Outpatient nurse staffing relationship with organizational, nurse and patient outcomes: A scoping review.

Background: Nurses are an integral part of outpatient healthcare settings and are needed to provide effective patient care. Ample research and reviews have been done on nurse staffing in inpatient settings relationship with a variety of organizational, nurse and patient outcomes, however there is no review of outpatient nurse staffing relationship with organizational, nurse and patient outcomes. Objectives: The purpose of this paper is to present a scoping review that evaluates the state of the literature on relationships among nurse staffing and organizational, nurse and patient outcomes in the outpatient setting. Methods: The review used PRISMA guidelines for scoping reviews. The search focused on nurse staffing and organizational outcome in outpatient settings and synonyms for those terms. PubMed, Ebscohost CINAHL, and Ebscohost Global Health were searched. Articles were included if they measured nurse staffing relationship with any organizational, nurse and patient outcome in an outpatient setting. Extraction was completed in a matrix first then charted into synthesis tables. Results: Thirty-seven studies were included in the review. Nurse staffing was measured in the literature by perceived staffing adequacy, types of healthcare workers staffed, full-time equivalents, nurse vacancies, proportion of nurses to total staff, agency or float nurse use, presence of nurse on the healthcare team and nurse to patient ratios. Nurse staffing of a variety of measures was associated with better patient outcomes, lower costs, and lower nurse turnover. Only one study of the 37 included did not show a positive outcome of better nurse staffing, which showed that increased nurse staffing was associated with less patient engagement in psychotherapy. Conclusions: Outpatient care setting stakeholders and policy makers should consider improving nurse staffing, as stronger nurse staffing is associated with better patient outcomes lower costs and less nurse turnover. In addition, better staffing helps improve nurses' attitudes towards their job and increase job satisfaction. Most of the studies included in this review only focused on the staffing measure of perceived staffing adequacy. While perceived staffing adequacy is a useful measure of nurse staffing able to capture nurses' perception, it should not be used in isolation and more researchers should focus on gaps in outpatient nurse staffing with more objective measures such as fulltime equivalents. Tweetable abstract: A 37 article scoping review on nurse staffing in outpatient care found that stronger staffing was linked with better patient outcomes, lower costs, and less turnover.