The impact of hospital nurse staffing, work environment and patient-centeredness on the quality of care and patient safety

The healthcare industry is complex in nature. The quality of care and patient safety has become a national and international priority. Limited efforts have been made on improving nursing care in order to optimize the outcomes of care. This study empirically investigated the impact of hospital nurse staffing and work environment on the quality of care and patient safety in the medical and surgical wards in
Malaysian private hospitals. The mediating effect of patient-centeredness on the effect of both hospital nurse staffing and work environment on the quality of care and patient safety was also investigated. A cross-sectional survey was conducted on 12 private hospitals. Data was collected, through questionnaires, from 652 nurses, with a 61.8 % response rate. The stratified simple random sampling was used to allow nurses from all shifts to participate in the study. Regression analyses and the Hayes PROCESS macro were conducted to test the hypotheses. The results showed that staffing had an insignificant negative impact on the outcomes of care, whereas work environment had a significant positive impact. Moreover, it was found that patient-centeredness significantly mediated the effect of both staffing and work
environment upon the outcomes. A model for improving the quality of care and patient safety was proposed. The practical implications indicated that patientcenteredness suppresses the negative impact of nursing shortage and shift length, and complements the positive impact of work environment on the outcomes of care. Further mediators are recommended for future research on the impact of both hospital nurse staffing and work environment on the quality of care and patient safety.