Nurse-to-patient ratios and staffing issues: a qualitative investigation of nurses’ perceived work environments in Quebec’s integrated healthcare centers

Titolo Rivista SALUTE E SOCIETÀ
Autori/Curatori Sara Nogues, Diane-Gabrielle Tremblay
Anno di pubblicazione 2024 Fascicolo 2024/2
Lingua Inglese Numero pagine 20 P. 33-52 Dimensione file 314 KB
DOI 10.3280/SES2024-002004
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Nurse-to-patient ratios (N/P) are designed to ensure acceptable levels of patient load as well as enough nurses to properly care for patients. Representatives of the nursing profession and unions have been urging government to implement regulation to ensure the respect of mini-mum established N/P ratios at all times in Quebec healthcare organizations. This paper aims to examine N/P ratios, in the context of demands of many organizations for a law enforcing mandatory staffing ratios in Quebec healthcare organizations. A qualitative exploration was conducted using 42 semi-directive interviews with unionized nurses throughout the province of Quebec. A thematic analysis was carried out using NVivo. Using the Nursing job de-mands-resource model, which gives importance to the broader organizational climate, we assessed nurses’ perceptions of their working environment. Four main themes emerged: 1) intensifying workload, 2) inadequate skill mix, 3) cost-effective management, 4) adverse outcomes. Our findings suggest that reducing the number of patients per nurse will not neces-sarily result in better working conditions if other lean strategies are adopted to compensate for the higher staffing costs, nor will it make the work environment fundamentally more attractive. While higher staffing levels are needed, seriously caution should be paid to the ways in which ratios are implemented. Alternative models of healthcare institutions, such as Magnet hospitals or other models, should be examined.

Keywords:nurse-to-patient ratios; lean management; nurse shortage; nurse staffing; nursing work environment; mandatory overtime.

  1. Aiken L., Sloane D., Clarke, S. et al. (2011). Importance of work environments on hospital outcomes in nine countries. International Journal for Quality in Health Care, 23(4): 357-364.
  2. Bakker A., Demerouti E. (2007). The Job Demands-Resources model: State of the art. Journal of Managerial Psychology, 22(3): 309-328. DOI: 10.1108/0268394071073311
  3. Ball J., Griffiths P., Rafferty A. et al. (2016). A cross-sectional study of “care left undone” on nursing shifts in hospitals. Journal of Advanced Nursing, 72(9): 2086-97.
  4. Broetje S., Jenny G.J., Bauer G.F. (2020). The key job demands and resources of nursing staff: an integrative review of reviews. Frontiers in Psychology, 11(84): 1-17.
  5. Buchan J. (1999). Still attractive after all these years? Magnet hospitals in a changing health care environment. Journal of Advanced Nursing, 30(1): 100-108.
  6. Cheng H., Yang H., Ding Y., Wang B. (2020). Nurses’ mental health and patient safety: An extension of the Job Demands–Resources model. Journal of Nursing Management, 28(3): 653-663.
  7. Dall’Ora C., Saville C., Rubbo B. et al. (2022). Nurse staffing levels and patient outcomes: A systematic review of longitudinal studies. International Nursing Studies, 134, 1-12.
  8. Descurningues C. (2023). Des organismes plaident pour l’imposition de ratios de patients. La Presse, August 30th 2023.
  9. Donaldson N., Shapiro S. (2011). Impact of California Mandated Acute Care Hospital Nurse Staffing Ratios: A Literature Synthesis. Policy, Politics and Nursing Practice, 11(3): 133-140. DOI: 10.1177/152715441039224
  10. Douglas K. (2010). Ratios – If it were only that easy. Nursing Economic, 28(2): 119-125.
  11. Driscoll A., Grant M., Carroll D. et al. (2018). The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: a systematic review and meta-analysis. European Journal of Cardiovascular Nursing, 17(1): 6-22. DOI: 10.1177/147451511772156
  12. Fédération Interprofessionnelle de la Santé du Québec (FIQ). Les partis politiques doivent s’engager à instaurer des ratios pour les professionnelles en soins. Available online: https://www.fiqsante.qc.ca/2022/08/27/les-partis-politiques-doivent-sengager-a-instaurer-des-ratios-pour-les-professionnelles-en-soins/. Published 27 August 2022 (12/02/2023).
  13. Fédération Interprofessionnelle de la Santé du Québec (FIQ). Les ratios sécuritaires sauvent des vies - Pour une loi garantissant des ratios sécuritaires professionnels en soins/patient-es. -- Available online: https://consultations.finances.gouv.qc.ca/Consultprebudg/2019-2020/memoires/Consultations1920_FIQ.pdf. Published July 2018 (12/02/2023).
  14. Grodal S., Anteby M., Holm A. (2021). Achieving rigor in qualitative analysis: the role of active categorization in theory building. Academy of Management Review, 46(3): 591-612.
  15. Holden R., Eriksson A., Andreasson J. et al. (2015). Healthcare workers’ perceptions of lean: A context-sensitive, mixed methods study in three Swedish hospitals. Applied Ergonomics, 47: 181-192.
  16. Kalisch B., Landstrom G., Hinshaw A. (2009). Missed nursing care: a concept analysis. Journal of Advanced Nursing, 65(7): 1509-1517.
  17. Keyko K., Cummings G.G., Yonge O., Wong C.A. (2016). Work engagement in professional nursing practice: a systematic review. International Journal of Nursing Studies, 61: 142-164.
  18. La Presse Canadienne. Des organismes de la santé plaident pour l’imposition de ratios de patients. -- Available online: https://ici.radio-canada.ca/nouvelle/1879919/ratio-infirmiere-patient-soins-quebec-professionnels-associations. Published 29 April 2022, (12/02/2023).
  19. Lake E. (2002). Development of the practice environment of the nursing work index. Research in Nursing & Health, 25: 176-188.
  20. Leigh J., Markis C., Losif A., Romano P. (2015). California’s nurse-to-patient ratio law and occupational injury. International Archives of Environmental Health, 88(4): 477-484.
  21. McHughs M., Aiken L.H., Sloane D. et al. (2021). Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals. Lancet, 397: 1905-1913. DOI: 10.1016/S0140-6736(21)00768-
  22. Nantsupawat A., Poghosyan L., Orn-Anong W. et al. (2022). Nurse staffing, missed care, quality of care and adverse events: A cross-sectional study. Journal of Nursing Management, 30(2): 447-454.
  23. Olley R., Edwards I., Avery M., Cooper H. (2018). Systematic review of the evidence related to mandated nurse staffing ratios in acute hospitals. Australian Health Review, DOI: 10.1071/AH16252
  24. Rousseau, Viau, Fecteau. (2019). “Implantation de ratios sécuritaires professionnelles en soins/patient-e-s : Une démarche prometteuse pour des soins sécuritaires au Québec”. Présentation dans le cadre du Congrès OIIQ, 25-26 novembre 2019.
  25. Schmalenberg C., Kramer M. (2008). Essentials of a productive nurse work environment. Nursing Research, 57: 2-13. DOI: 10.1097/01.NNR.0000280657.04008.2
  26. Schneider B., Ehrhart M., Macey W. (2013). Organizational climate and culture. Annual Review of Psychology, 64: 361-88.
  27. Serratt et al. (2011). Staffing Changes Before and After Mandated Nurse-to-Patient Ratios in California’s Hospitals. Policy, Politics, & Nursing Practice, 12(3): 133-140. DOI: 10.1177/152715441141788
  28. Shin S., Park J., Bae S. (2018). Nurse staffing and nurse outcomes: A systematic review and meta-analysis. Nursing Outlook, 66: 273-282.
  29. Shindul-Rotschild J. (2016) FIQ - Symposium international sur les soins de santé sécuritaire. -- https://www.youtube.com/watch?v=hwa9PP-dmkQ
  30. Simonetti M., Cerón C., Galiano A., Lake E., Aiken L. (2021). Hospital work environment, nurse staffing and missed care in Chile: A cross-sectional observational study, Journal of Clinical Nursing, 31, 17-18: 2518-2529.
  31. Sochalski J., Konetzka R., Zhu J., Volpp K. (2008). Will mandated minimum nurse staffing ratios lead to better patient outcomes? Medical Care, 46(6): 606-613.
  32. Spetz J., Donaldson N., Aydin N., Brown D.S. (2008). How Many Nurses per Patient? Measurements of Nurse Staffing in Health Services Research. Health Research and Educational Trust, 43(5).
  33. Tevington P. (2011). Mandatory nurse-patient ratios. Medsurg Nursing, 20, 5: 265-268.
  34. Thériault M., Dubois C.A., Borgès da Silva R., Prud’homme A. (2019). Nurse staffing models in acute care: A descriptive study. Nursing Open, 6: 1218-1229.
  35. Welton J. (2007). Mandatory hospital nurse to patient staffing ratios: time to take a different approach. The Online Journal of Issues in Nursing, 12(3), -- available online: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/MandatoryNursetoPatientRatios.aspx. Accessed 12 February 2023.
  36. World Health Organization (2020). Global strategy on human resources for health: Workforce 2030. -- Available online: https://www.who.int/publications/i/item/9789241511131. Accessed 12 February 2023.
  37. Wright P., Bretthauer K., Cote M. (2006). Reexamining the Nurse Scheduling Problem: Staffing Ratios and Nursing Shortages. Decision Sciences, 37(1): 39-70.
  38. Wynendaele H., Willems R., Trybou J. (2019). Systematic review: Association between the patient–nurse ratio and nurse outcomes in acute care hospitals. Journal of Nursing Management, 1-22: 896-917.

Sara Nogues, Diane-Gabrielle Tremblay, Nurse-to-patient ratios and staffing issues: a qualitative investigation of nurses’ perceived work environments in Quebec’s integrated healthcare centers in "SALUTE E SOCIETÀ" 2/2024, pp 33-52, DOI: 10.3280/SES2024-002004