Relationship between nursing care quality, nurse staffing, nurse job satisfaction, nurse practice environment, and burnout: literature review

Virya Koy, Jintana Yunibhand, Yupin Angsuroch, Mary L. Fisher


The purpose of this literature review is to explore the relationship between nurse staffing, nurse job satisfaction, nurse practice environment, burnout, and nursing care quality through a consideration of what is meant by perceptions of nursing care quality. Different people define nursing care quality in many ways. It is complex, multi-faceted and multi-dimensional, and attempts to assess, monitor, evaluate and improve nursing care quality have evolved over a number of years. Of particular interest is the way in which changes in nurse staffing, nurse job satisfaction, nurse practice environment, and burnout may affect the quality of nursing care delivery. A search was conducted using the CINAHL, Medline and Embase databases, HINARI, Science Direct, Google, and PubMed. The terms searched included quality of health care; nursing care quality; nurse job satisfaction; nurse practice environment; burnout; and nurse staffing. Papers were included for their relevance to the field of enquiry. The original search was conducted in 2003 and updated in 2004. Quality of care is a complex, multi-dimensional concept, which presents researchers with a challenge when attempting to evaluate it. Many different tools have assessed nursing care quality. In addition, the review found that there were relationships between nurse staffing, nurse job satisfaction, nurse practice environment, burnout, and nursing care quality.


Nursing care quality, Literature review, Nurse staffing, Nurse job satisfaction, Nurse practice environment, Burnout

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Ministry of Health (MoH). Health Strategic Plan, 2008-2015.

Blegan MA, Vaughn T. A multisite study of nurse staffing and patient occurrences. Nursing Economics. 1998;16:196–203.

Aiken LH, Clarke SP, Sloane DM, Sochalski JA, Clarke H, Giovannettii P, et al. Nurses reports on hospital care in five countries. Health Affairs. 2001;1–11.

Aiken LH, Clarke SP, Sloane DM, Solchalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002;288(16):1987–93.

Aiken L, Sermeus W, Van den Heede K, Sloane D, Busse R, McKee M, et al. Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ. 2012;344:e1717.

Nantsupawat A, Srisuphan W, Kunaviktikul W, Wichaikhum O, Aungsuroch Y, Aiken LH. Impact of Nurse Work Environment and Staffing on Hospital Nurse and Quality of Care in Thailand. Journal of Nursing Scholarship. 2011;43(4):426-33.

Mrayyan MT. Jordanian nurses’ job satisfaction, patients’ satisfaction and quality of nursing care. International Nursing Review. 2006;53:224–30.

Institute of Medicine. Keeping Patients Safe: Transforming the Work Environment of Nurses. Institute of Medicine of the National Academies. Executive Summary. National Academies Press, Washington, DC, 2004.

Donabedian A. Evaluating the quality of medical care. Milbank Memorial Fund Quarterly. 1966;44:166–206.

Donabedian A. An Introduction to Quality Assurance in Health Care. Oxford University Press, Oxford, 2003.

Mitchell PH, Ferketich S, Jennings BM. Quality health outcomes model. Journal of Nursing Scholarship. 1998;30(1):43–6.

Martsolf GR, Auerbach D, Benevent R, Stocks C, Jiang HJ, Pearson ML, et al. Examining the Value of Inpatient Nurse Staffing An Assessment of

Quality and Patient Care Costs. Med Care. 2014;52:982–8.

Duffield D, Diers D, O'Brien-Pallas L, Aisbett C, Roche M, King M, Aisbett K. Nursing staffing, nursing workload, the work environment and patient outcomes. Applied Nursing Research. 2011;24:244–55.

Borglund ST. Case management quality of life outcomes for adults with a disability. Rehabilitation Nursing. 2008;33(6):260–7.

Gerolamo AM. The conceptualization of physical restraint as a nursing-sensitive adverse outcome in acute care psychiatric treatment settings. Archives of Psychiatric Nursing. 2006;20(4):175–85.

Newhouse RP, Johantgen M, Pronovost PJ, Johnson E. Perioperative nurses and patient outcomes– Mortality, complications, and length of stay. Association of Peri-Operative Registered Nurses Journal. 2005;81(3):508–28.

Vahey DC, Aiken LH, Sloane DM, Clarke SP, Vargas D. Nurse burnout and patient satisfaction. Medical Care. 2004;42:II57–66.

Wandelt MA, Ager JW. Quality Patient Care Scale. Appleton-Century-Croft, New York, 1975.

Hogston R. Quality nursing care: a qualitative enquiry. Journal of Advanced Nursing. 1995;21:116-24.

Gunther M, Alligood MR. A discipline-specific determination of high quality nursing care. Journal of Advanced Nursing. 2002;38(4):353–9.

Izumi S, Baggs JG, Knafl KA. Quality Nursing Care for Hospitalized Patients With Advanced Illness: Concept Development Research in Nursing & Health. 2010;33:299–315.

Burhans LM, Alligood MR. Quality nursing care in the words of nurses. Journal of Advanced Nursing. 2010;66(8):1689–97.

Lucero RJ, Lake ET, Aiken LH. Nursing care quality and adverse events in US hospitals. Journal of Clinical Nursing. 2010;19:2185–95.

Sermeus W, Aiken LA, Van den Heede K, Rafferty AM, Griffiths P, Moreno-Casbas MT, et al. Nurse forecasting in Europe (RN4CAST): Rationale, design and methodology. Sermeus et al. BMC Nursing. 2011;10:6

Van Bogaert P, Kowalski C, Weeks SM, Van heusden D, Clarke SP. The relationship between nurse practice environment, nurse work characteristics, burnout and job outcome and quality of nursing care: A cross-sectional survey. International Journal of Nursing Studies. 2013;50:1667–77.

Aiken LH, Clarke SP, Sloane DM. Hospital staffing, organization, and quality of care: Cross-national findings. International Journal for Quality in Health Care. 2002;14(1):5–13.

Person SD, Allison JJ, Kiefe CI, Weaver MT, Williams OD, Centor RM, et al. Nurse staffing and mortality for Medicare patients with acute myocardial infarction. Medical Care. 2004;42:4–12.

Bruyneel L, Van den Heede K, Diya L, Sermeus W, Aiken LH, Sermeus W. Predictive Validity of the International Hospital Outcomes Study Questionnaire: An RN4CAST Pilot Study. Journal of Nursing Scholarship. 2009;41(2):202–10.

Ball JE, Murrells T, Rafferty AM, Morrow E, Griffiths P. Care left undone’ during nursing shifts: associations with workload and perceived quality of care. BMJ Quality and Safety. 2014;23:116–25.

Leinonen T, Leino-Kilpi H, Ståhlberg M, Lertola K. Comparing Patient and Nurse Perceptions of Perioperative Care Quality. Applied Nursing Research. 2004;16(1):29-37.

McKenna HP, Keeney S, Currie L, Harvey G, West E, Richey RH. Quality of Care: a comparison of perceptions of health professionals in clinical areas in the United Kingdom and the United States. Journal of Nursing Care Quality, 2006;21(4):344-51.

Cronenwett I, Slattery MA. Measure of perceptions of Unit Quality. University of North Carolina: Chapel Hill and Dartmount- Hitchcock, 1999.

Lindgren M, Andersson IS. The Karen instruments for measuring quality of nursing care: construct validity and internal consistency. International Journal for Quality in Health Care. 2011;23(3):292–301.

Williams AM. The delivery of quality nursing care: a grounded theory study of the nurse’s perspectives. Journal of Advanced Nursing. 1998;27:808-16.

Stimpfel AW, Aiken LH. Hospital Staff Nurses’ Shift Length Associated With Safety and Quality of Care. Journal Nursing Care Quality. 2013;28(2):122–9.

McHugh MD, Stimpfel AW. Nurse reported quality of care: a measure of hospital quality. Research in Nursing and Health, 2012. doi: 10.1002/nur.21503.

Sochalski J. Is more better? The relationship between nurse staffing and the quality of nursing care in hospitals. Med Care. 2004;42(2):II67-73.

Spilsbury K, Hewitt C, Stirk L, Bowman C. The relationship between nurse staffing and quality of care in nursing homes: A systematic review. International Journal of Nursing Studies. 2011;48:732–50.

Hayes LJ, O’Brien-Pallas L, Duffield C, Shamian J, Buchan J, Hughes F, et al. Nurse turnover: A literature review. International Journal of Nursing Studies. 2006;43:237–63.

Aiken LH, Clarke SP, Sloane DM, Lake ET, Cheney T. Effects of hospital care environment on patient mortality and nurse outcomes. Journal of Nursing Administration. 2008;38(5):223–9.

Laschinger HKS, Almost J, Tuer-Hodes D. Workplace empowerment and magnet hospital characteristics: Making the link. Journal of Nursing Administration. 2003;33(7/8):410–22.

Van Bogaert P, Clarke S, Vermeyen K, Meulemans H, Heyning PV. Hospital nurse practice environment, burnout, job outcomes and quality of care: Test of a structural equation model. Journal of Advanced Nursing. 2009;65(10):2175–85.

Laschinger HKS, Shamian J, Thomson D. Impact of magnet hospital characteristics on nurses’ perceptions of trust, burnout, quality of care, and work satisfaction. Nursing Economics. 2001;19(5):209–19.

Pantrician AP, Shang J, Lake ET. Organizational determinants of work outcomes and quality care ratings among army medical department registered nurses. Research in Nursing & Health. 2010;33:99–110.

McCloskey JC. Breaking the cycle. Journal of Professional Nursing. 1995;Il(2):67.

Li B, Bruyneel L, Sermeus W, Van den Heede K, Kinan M, Aiken L, et al. Group-level impact of work environment dimen- sions on burnout experiences among nurses: a multivariate multi- level probit model. International Journal of Nursing Studies. 2013;50(2):281–91.

Kirwan M, Anne Matthews A, Scott A. The impact of the work environment of nurses on patient safety outcomes: a multi-level modelling approach. International Journal of Nursing Studies. 2013;50(2):253–63.

Van Bogaert P, Clarke S, Vermeyen K, Meulemans H, Van de Heyning P. Practice environments and their associations with nurse- reported outcomes in Belgian hospitals: development and prelimi- nary validation of a Dutch adaptation of the revised nursing work index. International Journal of Nursing Studies. 2009;46:54–64.

Van Bogaert P, Clarke S, Willems R, Mondelaers M. Nurse practice environment, workload, burnout, job outcomes and quality of care in psychiatric hospitals: a structural equation model approach. Journal of Advanced Nursing. 2012;69(7):1515–24.

Van Bogaert P, Clarke S, Willems R, Mondelaers M. Staff engagement as a target for managing work environments in psychi- atric hospitals: implications for workforce stability and quality of care. Journal of Clinical Nursing 2012;22:1717–28.

Leiter M, Maslach C. Nurse turnover: the mediating role of burnout. Journal of Nursing Management. 2009;17:331–9.

Stuart E, Jarvis A, Daniel K. A ward without walls? District nurse perceptions of their workload management priorities and job satisfaction. Journal of Clinical Nursing. 2008;17(22):3012–20.

Chang EM, Hancock K, Johnson A, Daly J, Jackson D. Role stress in nurses: review of related factors and strategies for moving forward. Nursing and Health Sciences. 2005;7:57–65.

Cohen M, Village J, Ostry A, Ratner Cvitkovich Y, Yassi A. Workload as a determinant of staff injury in intermediate care. International Journal of Occupational Medicine and Environmental Health. 2004;10:375–83.

Maslach C, Schaufeli W, Leiter M. Job burnout. Annual Review of Psychology. 2001;52:397–422.

Poghosyan L, Clarke S, Finlayson M, Aiken LH. Nurse burnout and quality of care: Cross-national investigation in six countries. Research in Nursing & Health. 2010;33:288–98.

Kutney-Lee A, McHugh MD, Sloane DM, Cimiotti JP, Fynn L, et al. Nursing: A key to patient satisfaction. Health Affair. 2009;28:w667–9.