Safe nurse staffing levels in acute hospitals
Authors: Van Den Heede Koen , Bruyneel Luk , Beeckmans Dorien , Boon Niels , Bouckaert Nicolas , Cornelis Justien , Dossche Dorien , Van de Voorde Carine , Sermeus Walter 
Published: January 2025

FOREWORD 1 -- SYNTHESIS 2 -- 1. BACKGROUND 4 -- 1.1. THE BELGIAN NURSING WORKFORCE: A CONTEXT DESCRIPTION 5 -- 1.1.1. Two main educational pathways to enter the nursing profession 5 -- 1.1.2. The nursing workforce: facts and figures 5 -- 1.1.3. Nurse staffing levels in acute hospitals: licensing standards and hospital payment system 6 -- 1.2. THE IMPORTANCE OF ADEQUATE STAFFING LEVELS AND A GOOD NURSING WORK ENVIRONMENT 7 -- 1.2.1. Nurse staffing and outcomes are clearly associated but the relationship is complex 7 -- 1.2.2. Bedside nurse staffing levels in Belgian hospitals are known to be low in a European context 8 -- 1.3. A HOSPITAL LANDSCAPE IN EVOLUTION AND POTENTIAL IMPACT ON NURSING CARE 8 -- 1.4. STUDY OBJECTIVES  SCOPE AND APPROACH 9 -- 2. EVOLUTION IN THE INTENSITY OF NURSING CARE AND NURSE STAFFING LEVELS IN BELGIAN HOSPITALS 13 -- 2.1. EVOLUTION IN INTENSITY OF NURSING CARE AND NURSE STAFFING LEVELS 14 -- 2.1.1. Intensity of nursing care 14 -- 2.1.2. Nurse staffing levels 17 -- 2.1.3. Are nurse staffing levels adequate? 17 -- 2.1.4. Supporting staff 19 -- 2.2. RELATIONSHIP BETWEEN NURSE STAFFING LEVELS AND THE HOSPITAL BUDGET 19 -- 3. NURSE STAFFING LEVELS AND NURSING WORK ENVIRONMENT IN BELGIAN HOSPITALS 20 -- 3.1. NURSING WORK ENVIRONMENT 20 -- 3.2. NURSE STAFFING LEVELS 23 -- 3.2.1. Patient-to-nurse ratios 23 -- 3.2.2. Proportion of Bachelor-prepared nurses 24 -- 3.3. NURSING ACTIVITIES 24 -- 3.3.1. Care left undone as reported by nurses 24 -- 3.3.2. Non-nursing tasks 26 -- 3.4. NURSE OUTCOMES 26 -- 3.4.1. Risk of burnout 26 -- 3.4.2. Job dissatisfaction and intention to leave 28 -- 3.5. NURSE-PERCEIVED QUALITY OF CARE 28 -- 3.6. THE IMPACT OF FACTORS OF THE NURSING WORK ENVIRONMENT AND STAFFING ON (NURSE) OUTCOMES 28 -- 4. INTERNATIONAL SAFE STAFFING POLICIES 29 -- 4.1. BACKGROUND 29 -- 4.2. NURSING EDUCATION AND SKILL MIX 30 -- 4.3. WHY WERE SAFE STAFFING POLICIES DEVELOPED? 30 -- 4.4. POLICY OPTIONS VARY FROM FLEXIBLE TO RIGID AND FROM LIMITED IN SCOPE TO VERY COMPREHENSIVE 31 -- 4.5. COMMON ELEMENTS AND OBJECTIVES OBSERVED IN SAFE STAFFING POLICIES 34 -- 4.6. IMPACT OF SAFE STAFFING POLICIES 35 -- 5. TOWARDS A SAFE STAFFING POLICY IN BELGIAN ACUTE HOSPITALS 37 -- 5.1. IMPROVE PATIENT-TO-NURSE RATIOS IN ACUTE HOSPITALS 37 -- 5.1.1. Use the nursing expertise for nursing care 45 -- 5.1.2. Simplify the hospital payment system and ensure a fair allocation system of (additional) resources for nurse staffing 45 -- 5.1.3. Nurse staffing levels on geriatric wards require specific attention 46 -- 5.2. A SAFE STAFFING POLICY AT THE MACRO-LEVEL 47 -- 5.2.1. Data-information system to inform and monitor a safe-staffing policy 47 -- 5.2.2. Evaluate the impact in a pro-active and systematic way 49 -- 5.3. STAFFING MATTERS FROM BOARD TO BEDSIDE 50 -- 5.3.1. Building a good environment for nurses with attention for staffing levels from board to bedside 50 -- 6. CONCLUSION 52 -- REFERENCES 53 -- RECOMMENDATIONS 59