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Commentary on: Shen K, McGarry BE, Gandhi AD. Health care staff turnover and quality of care at nursing homes. JAMA internal medicine. 2023 Nov 1;183(11):1247–54.
Implications for practice and research Reducing staff turnover in nursing homes can lead to significant improvements in the quality of care. Future research should focus on the factors influencing staff retention and the mechanisms through which turnover affects care quality.
This study investigates the association between healthcare staff turnover and quality of care in nursing homes.
To evaluate the maximum number of patients per nurse before quality and safety outcomes deteriorate in medical-surgical settings.
A secondary analysis of cross-sectional survey data.
We analysed data from 609 direct care nurses working in British Columbia's medical-surgical areas. The relationship between nurse-to-patient ratios and quality and safety outcomes was analysed using both two-level and one-level regression models, including visualisations such as boxplots and scatterplots with LOESS curves. The analysis controlled for nurse demographics and hospital clustering effects.
Ratios ranged from 1:1 to 1:9, with outliers above 1:9 excluded. For desirable outcomes, last shift quality of care, unit safety grade, and recommending units to friends/family and to colleagues, the means were generally positive for ratios ranging from 1:2 or 1:3 to 1:4 but negative for ratios ranging from 1:5 to 1:8 or 1:9. This pattern was reversed for adverse outcomes, undone tasks and emotional exhaustion; the means were generally negative for ratios between 1:1 and 1:3 to 1:4 but became positive for ratios between 1:5 and 1:6 to 1:8. A turning point (crossing zero) was found between the ratios of 1:4 and 1:5 for all outcomes except patient adverse events, where the turning point was between the ratio of 1:3–1:4.
The findings provide preliminary evidence in support of minimum nurse-to-patient ratios of 1:4 in British Columbia's medical-surgical areas. Policy-makers and decision-makers should augment minimum nurse-to-patient ratios with other nurse-driven tools and nurse-management staffing methods that provide more flexibility to better meet fluctuating environmental, patient and staffing needs.
This study did not include patient or public involvement in its design, conduct, or reporting.
Minimum ratios should be complemented by nurse-driven tools and flexible staffing strategies to account for contextual and resource variability.
This secondary analysis of 2015 survey data from 609 medical-surgical nurses in British Columbia, Canada supported a minimum nurse-to-patient ratio of 1:4 using a series of quality and safety outcomes for patients and nurses. This finding provides important preliminary evidence in support of the specific minimum nurse-to-patient ratios of 1:4 as the province prepares to implement this ratio in medical-surgical settings. Existing staffing models using minimum nurse-to-patient ratios may be augmented by employing additional staffing tools and methodologies that provide more flexible resource allocation.
This study adheres to STROBE guidelines.
This study aimed to evaluate the ability of three generative artificial intelligence tools (ChatGPT, Gemini and DeepSeek) to generate clinically accurate, comprehensive, and readable nursing care plans aligned with standardised nursing taxonomies (North American Nursing Diagnosis Association International, Nursing Interventions Classification, and Nursing Outcomes Classification). The study further explored variations in tool performance across different nursing specialties.
A descriptive comparative design was used.
Ten expert-validated clinical scenarios representing five nursing specialties (Fundamentals of Nursing, Medical, Surgical, Paediatric and Psychiatric Nursing) were presented to the three artificial intelligence tools. Each tool responded to four standardised prompts based on the latest North American Nursing Diagnosis Association International, Nursing Interventions Classification and Nursing Outcomes Classification taxonomies. Outputs were assessed for quality, accuracy, completeness and readability by expert evaluators using validated scales.
All tools produced nursing care plans of moderate-to-high quality. DeepSeek demonstrated slightly higher accuracy and completeness compared with Gemini and ChatGPT. Surgical nursing scenarios yielded the highest performance, likely reflecting the more protocolised and pathway-driven nature of perioperative care. However, all outputs were incomplete and written at a college-level readability, limiting accessibility for clinical use.
Generative artificial intelligence tools can support the production of structured nursing care plans requiring expert review and adaptation, particularly in less standardised clinical domains, but their limitations in completeness and readability indicate they should be regarded only as preliminary drafts requiring expert review and adaptation.
The study examined whether generative artificial intelligence can reliably assist in creating nursing care plans. All tools performed moderately well, with DeepSeek showing slight advantages, but outputs were incomplete and difficult to read. Findings are relevant to clinical nurses, educators, healthcare managers and policymakers worldwide who are exploring artificial intelligence in nursing workflows.
This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.
This study did not include patient or public involvement in its design, conduct or reporting.
To report on the unique perspectives of senior nursing leaders on the value proposition of the Clinical Nurse Specialist (CNS) role, their organisational experience and the barriers and facilitators to optimise and promote the long-term sustainability.
A qualitative sub-study of a larger multi-method study focused on informing policy recommendations to optimise the CNS workforce, informed by integrated knowledge translation.
Chief Nursing Officers (CNOs) and other senior leaders in all health authorities in British Columbia, Canada, were invited to participate in semi-structured interviews via video call between August–December 2023. We recruited 13 participants from diverse health regions, including 5 CNOs.
Leaders collectively conveyed a renewed interest in the CNS role to support nursing and multidisciplinary teams to better meet patient and system needs, and a sense of urgency to optimise the role in diverse settings. The overarching theme of “success by design” was supported by three thematic priorities: (1) understanding the CNS role, (2) a role that needs protection and connections and (3) moving forward together. Views were aligned to co-construct implementation-ready policy recommendations to guide provincial strategies.
Senior leaders reported a common understanding of the value-add of the CNS workforce and had a shared experience of barriers to optimisation. Contemporary policy guidance is needed to equip health systems to address this gap.
Across international regions, the role of CNSs is not fully optimised. This is a wasted opportunity to address the pressing need for nursing practice leaders to transform health systems and improve outcomes. This study provides new knowledge about the perspectives of Chief Nursing Officers and other nursing leaders to shape comprehensive and targeted policy recommendations and address enduring and new challenges to realise the full impact of the CNS workforce.
We have adhered to COREQ reporting guidelines (See supplemental file).
This study did not include patient or public involvement in its design, conduct, or reporting.
Current research lacks a comprehensive understanding of evidence-based practice (EBP) adoption and its predictors across diverse healthcare professionals (HCPs) in the Eastern Mediterranean Region (EMR), particularly with a direct comparison between nurses and other professional groups.
This study aims to evaluate the EBP competencies, adoption levels, identified barriers, and associated predictors among nurses and other healthcare professionals (HCPs) within the EMR.
A cross-sectional, correlational, and comparative design was used. An electronic survey was distributed (April 27th–August 17th, 2023) via convenience/snowball sampling, inviting nurses, physicians, physiotherapists, dentists, and pharmacists across the EMR to complete the survey. Multivariate regression analysis and structural equation modeling (SEM) were used to identify predictors of EBP adoption.
A total of 4673 HCPs participated and reported several barriers to EBP adoption, including time constraints, difficulties in interpreting statistics, lack of authority to change practices, and insufficient equipment. Nurses had fewer postgraduate degrees but more work experience and full-time employment than other HCPs. Despite reporting more workplace EBP support, nurses read less research, had lower EBP scores and adoption propensity, and perceived greater barriers than other HCPs (p < 0.002). Multivariate regression showed the highest barrier scores in Syria/Tunisia and the lowest in the United Arab Emirates. Nurses reported significantly higher barriers compared to other HCPs (p < 0.001). Fear of Change was not a primary barrier overall, but was elevated in specific subgroups of nurses. SEM showed good fit: RMSEA = 0.077, SRMR = 0.053, CFI = 0.80, χ 2(df) = 917, p < 0.001. SEM showed that EBP adoption propensity and fear of change significantly mediate the relationship between HCPs' characteristics and EBP scores.
Despite having a positive attitude and propensity towards EBP, nurses lack the necessary knowledge and support to adopt it, and they face more barriers than other healthcare professionals. Nurses require greater support from healthcare leaders to enhance their EBP competencies and address the reported barriers. Policymakers and organizations should prioritize tailored, role-specific training and supportive structures and environments to ensure equitable and effective EBP implementation for improving patient outcomes across the EMR.
This study aims to explore the relationship between nurses' knowledge, attitudes, and practices regarding older adult abuse and their caring behaviours, focusing on Iranian nurses.
A cross-sectional exploratory study.
A cross-sectional correlational design included 250 nurses from medical education centres in Ardabil. A three-part questionnaire assessed demographic characteristics, knowledge, attitudes, and practices regarding elder abuse and caregiving. Data were collected from August to October 2024 and analysed using ANOVA, t-tests, Pearson correlations, and multiple regression analysis.
The study's findings are significant, revealing a moderate level of knowledge among nurses about older adult abuse. There are significant positive correlations between knowledge, attitudes, and caring behaviours, with higher education levels associated with better caring behaviours. However, practice scores did not align with knowledge and attitudes, indicating barriers such as workload and lack of training.
The findings reveal a significant link between nurses' knowledge and attitudes toward older adult abuse and their caring behaviours. Positive attitudes are associated with higher Caring Behaviours Assessment scores, suggesting that educational programs should enhance nurses' understanding and empathy toward older adult care. Addressing the identified gaps in knowledge and practice can lead to improved patient outcomes and a more compassionate healthcare environment for older adults. It is crucial to provide continuous training and support to empower nurses to apply their knowledge in practice effectively.
The study highlights the necessity for regularly occurring targeted educational interventions to enhance nurses' understanding of older adult abuse. Implementing continuous professional development programs for nurses can significantly improve patient outcomes and reduce instances of abuse. Healthcare organisations should foster supportive environments that encourage the regular reporting of suspected cases of abuse and ensure that nurses are consistently updated on best practices. Increasing community awareness about elder abuse is crucial for safeguarding vulnerable older adults.
EQUATOR guidelines were followed using the STROBE reporting method.
This study did not include patient or public involvement in its design, conduct, or reporting. Only nurses were involved in data collection.
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