Relationships Between Nurse Staffing and Patients’ Experiences, and the Mediating Effects of Missed Nursing Care

PURPOSE:The aims of this study were to examine the relationships between nurse staffing and patients' experiences, and to determine the mediating effects of patient-reported missed care on the relationship between nurse staffing and patients' experiences. DESIGN:The study included 362 nurses and 208 patients from 23 nursing units of six hospitals in South Korea. METHODS:Nurse staffing was measured by patient-to-nurse ratios and by nurse- and patient-perceived staffing adequacy. Patients' experiences included adverse events, communication with nurses, and overall hospital rating. Patient-reported missed care was measured using the MISSCARE Survey-Patient with three domains: communication, basic care, and timely response. FINDINGS:Lower nurse-perceived staffing adequacy was associated with more patient-reported missed communication. Lower patient-perceived staffing adequacy was associated with more missed care and adverse events, and a lower likelihood of experiencing good communication with nurses and of giving a high overall rating to the hospital. Patient-reported missed care mediated the relationship between nurse staffing and patients' experiences. CONCLUSIONS:Nurse staffing adequacy, particularly as perceived by patients, was significantly associated with patient-reported missed communication and basic care, as well as patients' experiences. CLINICAL RELEVANCE:Appropriate nurse staffing is required to reduce missed care and to improve patients' experiences.