Nurse Staffing and the Relationship to Job Satisfaction and Retention

Debra C. Hairr, DHSc, MSN, RNC-OB; Helen Salisbury, PhD; Mark Johannsson, DHSc, MPH; Nancy Redfern-vance, PhD, RN, CNM


Nurs Econ. 2014;32(3):142-147. 

In This Article


In 2004, the Institute of Medicine released a report, Keeping Patients Safe: Transforming the Nursing Work Environment. This report recognized appropriate nurse staffing levels are essential for patient safety. Nurse-patient ratios are a starting point in the discussion of appropriate levels of nurse staffing. Researchers agree patient acuity and skill mix must also be taken into consideration when addressing nurse staffing issues (Tevington, 2011). There is a paucity of research that addresses patient acuity, skill mix, and nurse-patient ratios.

The American Nurses Credentialing Center (ANCC) Magnet® hospitals are widely recognized for promoting safe and appropriate nurse staffing and generally have good patient outcomes (Trinkoff et al., 2010). According to Needleman and colleagues (2011), Magnet hospitals also have lower patient morbidity and mortality rates than non-Magnet hospitals. A 3-year study conducted in a Magnet hospital analyzed over three million patient records. Researchers examined the effect of inadequate nurse staffing on mortality. There was a 6% risk of death for patients when a shift with a nurse staffing shortage of just 8 hours occurred. The literature suggests nurse-patient ratios of 4:1 or less provide the most optimal outcomes for patients (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002; Aiken, Clarke, Sloane, Lake, & Cheney, 2008; Aiken et al., 2010; Needleman et al., 2011; Rosenberg, 2011).

Health care in the United States is a commodity, and nurses are an expensive budgetary consideration. Health care facilities have the potential to achieve large financial savings by reducing the number of nurses. Despite the evidence, many institutions are unwilling or unable to provide nurse staffing that is supported by the growing body of research (Duffin, 2012; Garretson, 2004). Implementing this one evidence-based practice could have a positive impact on patient outcomes, ultimately decreasing patient morbidity and mortality (Aiken et al., 2002; Aiken et al., 2008; Aiken et al., 2010; Needleman et al., 2011; Shamliyan, Kane, Mueller, Duval, & Wilt, 2009).

Positive patient outcomes are not the only benefit from improved nurse staffing. Aiken and associates (2002) examined nurse satisfaction and retention issues. The authors noted that when nurses are exposed to inadequate staffing levels, they leave their positions. Retaining as many nurses in their roles as possible makes fiscal sense for any organization. Costs to an organization to retrain a specialty nurse have been estimated as being as high as $80,000 (Burr, Stichler, & Poeitler, 2011; Tellez, 2012). Not only will patient care and outcomes improve with additional nurses, but also cost savings may result. Aiken and co-authors (2010) suggested a ratio of four patients to one nurse will save each health care organization $60,000 a year. Retaining just one nurse and utilizing the recommended nurse-patient ratios may result in savings of around $140,000 every year. That is just for one nurse retained in his or her position, taking care of four patients on a medical-surgical floor. Extrapolating that number to every medical-surgical floor, in every hospital across the United States, would result in the realization of enormous savings to health care. In the current economy, administrators would not be fiscally responsible if they did not examine every avenue that could save lives, improve nursing job satisfaction, retain nurses at the bedside, and save health care dollars.