Lasater Karen B, Aiken Linda H, Douglas Clint, Windsor Carol, Yates Patsy, Smith Herbert L, McHugh Matthew D
Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA; The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA; The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
Int J Nurs Stud. 2025 Nov;171:105178. doi: 10.1016/j.ijnurstu.2025.105178. Epub 2025 Aug 6.
Nurse retention and wellbeing have reached alarmingly low levels in recent years and health systems globally are searching for large-scale systemic solutions to reduce nurse burnout, improve wellbeing, and increase job satisfaction and retention while simultaneously enhancing patient care quality and safety.
To evaluate whether a minimum nurse staffing policy intervention in Queensland Australia improved nurse wellbeing, intentions to leave employment, and patient safety.
This is a quasi-experimental intervention study in which we compared nurse outcomes, patient safety measures, quality of care indicators, and operational failures among 27 hospitals subject to a minimum nurse staffing policy (i.e. intervention hospitals) and 41 hospitals not subject to the policy (i.e. comparison hospitals) at two points in time: prior to implementation of the policy (i.e. baseline) and two years after implementation (i.e. post-implementation). Percentages of nurses with unfavorable outcomes and unfavorable ratings of quality of care and patient safety are reported for intervention and comparison hospitals at baseline and post-implementation of the staffing policy. Fixed effects logistic regression models evaluated the interaction between the intervention effect and the post-implementation period to report the impact of the staffing policy on outcomes.
The minimum nurse staffing policy intervention was associated with improvements in staffing, nurse wellbeing and job outcomes, and quality of care and patient safety in the intervention hospitals. Nurses in intervention hospitals had 24 % lower odds of high burnout (OR 0.76, 95 % CI 0.61-0.94, p < 0.05) and 27 % lower odds of job dissatisfaction (OR 0.73, 95 % CI 0.59-0.91, p < 0.01) at post-implementation relative to the baseline; no statistically significant differences in these outcomes were found among comparison hospitals. Job dissatisfaction with workload, professional development, autonomy at work, and work schedule all declined significantly in intervention hospitals and worsened over time in comparison hospitals. Nurse work environment scores improved in the intervention hospitals and worsened in the comparison hospitals. Quality of care, patient safety, and operational failures markedly improved in the intervention hospitals and generally worsened in the comparison hospitals.
The quasi-experimental study design gives policymakers and hospital administrators strong confidence that minimum nurse staffing policy interventions can result in more favorable work environments for nurses, better job outcomes including lower nurse burnout and job dissatisfaction, and improvements in quality of care and safety for patients.
