ARTICLE POLICY, POLITICS, & NURSING PRACTICE / May 2003 Evidence of Nurse Working Conditions: A Global Perspective Patricia W. Stone, RN, MPH, PhD Ann E. Tourangeau, RN, PhD Christine M. Duffield, RN, PhD Frances Hughes, RN, MA Cheryl B. Jones, RN, PhD Linda O’Brien-Pallas, RN, PhD Judith Shamian RN, PhD R ecently, major reports have highlighted threats to patient safety that exist in health care delivery systems, and experts again are calling for restructuring within systems to improve quality outcomes (Institute of Medicine, 1996, 2000). Ironically, these calls for needed change may be the results of past efforts to reduce costs and streamline the delivery of health care. In Canada and the United States during the 1980s, there was widespread recognition that health care costs were rising at alarming and unsustainable rates (Angus, Auer, Cloutier, & Albert, 1995). Because nursing services accounted for the highest proportion of operating expenses in hospitals, these services became an obvious target in hospital reorganization activities (Ritter- Teitel, 2002). With the aim of decreasing total expenditures, many hospitals began lowering the skill mix of nursing care providers by substituting registered nurses (RNs) with less expensive and less qualified nursing personnel, replacing RN manager positions with more business-oriented administrators, and decreasing the amount of indirect RN support positions such as nurse 120 There is a global nursing shortage. Few health services decision makers have made the critical link between the number of human resources, the characteristics of the work environment and the impact on patients, nurses, and the system as a whole. The purpose of this article is to review evidence about nurse workload, staffing, skill mix, turnover, and organizational characteristics’ effect on outcomes; discuss methodological considerations in this research; discuss research initiatives currently under way; review policy initiatives in different countries; and make recommendations where more research is needed. Overall, an understanding of the relationships among nurse staffing and organizational climate to patient safety and health outcomes is beginning to emerge in the literature. Little is known about nursing turnover and more evidence is needed with consistent definitions and control of underlying patient characteristics. Research and policy initiatives in Australia, Canada, New Zealand, and the United States are summarized. Keywords: nurse workload; staffing; skill mix; turnover; organizational climate Author’s Note: This article reflects the views of the authors and does not necessarily reflect the views of the institutions where they are employed. Policy, Politics, & Nursing Practice Vol. 4 No. 2, May 2003, 120-130 DOI: 10.1177/1527154403251862 © 2003 Sage Publications at University of Technology Sydney on August 25, 2015 ppn.sagepub.com Downloaded from