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Introduction
The research regarding nursing staff and its correlation to the quality that health services provided locates at the nursing research center. It was not until 1983, that the first extended study was published. That study investigated the work environment characteristics, which affects nurses’ retention and recruitment (McClure et al., 1983). Since then, a large number of studies have been implemented, revealing the correlation between nursing staff and the healthcare services quality (Needleman et al., 2002; Aiken et al., 2011, 2012).
Background
The patients’ safety remains, among other dimensions of healthcare quality services, the most significant one and is affected by nursing staff. Patients who are hospitalized in understaffed units are at greater risk to experience an adverse event or error compared to those in better-staffed units. Nosocomial infections, falls, pressure ulcers and medication errors are adverse events and errors that patients may experience during their hospitalization and are correlated to nursing staff and its characteristics (Tissot et al., 2003; Patrician et al., 2011; Cimiotti et al., 2012; Zhao et al., 2018). Also, critically ill patient’s survival is related to the nursing staff (West et al., 2014). Adverse events have a negative effect on hospital and insurance companies, as they extend the length of stay (LOS), reduce bed availability and increase hospital costs. The nursing staff has found to affect the patient’s readmission probability. By 2012, Medicare and Medicaid services in the USA implemented a program which penalizes hospitals for excessive 30-day readmissions, with a reduction up to 1 percent for the diagnosis-related group (DRG) payments. Hospitals with higher nurse staffing levels had 25 percent lower odds to be penalized, compared to the ones with lower levels (McHugh et al., 2013).
Among the most important nursing activities are the education and communication both with patients and their families, together with the nursing care plans and pathways development and update. These activities play a vital role in quality and integrated care. A large study among nurses from 12 European countries revealed that these nursing activities left undone at the hospitals with the higher patient to nurse ratios and downgrade overall quality of care (Ausserhofer et al., 2014). According to a recent study, missed nursing care is...