RELATIONSHIPS AMONG NURSE STAFFING, WORKLOAD PERCEPTION, WORK ENVIRONMENT SATISFACTION, NURSE PERFORMANCE, AND PATIENT OUTCOMES IN HEALTH CARE SETTING: CORRELATIONAL RESEARCH DESIGN

Abstract Background: Nurse staffing, measured by nurse-patient ratios, workload perceptions, and work environment satisfaction, is associated with nurse performance and patient outcomes. Poor staffing and heavy workload can contribute to decreases in quality of care, burnout, and an increased number of adverse patient outcomes. This study aimed to examine nurse staffing, perception of workload, work environment satisfaction, nurses' performance, and their relation to patient outcomes in the context of a hospital in Egypt. Methods: A descriptive, correlational cross-sectional study design was used, with 200 nurses and 240 patient records surveyed. Participants were in the medical surgical, intensive care, and oncology units in a tertiary hospital in Egypt. The study instruments included a demographic questionnaire, perceived workload scale, work environment satisfaction scale, assessment of nurse-patient ratio, and nursing performance evaluation checklist. Patient outcome data were obtained from patient medical records (30-day mortality, 7-day readmission, and length of stay). Analyses included descriptive statistics, independent t-test, one-way ANOVA, Chi-square, and Pearson correlation. Results: Significant differences in the nurse-patient ratios existed across the departments (F=61.38, p<0.001); the ratio was highest in the medical-surgical units. A statistically significant inverse relationship between the nurse-patient ratio and satisfaction with the work environment, and several domains of nursing performance, was demonstrated, including assessment, implementation, professionalism, documentation, and education. Perceived workload was significantly negatively correlated with communication, assessment, diagnosis, implementation of nursing practice, work satisfaction, and performance evaluation domains, including implementation and professionalism. Increased nurse-patient ratios had a significant relationship with 7-day readmissions (t=2.25, p=0.03). Differences in 30-day mortality were significant between departments (χ² =92.04, p<0.001) and found mainly among ICU patients. Conclusion: Nurse staffing was significantly correlated with nursing performance and some of the selected patient outcomes. High nurse-patient ratio and work overload were correlated with poor nursing performance and low work environment satisfaction. Despite the lack of significant association between workload perception, patient acuity, dependence, and satisfaction with work environment on patient outcomes, there may be an indirect association. Improved staff assignment and working environments could be beneficial for increasing the quality of nursing practice in Egypt.