• Linda H Aiken, Sean P Clarke, Douglas M Sloane, and International Hospital Outcomes Research Consortium.
• Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia 19104-6069, USA. laiken@nursing.upenn.edu
• Int J Qual Health Care. 2002 Feb 1;14(1):5-13.

ObjectiveTo examine the effects of nurse staffing and organizational support for nursing care on nurses' dissatisfaction with their jobs, nurse burnout, and nurse reports of quality of patient care in an international sample of hospitals.DesignMultisite cross-sectional survey.SettingAdult acute-care hospitals in the United States (Pennsylvania), Canada (Ontario and British Columbia), England, and Scotland.Study Participants10 319 nurses working on medical and surgical units in 303 hospitals across the five jurisdictions.InterventionsNone.Main Outcome MeasuresNurse job dissatisfaction, burnout, and nurse-rated quality of care.ResultsDissatisfaction, burnout, and concerns about quality of care were common among hospital nurses in all five sites. Organizational/managerial support for nursing had a pronounced effect on nurse dissatisfaction and burnout, and both organizational support for nursing and nurse staffing were directly, and independently, related to nurse-assessed quality of care. Multivariate results imply that nurse reports of low quality care were three times as likely in hospitals with low staffing and support for nurses as in hospitals with high staffing and support.ConclusionAdequate nurse staffing and organizational/managerial support for nursing are key to improving the quality of patient care, to diminishing nurse job dissatisfaction and burnout and, ultimately, to improving the nurse retention problem in hospital settings.

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