Staffing and Job Satisfaction and Burnout
Higher emotional exhaustion and greater job dissatisfaction in nurses were strongly and significantly associated with patient-to-nurse ratios. Table 4 shows odds ratios (ORs) indicating how much more likely nurses in hospitals with higher patient-to-nurse ratios were to exhibit burnout scores above published norms and to be dissatisfied with their jobs. Controlling for nurse and hospital characteristics resulted in a slight increase in these ratios, which in both cases indicated a pronounced effect of staffing. The final adjusted ORs indicated that an increase of 1 patient per nurse to a hospital's staffing level increased burnout and job dissatisfaction by factors of 1.23 (95% CI, 1.13-1.34) and 1.15 (95% CI, 1.07-1.25), respectively, or by 23% and 15%. This implies that nurses in hospitals with 8:1 patient-to-nurse ratios would be 2.29 times as likely as nurses with 4:1 patient-to-nurse ratios to show high emotional exhaustion (ie, 1.23 to the 4th power for 4 additional patients per nurse = 2.29) and 1.75 times as likely to be dissatisfied with their jobs (ie, 1.15 to the 4th power for 4 additional patients per nurse = 1.75). Our data further indicate that, although 43% of nurses who report high burnout and are dissatisfied with their jobs intend to leave their current job within the next 12 months, only 11% of the nurses who are not burned out and who remain satisfied with their jobs intend to leave.