The relationship between patient satisfaction with nursing care and nurse staffing

Abstract

<p>Nurse researchers and patient care administrators have long been concerned with understanding patient satisfaction with nursing care and its relationship to nurse staffing. This study focused on two major aspects of the problem, within the context of a single inpatient orthopaedic surgery unit during a three-year period. Using an ex post facto correlational design, this study used secondary data to examine (a) patient satisfaction with nursing care, and (b) the relationship of patient satisfaction with nursing care to nurse staffing. The research questions are framed within a conceptual framework based on Donabedian's model of quality assessment and stakeholder theory of strategic management. Nurse staffing variables include care intensity, skill mix, and staffing adequacy. Patient satisfaction variables include indicators derived from patients' perspectives of several care processes and outcomes, including overall nursing care. The study uses two levels of analysis. First, patient satisfaction with nursing care and its underlying structure is examined at the patient level of analysis. Second, the relationship between patient satisfaction and nurse staffing is assessed at the unit level. At the patient level of analysis, using 1076 patient surveys, patient satisfaction was not found to be comprised of two dimensions. Principal component analysis showed that patient satisfaction, as measured by the ten nursing variables in this study, is not comprised of perceptions of process and perceptions of outcome. However, satisfaction with pain management did not fit within the factor structure for satisfaction with nursing. In a separate analysis, satisfaction with nursing accounted for 42% of the variance in overall satisfaction with hospital care. Satisfaction with the time spent with nurses accounted for 26% of the variance with overall hospital satisfaction. At the unit level of analysis, four statistically significant relationships were found between the staffing and patient satisfaction variables: (a) LPN hours per patient day and time spent with nurses, (b) RN proportion and nurses introducing themselves, (c) RN proportion and nurses explaining their actions, and (d) Percent Staffing-LPN and time spent with nurses. In addition, several statistically significant inverse relationships were identified between selected patient satisfaction variables and volume in terms of patient days.</p>