Systematic review: Association between the patient–nurse ratio and nurse outcomes in acute care hospitals

Aims: To evaluate and summarize current evidence on the relationship between the patient-nurse ratio staffing method and nurse employee outcomes. Background: Evidence-based decision-making linking nurse staffing with staff-related outcomes is a much needed research area. Although multiple studies have investigated this phenomenon, the evidence is mixed and fragmented. Evaluation: A systematic literature search was conducted using PubMed, Embase, Web of Science, Cinahl, Cochrane Library and the ERIC databases. Thirty studies were identified, analysing eight selected key nurse outcomes. Key issue(s): Future research should focus on unit-level data, incorporate other methodologies and aim for comparability between different types of clinical settings as well as different health care systems. Conclusion: A relationship between the patient-nurse ratio and specific staff-related outcomes is confirmed by various studies. However, apart from the patient-nurse ratio other variables have to be taken into consideration to ensure quality of care (e.g., skill mix, the work environment and patient acuity). Implications for Nursing Management: Hospital management should pursue the access and use of reliable data so that the validity and generalizability of evidence-based research can be assessed, which in turn can be converted into policy guidelines

What is the impact of self-scheduling on the patient, employee and organisation? A systematic review

Aims: To evaluate the current evidence base and provide a systematic overview of this evidence on the relationship between self-scheduling and patient, employee- and organisation-related outcomes. Background: The ongoing shortage of qualified nursing staff together with the detrimental effects of shift work have resulted in a search for the perfect schedule for healthcare personnel. Self-scheduling is one method to enhance flexibility and give more control to the employee. At first sight, self-scheduling appears to be successful in some organisations and not in others. This inconsistency is confusing for policymakers and prevents further implementation of self-scheduling in practice. Evaluation: Twenty three studies were identified, and subdivided into exploratory and descriptive studies because of their distinct features. Following outcomes were analysed: patient- and employee-reported quality of care, job satisfaction, satisfaction with scheduling, work/life balance, planning involvement, interaction with colleagues, health and well-being, psychosocial factors, professional development, nurse manager's time on scheduling, general working conditions, turnover, agency utilization and absenteeism, recruitment and retention. Conclusion: Several studies confirmed that self-scheduling can have a positive impact (e.g. on work/life balance). However, negative impact on certain outcomes, opposite results or no statistically significant results have also been revealed. The evidence base is too thin and insufficient to make strong statements. Future research should use multimethod longitudinal studies, include patient-centred outcomes and employ a theoretical framework that gives attention to the concept of fairness or justice. Implications for management: The implementation and sustainability of the self-scheduling system is a major challenge for healthcare management. This review summarizes practical tips for a successful implementation in order that future policy can be adjusted according to lessons learned in the past

The relationship of nursing home price and quality of life

Background: Knowledge about the relationship between the residents’ Quality of Life (QOL) and the nursing home price is currently lacking. Therefore, this study investigates the relationship between 11 dimensions of QOL and nursing homes price in Flemish nursing homes. Methods: The data used in this cross-sectional study were collected by the Flemish government from years 2014 to 2017 and originates from 659 Flemish nursing homes. From 2014 to 2016, data on the QOL of 21,756 residents was assessed with the InterRAI instrument. This instrument contains 11 QOL dimensions. Multiple linear regression analyses were conducted to examine the research question. Results: The multiple linear regressions indicated that a 10 euro increase in the daily nursing home price is associated with a significant decrease (P<0.001) of 0.1 in 5 dimensions of QOL (access to services, comfort and environment, food and meals, respect, and safety and security). Hence, our results indicate that the association between price and QOL is very small. When conducting a subgroup analysis based on ownership type, the earlier found results remained only statistically significant for private nursing homes. Conclusion: Our findings show that nursing home price is of limited importance with respect to resident QOL. Contrary to popular belief, our study demonstrates a limited negative effect of price on QOL. Further research that includes other indicators of QOL is needed to allow policymakers and nursing home managers to improve nursing home residents’ QOL

An organizational design perspective on the monthly self‐scheduling process in nursing homes : a multiple case study

AimsTo describe the monthly self-scheduling process in nursing homes (NH), to determine how specific organizational design characteristics (including interpersonal relationships and leadership style) influence this process, and to examine the effect on individual, team, and organization-related outcomes. DesignA multiple case study using an organizational design perspective as the overarching theoretical and explanatory framework. MethodsData collection was performed in four Belgian NH during Spring 2019 using semi-structured interviews (n = 39), documents, and observations. Open, axial, and selective coding was used for the data reduction process, and a within-case and cross-case analysis was performed. The COREQ checklist was used for reporting the findings. ResultsOne group (two NH) used self-scheduling because it corresponds with their decentralized organizational design. Together with a motivating head nurse and additional resources during the core phase of the process, this led to positive outcomes. In contrast, another group used self-scheduling under the assumption that it would solve the mismatch between their organizational design and other organizational problems, which resulted in less positive work attitudes. ConclusionSelf-scheduling should match the organizational structure and culture. Additional resources and an adaptive leadership style can help mobilize and support employees. Future research may use quantitative methods to confirm positive outcomes. ImpactThis study contributes to the rare literature on self-scheduling in NHs by focusing on the monthly self-scheduling process and by including an organizational design perspective. NH management can become informed of different self-scheduling methodologies and the impact of specific organizational characteristics on this process. Head nurses can become aware that they need to adapt their leadership style to obtain improved outcomes. Patient or Public ContributionThree members of the study team met with several caregivers during field visits to conduct interviews and to observe the monthly self-scheduling process