Promotion Survey in 2005. Health status was measured by the respondents’ perception of health. Health service utilization included the availability of healthcare services, the type of healthcare institution, and intent to revisit. Predisposing and enabling factors, as well as health care needs were used for this study. Results: Compared to National Health Insurance beneficiaries, Medicaid beneficiaries reported lower levels of health status and fewer enabling factors. They had more chronic diseases and disabilities. Education level, existence of chronic diseases, exercise patterns, and disabilities were associated with health status. Conclusion: We found that Medicaid beneficiaries had fewer resources and higher levels of health needs. As Medicaid is reformed, policy makers and administrators should understand healthcare utilization behaviors of Medicaid beneficiaries and the factors hindering access to care.

Based on the job demands–resources (JD-R) model, this study explored the impact of job demands (physical injury and racial/ethnic discrimination) and resources (self-confidence in job performance and recognition by supervisor/organization/society) on home health workers’ employee outcomes (job satisfaction and turnover intent). Using data from the National Home Health Aide Survey ( N = 3,354), multivariate models of job satisfaction and turnover intent were explored. In both models, the negative impact of demands (physical injury and racial/ethnic discrimination) and the positive impact of resources (self-confidence in job performance and recognition by supervisor and organization) were observed. The overall findings suggest that physical injury and discrimination should be prioritized in prevention and intervention efforts to improve home health workers’ safety and well-being. Attention also needs to be paid to ways to bolster work-related efficacy and to promote an organizational culture of appreciation and respect.

The magnitude of negative consequences of clinician disruptive behaviors on patients and clinicians was examined using data collected from 1559 clinicians working at an urban academic medical center in the United States. For the impact of disruptive behavior on patient safety, psychological aggression as caused by disruptive behavior or incivility increased the likelihood of patient harm as well as job dissatisfaction and physical symptoms.

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.

A systematic literature review was performed to review empirical evidence, published between 1946 and 2015, regarding Korean immigrant women’s health care utilization and factors affecting their health care utilization in the United States. Andersen’s behavioral model of health services utilization was used as a framework and was expanded to analyze the pattern of health services utilization and to identify characteristics of access to health care. A total of 32 reports were included. Variables were categorized into 1 of 5 individual determinants: cultural, enabling, predisposing, need, and reinforcing factor. A total of 423 relationships were found between individual determinants and health care utilization. All reinforcing variables were effective in increasing Korean immigrant women’s health care utilization in a positive way. Interventions targeting multiple factors were strongly effective in encouraging Korean immigrant women to utilize health services for cancer screening. However, these studies yielded inconsistent findings related to outcome measures due to the variability of measurement criteria.

The Centers for MedicareMedicaid Services (CMS) reimbursement policy identified 11 preventable adverse outcomes. Of these 11 patient outcomes, four (severe pressure ulcers, falls and trauma, catheter-associated urinary tract infections, and vascular catheter-associated infections) are considered nursing-sensitive quality outcomes that can be decreased with greater and better nursing care. A cross-sectional study examined the CMS reimbursement policy focusing on nursing-sensitive adverse patient outcomes. The percentage of Medicare patients served as a proxy for a measure of the CMS changes in reimbursement. The CMS reimbursement policy measured by the proxy variable was not related to a reduction of the four adverse 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.