Almost 40 % of all paediatric ED attendances did not require hospital expertise. The risk of an inappropriate use of ED by pediatrician patients is predominantly associated with organizational and cultural factors. Access, equity, quality of care, and medical human resources availability have to be taken into account to design financially sustainable model of care for those patients. Furthermore, future research is needed to explain reasons why parents visit ED rather than using of primary-care services.

BackgroundBelgian hospitals face a growing shortage of physicians and increasingly competitive market conditions. In this challenging environment hospitals are struggling to build effective hospital-physician relationships which are considered to be a critical determinant of organizational success.MethodsEmployed physicians of a University hospital were surveyed. Organizational attributes were identified through the literature and two focus groups. Variables were measured using validated questionnaires. Descriptive analyses and linear regression were used to test the model and relative importance analyses were performed.ResultsThe selected attributes predict hospital attractiveness significantly (79.3%). The relative importance analysis revealed that hospital attractiveness is most strongly predicted by professional attributes (35.3%) and relational attributes (29.7%). In particular, professional development opportunities (18.8%), hospital prestige (16.5%), organizational support (17.2%) and leader support (9.3%) were found to be most important. Besides these non-economic aspects, the employed physicians indicated pay and financial benefits (7.4%) as a significant predictor of hospital attractiveness. Work-life balance and job security were not significantly related to hospital attractiveness.ConclusionsThis study shows that initiatives aimed at strengthening physicians’ positive perceptions of professional and relational aspects of practicing medicine in hospitals, while assuring satisfactory financial conditions, may offer useful avenues for increasing the level of perceived hospital attractiveness. Overall, hospitals are advised to use a differentiated approach to increase their attractiveness to physicians.

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.

Our study demonstrates the importance of social exchange to nurses and nurse assistants and therefore nursing administrators and leaders. When registered nurses and nurse assistants perceive high-quality social exchange, they are more likely to go the extra mile on behalf of the organization. Fostering social identification could enhance this.

This study has implications for human resources management in nursing organizations. Nursing administrators are advised to monitor and balance nurses' job demands and efforts. They should recognize the importance of social support, job control, job rewards, and overcommitment in order to reduce the job stress of nurses.