Impact of safe nurse staffing on the quality of care in Portuguese public hospitals: A cross-sectional study

Aim To assess the impact of safe nurse staffing on the quality of care, based on the structure-process-outcome approach, in Portuguese hospitals. Background Safe nurse staffing is essential for the quality of care in hospital settings, together with work environment, organisational commitment and nursing practices. However, there is little evidence of its analysis in the Portuguese context. Method A cross-sectional survey study was conducted using a sample of 850 nurses from 12 public hospital units in the central and northern regions of Portugal. Results The proposed structural equation model for quality assessment has a good fit (chi(2)/df = 2.37; CFI = 0.88, PCFI = 0.83; PGFI = 0.77, RMSEA = 0.04), showing the impact of safe nurse staffing, work environment, and affective and normative organisational commitment on the quality of care (mortality rate and adverse events). The mediating effect of nursing practices was also found. Conclusion Safe nurse staffing, which is compromised in 90% of the units, is a predictor of the quality of care through the mediating effect of nursing practices. Implications for Nursing Management The results not only highlight the need for urgent intervention but also support political decision-making with a view to improving the access to quality care.