wileyonlinelibrary.com/journal/jonm J Nurs Manag. 2018;26:94–107.
© 2018 John Wiley & Sons Ltd
Accepted: 5 July 2017
Interventions to improve working conditions of nursing
staff in acute care hospitals: Scoping review
Sergio Barrientos-Trigo RN, BSc, PhD
| Laura Vega-Vázquez RN
| Rocío De Diego-
Cordero RN, PhD
| Bárbara Badanta-Romero RN, MSN
| Ana M. Porcel-Gálvez RN, BSc,
Department of Nursing, Faculty of Nursing,
Physiotherapy and Podiatry, University of
Seville, Seville, Spain
Royal Devon and Exeter Hospital, Exeter, UK
Sergio Barrientos-Trigo, Department of
Nursing, Faculty of Nursing, Physiotherapy
and Podiatry, University of Seville, Seville,
Aim: To conduct a scoping review to examine and map the interventions proposed for
the improvement of the working conditions of nursing staff in acute care hospitals.
Background: The Registered Nurse Forecasting (RN4CAST) project and other studies
have determined the impact that the nursing staff has on the quality of care. The nurs-
ing staff’s higher levels of burnout, job dissatisfaction and negative perception of the
quality of care provided caused worse health outcomes.
Methods: A scoping review was carried out. By searching in SCOPUS, PubMed,
CINAHL, Cochrane, Dialnet and in the grey literature, 705 potentially relevant papers
were identified. The final analysis included 21 papers and three grey documents.
Results: The studies analysed proposed interventions at the macro- management,
meso- management and micro- management levels, although the interventions at the
macro- and meso- levels produce better staff outcomes.
Conclusions: The findings of this review can be applied to management at different
levels: measures to improve the patient–nurse ratio at the macro- management level,
the horizontal hierarchies at the meso- management level, the mind–body techniques
at the micro- management level.
Implications for Nursing Management: Nurse managers and leaders should implement
interventions at different organisational levels to improve the working conditions of
the nursing staff and other health outcomes.
hospitals, nursing staff, working conditions, working environment, workplace
1 | BACKGROUND
The increasing demand, fiscal constraints and an increased need for
accountability have brought about a reorganisation of health ser-
vices focused essentially on the optimization of resources. At times,
this optimization has led to unjustified and inappropriate cutbacks
of human and material resources (Reeves, McKee, Basu, & Stuckler,
2014). Among health professions, nursing is the one that is most af-
fected by reductions in salary, rest days and recruitment, as well as
by poorer working conditions and the elimination of bonuses (Phua &
The World Health Statistics by the World Health Organization
(WHO) indicate that the global average ratio (AR) of nurses is 28.6
per 10,000 inhabitants. There are significant differences between the
least developed regions (Africa 12.4, South- East Asia 15.3) and the
most developed ones (the Americas 44.9, Europe 80.2) (World Health
Organization, 2015). The intra- hospital nurse- to- patient ratio is also
used as a coefficient to determine the workload of professionals.