J Nurs Manag. 2019;1–22. wileyonlinelibrary.com/journal/jonm | 1 © 2019 John Wiley & Sons Ltd 1 | BACKGROUND Over the past two decades, the health care sector has been in the midst of changes. Increased pressure on health care expenditure, rising patient expectations and new technologies are just a few challenges hospital management has been facing (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002; Aiken, Sloane, Bruyneel, Heede, & Sermeus, 2013; Sermeus et al., 2011). Finding the perfect bal‐ ance between patients’ needs and the right number of nursing staff is essential, especially given the fact that cost‐saving mea‐ sures have led to less available qualified staff (Duffield, Kearin, Johnston, & Leonard, 2007). This shortage makes nursing in most countries a much sought‐after resource and, consequently, causes an increased burden for these nurses (Aiken et al., 2013). In addition, research has shown that a considerable number of nurses experience high levels of job stress, which increases sick‐ ness absence and puts pressure on the remaining nurses causing a vicious circle of absenteeism (Van den Heede et al., 2013; Trybou et al., 2014). Evidence‐based decision‐making linking nurse staff‐ ing with constantly changing patients’ care needs is therefore a much needed area of expertise (Squires, Jylha, Jun, Ensio, & Kinnunen, 2017). Received: 26 November 2018 | Revised: 1 February 2019 | Accepted: 20 February 2019 DOI: 10.1111/jonm.12764 REVIEW ARTICLE Systematic review: Association between the patient–nurse ratio and nurse outcomes in acute care hospitals Herlinde Wynendaele | Ruben Willems | Jeroen Trybou Department of Public Health, Ghent University, Ghent, Belgium Correspondence Herlinde Wynendaele, Department of Public Health, Ghent University, Ghent, Belgium. Email: herlinde.wynendaele@ugent.be Funding information Ghent University funded the research. Abstract Aims: To evaluate and summarize current evidence on the relationship between the patient–nurse ratio staffing method and nurse employee outcomes. Background: Evidence‐based decision‐making linking nurse staffing with staff‐re‐ lated outcomes is a much needed research area. Although multiple studies have in‐ vestigated this phenomenon, the evidence is mixed and fragmented. Evaluation: A systematic literature search was conducted using PubMed, Embase, Web of Science, Cinahl, Cochrane Library and the ERIC databases. Thirty studies were identified, analysing eight selected key nurse outcomes. Key issue(s): Future research should focus on unit‐level data, incorporate other meth‐ odologies and aim for comparability between different types of clinical settings as well as different health care systems. Conclusion: A relationship between the patient–nurse ratio and specific staff‐related outcomes is confirmed by various studies. However, apart from the patient–nurse ratio other variables have to be taken into consideration to ensure quality of care (e.g., skill mix, the work environment and patient acuity). Implications for Nursing Management: Hospital management should pursue the ac‐ cess and use of reliable data so that the validity and generalizability of evidence‐ based research can be assessed, which in turn can be converted into policy guidelines. KEYWORDS health care, nurse outcome, patient–nurse ratio, staffing, work environment brought to you by CORE View metadata, citation and similar papers at core.ac.uk provided by Ghent University Academic Bibliography