Health Care Manage Rev. 2024;49(1):23-34. doi: 10.1097/HMR.0000000000000390.
Hospitals are often tasked with improving patient care while simultaneously increasing operational efficiency. Although efficiency may be gained by maintaining higher patient volume per nurse (higher workload), high-quality patient care requires low levels of nurse turnover, which might be adversely affected by an increase in workload.
Drawing upon job demands-resources theory, we hypothesized that hospital-level workload will predict nurse turnover and that nurse turnover will predict patient mortality, and that registered nurse hiring rates and human resource management practices will moderate (buffer) the positive relationship between nurse workload and nurse turnover, whereas quality care structures will moderate (buffer) the positive relationship between nurse turnover and patient mortality.
We tested this model utilizing multiple sources of time-lagged data collected from a sample of 156 hospitals in the United States.
Our findings suggest that (a) nurse workload is associated with higher nurse turnover, (b) nurse turnover is positively associated with patient mortality, (c) nurse staffing buffers the workload-turnover relationship as a first-stage moderator, and (d) quality care structures act as a second-stage moderator that mitigates the effects of turnover on mortality.
CONCLUSIONS/PRACTICE IMPLICATIONS: The reduction of nurse turnover and patient mortality requires investments in adequate levels of nurse staffing and implementation of quality care structures.
医院通常需要在提高患者护理质量的同时提高运营效率。虽然通过维持每名护士更高的患者量（更高的工作量）可以提高效率，但高质量的患者护理需要低水平的护士离职率，而工作量的增加可能会对其产生不利影响。
根据工作要求-资源理论，我们假设医院层面的工作量将预测护士离职率，而护士离职率将预测患者死亡率，并且注册护士招聘率和人力资源管理实践将缓冲（缓冲）护士工作量和护士离职率之间的正相关关系，而高质量的护理结构将缓冲（缓冲）护士离职率与患者死亡率之间的正相关关系。
我们使用从美国的 156 家医院的样本中收集的多个时间滞后数据源来测试该模型。
我们的研究结果表明：（a）护士工作量与更高的护士离职率有关，（b）护士离职率与患者死亡率呈正相关，（c）护士人员配备缓冲了工作量-离职率关系作为第一阶段的调节因素，（d）高质量的护理结构作为第二阶段的调节因素，可以减轻离职对死亡率的影响。
结论/实践意义：降低护士离职率和患者死亡率需要在充足的护士人员配备和实施高质量的护理结构方面进行投资。
