Patient–Nurse Ratio is Related to Nurses’ Intention to Leave Their Job through Mediating Factors of Burnout and Job Dissatisfaction

Abstract

In healthcare settings, nurses’ workload, burnout, and job satisfaction are associated to the patient–nurse ratio. Whether this ratio also affects their intention to leave the nursing profession, along with the underlying stress pathway, remains unclear. This study aimed to investigate the effects of the patient–nurse ratio on nurses’ intention to leave and considering the mediating roles of burnout and job dissatisfaction. The study analyzed the data of two pooled cross-sectional surveys collected in 2013 and 2014. Measures were obtained by a structure questionnaire, which queried the average daily patient–nurse ratio (ADPNR), nurses’ personal burnout, client-related burnout, job dissatisfaction, intention to leave, and other demographics. ADPNRs were standardized according to hospital levels. Multiple regression models examined mediation hypotheses, and a percentile bootstrap confidence interval was applied to determine the significance of indirect effects. A total of 1409 full-time registered nurses in medical and surgical wards of 24 secondary or tertiary hospitals in Taiwan completed self-administered questionnaires. Most of the participants were female (97.2%), and the mean age was 29.9 years. The association between the standardized ADPNR and intention to leave their job was significantly mediated by personal burnout, client-related burnout, and job dissatisfaction. Higher standardized ADPNRs predicted higher levels of personal burnout, client-related burnout, and job dissatisfaction, each of which resulted in higher levels of intention to leave the current job. The results highlight that appropriate patient–nurse ratio standards may be further discussed by selecting personal burnout, client-related burnout, and job dissatisfaction as indicators.

Assessment of Magnet status and Textbook Outcomes among medicare beneficiaries undergoing hepato‐pancreatic surgery for cancer

“…Improved nurse-to-bed ratio may alleviate nurse workload and mitigate burnout, thus improving workplace satisfaction and performance. 31 Although not associated with TO in the current study, other structural measures such as hospital teaching status have been associated with TO. 32,33 Of note, the beneficial effect of these hospital "structural" factors were associated with improved odds of TO among both Magnet and non-Magnet hospitals.…”

Working Hours, Job Burnout, and Subjective Well-Being of Hospital Administrators: An Empirical Study Based on China’s Tertiary Public Hospitals

“…The completely standardized effect size was estimated by 95% confidence intervals (CIs) with a bootstrap of 5000 times. A significant indirect effect was presumed when the 95% CIs did not contain 0 [ 47 ]. The significance level was set at 0.05 (two-tailed).…”

How does the patient to nurse ratio relate to the quality of patient care and nurse burnout in the hospital?

“…In 2014, 1378 of the same nurses were recruited and 1190 once again completed the questionnaire. In the secondary and tertiary hospitals, the ADPNRs were 13.1 and 10.7 respectively (Chen, Yi-Chuan, et al, 2019).…”

“…Hospital context includes inadequate nurse staffing, workload, workplace injustice, workplace violence, interpersonal relationship, burnout, and job dissatisfaction (Chen, Yi-Chuan, et al, 2019). Single marital status, unsatisfactory workplace justice, ill nurse-physician relationships, no nurse staff leadership, and no participation in hospital affairs were found to correlate positively with intention to leave (Chen, Yi-Chuan, et al, 2019). The researchers determined that an increased patient-to-nurse ratio would influence the nurses' intention to leave their job.…”