The Relationship Between Nurse Staffing Levels and Job Dissatisfaction, Emotional Exhaustion and Needle Stick and Sharps Injuries in Community Hospitals in Thailand

Case Study Submitted by: Apiradee Nantsupawat, PhD, RN, Department of Nursing Administration, Chiang Mai University
Matthew D. McHugh, PhD, JD, MPH, RN, FAAN , Center for Health Outcomes & Policy Research, University of Pennsylvania School of Nursing
Country: Thailand

A recent study carried out by Apiradee Nantsupawat and Matthew McHugh in Thailand showed that the average number of working hours of nurses was 55 hours per week and the average number of patients per nurse was 11, which is relative to many countries. Moreover, each additional patient per nurse was associated with an additional 5% of nurses reporting dissatisfaction in their job, 8% of nurses reporting high emotional exhaustion, and 4% of nurses reporting needle stick and sharps injuries.

The findings from this study, which looked at 92 community hospitals and assessed outcome from 1,412 registered nurses, are consistent with a large body of previous international research and highlight the link between low staffing levels and job dissatisfaction, emotional exhaustion, and needle stick and sharps injuries. This study provides evidence of how nurse staffing levels result in nurse job outcomes.

Despite a Universal Health Coverage Scheme which provides equitably accessible, responsive, qualified, and efficient services to Thai citizens, the nursing shortage in Thai public hospitals, the sector with primary responsibility for providing health care services, raises concerns about variations in the quality of care. The nursing shortage is linked to a higher turnover of nurses and concerns about workplace safety, particularly in community hospitals which make up the front-line public hospitals serving fundamental health care to the population. Although the Government has approved an increase in the training of new nurses, retention strategies are needed. This study enables a greater understanding of the underlying causes for the high nurse turnover.

Policy makers and hospital managers can use these findings to justify improving patient-to-nurse ratios, and by doing so, reducing nurse burnout and improving patient safety and nurse retention rates.  Findings also suggest that improving patient-to-nurse ratios might decrease hospital costs for tests and treatments of infections resulting from needle stick and sharps injuries. Because these findings are consistent with similar studies in other countries, they suggest that the relationship between poor staffing levels and nurse outcomes is not specific to any one country or health care system; rather, they suggest a universal phenomenon that needs to be addressed worldwide to ensure high quality and safe care as well as good work environments for nurses regardless of country.

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