International Research Finds Quality and Safety Problems in Hospitals in 13 Countries

In one of the largest studies of its kind, a consortium of investigators from 13 countries led the University of Pennsylvania School of Nursing in the U.S. and the Catholic University of Leuven, Belgium in Europe, found that 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. The study was released today in the current issue of the British Medical Journal.

The massive study, which in some countries involved every hospital, surveyed 61,168 bedside nurses and 131,318 patients in more than 1,000 hospitals in 13 countries over the course of three years, finding that in those hospitals with better work environments and fewer patients in each nurse's workload, patient and nurses both reported higher standards of care and more satisfied patients.

"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, wrote the study's lead author, Linda H. Aiken, PhD, RN, 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.

Patient safety is also a concern in hospitals that have poor work environments and insufficient nurse staffing, said Walter Sermeus, professor at Catholic University of Leuven, Belgium, leader of the European consortium.

Nurses in Poland and Greece were three times more likely to give their hospitals a failing grade for safety than nurses in the U.S. and Norway. The majority of nurses in every country expressed a lack of confidence that hospital management would resolve problems in patient care.

Specifically the researchers found that:
- High nurse burnout and job dissatisfaction were common among hospital nurses in Europe and the U.S.
- On average, only 60 percent of patients were satisfied with their hospital care.
 - Those nurses reporting high levels of burnout (notably in Greece and England) also reported an intention to leave their current positions.
 - Each additional patient added to a nurse's workload increased the odds of a nurse reporting poor or fair quality of care.
 - Patients were less satisfied with their hospital stay in those hospitals that had higher percentages of burnt out or dissatisfied nurses.

Policy implications for the findings suggest that despite the differences among the healthcare systems studied, particularly in terms of both organization and financing, all countries encountered problems of "hospital quality, safety, and nurse burnout and dissatisfaction." Many European nurses report they intend to leave their hospital positions, from 19 percent in The Netherlands to nearly half of all nurses (49 percent) in Finland and Greece, leading the researchers to ponder the potential for a worsening shortage of nurses.

A significantly lower proportion of nurses in the U.S. (14 percent) reported their intentions to leave their current positions, possibly due to increased efforts in the U.S. to improve hospital nurse staffing levels. Having fewer patients per nurse has been linked to better outcomes for patients, including lower rates of death following everyday surgeries. Nearly 7 percent or 400 in the hospitals in the U.S. have achieved "magnet status," so-called due to its ability to attract and retain nurses because of good work environments. No hospital in Europe has a similar "magnet" designation.

The study, conducted with a 3 million euro grant from the European Commission with additional funding from the National Institute of Nursing Research of the National Institutes of Health in the U.S., investigated hospital quality and safety of care in Belgium, England, Finland, Ireland, Germany, Greece, Netherlands, Norway, Poland, Spain, Sweden, Switzerland, and the U.S.