Brady Noeleen, O'Connell Selena, Gilligan David, Madden Caoimhe, Gannon Lisa, Howson Victoria, Ball Jane E, Murphy Aileen, Griffiths Peter, Duffield Christine, Scott P Anne, Mc Carthy Vera J C, Drennan Jonathan
University College Cork, Cork, Ireland.
University of Galway, Galway, Ireland.
J Adv Nurs. 2025 Sep;81(9):5973-5983. doi: 10.1111/jan.16752. Epub 2025 Jan 22.
Job satisfaction and intention to leave have been consistently linked to the working environment. However, there are few studies of interventions for improving the environment or staff outcomes.
To determine the impact of implementing a framework for safe nurse staffing on the environment and staff outcomes. This involved an assessment of required nursing hours per patient day, supernumerary nurse in charge and minimum 80:20 skill-mix, with intentional changes in staffing if required.
A pre-post observational design.
This was a prospective observational study in six medical and/or surgical wards across three acute hospitals in Ireland. The outcomes were measured pre- and post-implementation, and included the environment, using the Practice Environment Scale of the Nursing Work Index; and job satisfaction and intention to leave using a dichotomised 4-point scale.
Changes in staffing levels, adjustments to skill-mix and the supervisory role of the ward leader were seen following the implementation. A multilevel model found significant increases over time on three of the five Nursing Work Index subscales: Staffing and Resource Adequacy, Collegial Nurse-Physician Relations, and Nurse Participation in Hospital Affairs. Job satisfaction increased and intention to leave decreased, although the differences were not statistically significant. Increased job satisfaction was significantly associated with Staffing and Resource Adequacy, Collegial Nurse Physician Relations and Nurse Manager, Leadership and Support. A decreased odds of intention to leave was associated with increased job satisfaction.
There were significant improvements in the environment following the implementation of the Framework. Three of the practice environment subscales were significantly associated with job satisfaction, while job satisfaction is a predictor of intention to stay. This study indicates that intentional changes to staffing can result in improvements to working environments which may in turn have an impact on job satisfaction and furthermore, on intention to stay.
This study investigated intentional changes to nurse staffing in medical and surgical wards, examining the impact pre- and post-implementation. This study underlined that when staffing is based on a systematic approach, based on a Framework for Safe Nurse Staffing, a subsequent improvement can be seen in staff's perceptions of the work environment, along with improvements in staff outcomes. This research will impact on staff working in acute settings as a means of determining staffing and improving outcomes using a Framework for Safe Nurse Staffing.
STROBE checklist.
No patient or public contribution.
工作满意度和离职意愿一直与工作环境相关。然而，针对改善环境或员工成果的干预措施研究较少。
确定实施安全护士人员配置框架对环境和员工成果的影响。这包括评估每位患者每天所需的护理时长、额外的护士长以及至少80:20的技能组合，并在必要时对人员配置进行有意调整。
前后观察性设计。
这是一项在爱尔兰三家急症医院的六个内科和/或外科病房进行的前瞻性观察研究。在实施前后对结果进行测量，包括使用护理工作指数实践环境量表评估环境；使用二分制4分制评估工作满意度和离职意愿。
实施后人员配置水平发生变化，技能组合得到调整，病房护士长的监督角色也有所改变。多层次模型发现，随着时间推移，护理工作指数的五个子量表中的三个有显著增加：人员配置与资源充足性、医护人员合作关系以及护士参与医院事务。工作满意度提高，离职意愿降低，尽管差异无统计学意义。工作满意度的提高与人员配置与资源充足性、医护人员合作关系以及护士长的领导与支持显著相关。离职意愿降低与工作满意度提高相关。
实施该框架后环境有显著改善。实践环境的三个子量表与工作满意度显著相关，而工作满意度是留任意愿的预测指标。本研究表明，对人员配置进行有意调整可改善工作环境，进而可能影响工作满意度，并进一步影响留任意愿。
本研究调查了内科和外科病房护士人员配置的有意变化，考察了实施前后的影响。本研究强调，当基于安全护士人员配置框架采用系统方法进行人员配置时，员工对工作环境的认知随后会得到改善，员工成果也会得到改善。这项研究将影响急症环境中的工作人员，作为使用安全护士人员配置框架确定人员配置和改善成果的一种方式。
STROBE清单。
无患者或公众参与。
