International survey links nurse, patient satisfaction

( Nurses who reported better working conditions in hospitals and less likelihood of leaving also had patients who were more satisfied with their hospital stay and rated their hospitals more highly, according to an international study.

The study encompassed 13 countries, surveying 61,168 bedside nurses and 131,318 patients in more than 1,000 hospitals over three years. It found that in those hospitals with better work environments and fewer patients per nurse, patients and nurses both reported higher standards of care and greater satisfaction.

“Patients in European and U.S. hospitals with better work environments were more likely to rate their hospital highly and to recommend their hospital” to others, lead author Linda H. Aiken, RN, PhD, a professor of nursing and sociology and director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing, said in a news release

Patient safety was a concern in hospitals with poor work environments and insufficient nurse staffing, added Walter Sermeus, RN, PhD, professor at Catholic University of Leuven (Belgium) and leader of the study’s European consortium.

The majority of nurses in every country expressed a lack of confidence that hospital management would resolve problems in patient care. High nurse burnout and job dissatisfaction were “common” among hospital nurses in Europe and the United States, according to the researchers. For each additional patient added to a nurse’s workload, odds increased that the nurse would report poor or fair quality of care.

Patients were less satisfied with their hospital stays in facilities that had higher percentages of burnt-out or dissatisfied nurses. On average, only 60% of patients were satisfied with their hospital care.

The researchers said policy implications of the findings suggest that despite the differences among healthcare systems studied, especially in organization and financing, all countries encountered problems of “hospital quality, safety and nurse burnout and dissatisfaction.”

Many European nurses reported an intention to leave their hospital positions, from 19% of those surveyed in the Netherlands to 49% in Finland and Greece, leading the researchers to consider the potential for a worsening shortage of nurses.

The proportion of nurses in the U.S. saying they planned to leave their current position was significantly lower at 14%, perhaps due to increased efforts to improve hospital nurse staffing levels, the researchers said. Having fewer patients per nurse has been linked to better outcomes for patients, including lower rates of death following everyday surgeries.

Nearly 7% of hospitals in the U.S. have achieved Magnet status for their ability to attract and retain nurses with good work environments. The researchers said no hospital in Europe has achieved this designation, which is recognized internationally.

The study appeared in the March 20 issue of the British Medical Journal. To read it, visit