Organization of Hospital Nursing, Provision of Nursing Care, and Patient Experiences With Care in Europe

Abstract

This study integrates previously isolated findings of nursing outcomes research into an explanatory framework in which care left undone and nurse education levels are of key importance. A moderated mediation analysis of survey data from 11,549 patients and 10,733 nurses in 217 hospitals in eight European countries shows that patient care experience is better in hospitals with better nurse staffing and a more favorable work environment in which less clinical care is left undone. Clinical care left undone is a mediator in this relationship. Clinical care is left undone less frequently in hospitals with better nurse staffing and more favorable nurse work environments, and in which nurses work less overtime and are more experienced. Higher proportions of nurses with a bachelor's degree reduce the effect of worse nurse staffing on more clinical care left undone.

Keywords: baccalaureate nursing education; nursing administration research; patient satisfaction; personnel staffing and scheduling; work schedule tolerance.

Figure 1

Path diagram illustrating (a) the relationship between work environments and patient experiences with care through clinical care left undone (mediator) and (b) the effect of nurse education (moderator) on the relationship between patient-to-nurse ratios and patient experiences with care through clinical care left undone (mediator).