Antecedents of unfinished nursing care: a systematic review of the literature

Chiappinotto, Stefania; Papastavrou, Evridiki; Efstathiou, Georgios; Andreou, Panayiota; Stemmer, Renate; Ströhm, Christina; Schubert, Maria; de Wolf-Linder, Susanne; Longhini, Jessica; Palese, Alvisa

doi:10.1186/s12912-022-00890-6

BMC Nursing

Table 4 Unfinished nursing care antecedents and the direction of their relationship, according to the study design

From: Antecedents of unfinished nursing care: a systematic review of the literature

Antecedents	Author(s)	Brief description	Study design	Outcome: Unfinished nursing care
Antecedents	Author(s)	Brief description	Study design	↓	↑	≈
Unit level
Staffing levels, including staff adequacy as perceived by nurses, patient-to-nurse ratio and hour-per-patient day	Al-Kandari et al., 2009 [80]	More RNs in the unit (some of the tasks)	Cross-sectional	*
	Ball et al., 2018 [72]	Better nurse staffing (mediation analysis)	Cross-sectional	*
	Blackman et al., 2018 [56]	Nursing staff perceived as more adequate	Cross-sectional	*
	Cho et al., 2015 [74]	Working in the highly staffed units (compared with low staffed units)	Cross-sectional	*
	Kalisch & Lee, 2010 [38]	Respondents who perceived their unit staffing level to be high (compared with staff who felt staffing was inadequate)	Cross-sectional	*
	Kalisch et al., 2011 [43]	Staff who perceived their staffing as adequate (versus inadequate)	Cross-sectional	*
	Nelson, 2017 [44]	Better perceptions of staffing adequacy (also for licensed staffing)	Cross-sectional	*
	Orique et al., 2016 [40]	Better unit staffing adequacy perception	Cross-sectional		*
	Park et al., 2018 [46]	Higher staffing and resource adequacy score	Cross-sectional	*
	Schubert et al., 2013 [59]	Better nurse practice environment ‘staff resource adequacy’ at the unit level	Cross-sectional	*
	Winsett et al., 2016 [50]	Higher staffing adequacy perception reduces reasons for MNC (communication, material resources, labour resources)	Cross-sectional	*
	Zúñiga et al., 2015 [60]	Higher staffing and resources adequacy	Cross-sectional	*
	Castner et al., 2014 [41]	Increased skill mix	Cross-sectional	*
	Duffy et al., 2018 [45]	Higher staffing/resource adequacy as measured with the PES-NWI	Cross-sectional	*
	Hessels et al., 2015 [29]	PES-NWI subscale: better staffing and resource adequacy	Cross-sectional	*
	Smith et al., 2018 [49]	Higher staffing and resource adequacy (PES-NWI subscale)	Cross-sectional	*
	Griffiths et al., 2018 [32]	Higher health care assistant staffing levels (medical wards)	Cohort	*
	Griffiths et al., 2018 [32]	Higher RN staffing levels (medical wards)	Cohort	*
	Griffiths et al., 2018 [32]	Higher RN staffing level (wards that care for older people)	Cohort		*
	Blackman et al., 2019 [11]	Staffing inadequacy as perceived by nurses	Cross-sectional		*
	Blackman et al., 2019 [11]	Insufficient staff	Cross-sectional		*
	Blackman et al., 2014 [55]	Issues in nursing care resource provision	Cross-sectional		*
	Bragadòttir et al., 2016 [76]	Nurses who perceived adequate staffing ≤ 50% of the time (compared with those who felt it was adequate 100% of the time)	Cross-sectional		*
	Cho et al., 2016 [65]	Low nurse staffing levels	Cross-sectional		*
	Kalisch et al., 2011 [43]	Nurses who perceived their staffing as less adequate	Cross-sectional		*
	Al-Kandari et al., 2009 [80]	More patients in the unit (completion of routine Foley catheter care and with oral hygiene)	Cross-sectional		*
	Al-Kandari et al., 2009 [80]	More patients assigned (completion of routine Foley catheter care, with developing/updating NCP, with dressing changes, and providing comfort talk to the patients)	Cross-sectional		*
	Ball et al., 2014 [64]	More patients requiring assistance with daily living	Cross-sectional		*
	Bragadòttir et al., 2016 [76]	More patients taken care of during the last shift	Cross-sectional		*
	Cho et al., 2016 [65]	An increase of 1 patient/nurse	Cross-sectional		*
	Drach-Zahavy & Srulovici, 2019 [67]	Higher workload as the patient-to-nurse ratio (also used for path analysis)	Cross-sectional		*
	Friese et al., 2013 [51]	Higher number of patients cared for during the last shift (oncologic units)	Cross-sectional		*
	Kalisch et al., 2011 [43]	Nurses who cared for more patients in the previous shift	Cross-sectional		*
	Orique et al., 2016 [40]	More patients under care	Cross-sectional		*
	Palese et al., 2015 [77]	Lower daily care in minutes offered by NAs	Cross-sectional		*
	Schubert et al., 2013 [59]	Higher patient-to-nurse ratio at the unit level (in a separate model)	Cross-sectional		*
	Schubert et al., 2013 [59]	Higher patient-to-nurse ratio at the unit level (in an adjusted model)	Cross-sectional			*
	VanFosson et al., 2018 [39]	Mean nursing care hours provided by float staff	Cross-sectional		*
	Zander et al., 2014 [81]	Poor nurse-to-patient ratio	Cross-sectional		*
	Zander et al., 2014 [81]	Poor nurse-to-NA ratio	Cross-sectional		*
	Ausserhofer et al., 2014 [71]	Lower patient-to-nurse ratios	Cross-sectional	*
	Ball et al., 2014 [64]	RNs caring for the fewest patients (6.13 or fewer)	Cross-sectional	*
	Ball et al., 2016 [82]	Shifts with RN staffing levels < 10 patients/RN (compared with those with ≥ 10 patients/RN)	Cross-sectional	*
	Ball et al., 2016 [82]	Shifts with RN staffing levels ≤ 6 patients/RN	Cross-sectional	*
	Ball et al., 2016 [82]	Shifts with RN staffing levels < 4 patients/RN (best ratio)	Cross-sectional	*
	Kalisch et al., 2011 [36]	More hours per patient day	Cross-sectional	*
	Kalisch et al., 2011 [36]	More RN hours per patient day	Cross-sectional	*
	Kalisch et al., 2012 [83]	More hours per patient day	Cross-sectional	*
	Liu et al., 2018 [69]	Lower day shift patient-to-nurse ratio (or workload)	Cross-sectional	*
	Nelson, 2017 [44]	More RN hours per resident day rate	Cross-sectional	*
	Palese et al., 2015 [77]	Fewer patients in their charge during the last shift	Cross-sectional	*
	Palese et al., 2015 [77]	More daily care offered by RNs (in minutes/day)	Cross-sectional	*
	Zhu et al., 2019 [70]	Lower nurse-to-patient ratios	Cross-sectional		*
	Griffiths et al., 2018 [32]	More RN and health-care assistant hours per patient day	Cohort	*
	Griffiths et al., 2018 [32]	Additional health care assistant hours per patient day	Cohort	*
	Griffiths et al., 2018 [32]	More RN hours per patient day (high-acuity patients)	Cohort	*
	Griffiths et al., 2018 [32]	Additional RN hours per patient day	Cohort	*
	Griffiths et al., 2018 [32]	Increased health care assistant hours per patient day (wards that care for older people)	Cohort	*
	Griffiths et al., 2018 [32]	More RN hours per patient day (high-acuity patients on early and twilight shifts)	Cohort	*
	Griffiths et al., 2018 [32]	More RN hours per patient day rate during the previous shift and the subsequent shift (i.e., the early shift)	Cohort	*
	Griffiths et al., 2018 [32]	More RN hours per patient day	Cohort	*
	Griffiths et al., 2018 [32]	More health care assistant hours per patient day	Cohort	*
	Griffiths et al., 2018 [32]	There was no significant main effect for RN hours per patient day	Cohort			*
	Griffiths et al., 2018 [32]	Significant but non-linear association between total care hours per patient day and the rate of missed observations	Cohort	*
Griffiths et al., 2018 [32]	Non-linear effects for RN hours par patient days, with incremental benefits continuing at higher staffing levels (> 7 h/day)	Cohort			*
Workloads	Al-Kandari et al., 2009 [80]	Total workloads	Cross-sectional		*
	Al-Kandari et al., 2009 [80]	More discharges made (back rub/skin care and with oral hygiene)	Cross-sectional		*
	Al-Kandari et al., 2009 [80]	More transfers made (all nursing tasks)	Cross-sectional		*
	Al-Kandari et al., 2009 [80]	Performing extraordinary life support	Cross-sectional		*
	Blackman et al., 2014 [55]	Higher work intensity	Cross-sectional		*
	Blackman et al., 2014 [55]	Workload unpredictability	Cross-sectional		*
	Blackman et al., 2017 [73]	Missed lower priority nursing care	Cross-sectional		*
	Blackman et al., 2017 [73]	Missed higher priority nursing care	Cross-sectional		*
	Castner et al., 2014 [41]	Increased unit workload	Cross-sectional		*
	McNair et al., 2016 [42]	Spending more time (more minutes per hour) on tasks (activities of daily living, assessment and monitoring, clinical care, communication with patient, communication with care team, documentation)	Cross-sectional			*
	Nelson, 2017 [44]	Higher perception of workloads (also for licensed staffing)	Cross-sectional		*
	Orique et al., 2016 [40]	Higher unit-level nurse workload (number of admissions, discharges, transfers in, and transfers out)	Cross-sectional			*
	Griffiths et al., 2018 [32]	More admissions per RN	Cohort		*
	McNair et al., 2016 [42]	Spending less time on documentation (fewer minutes per hour)	Cross-sectional			*
	Srulovici et al., 2017 [68]	Lower workloads, captured as fewer patients per nurse (focal and incoming nurse)	Cross-sectional	*
Non-nursing tasks	Al-Kandari et al., 2009 [80]	More non-nursing tasks	Cross-sectional		*
	Bekker et al., 2015 [84]	High occurrence of non-nursing tasks (‘Delivering and retrieving food trays’)	Cross-sectional		*
	Bekker et al., 2015 [84]	High occurrence of non-nursing tasks (‘Routine phlebotomy/blood drawing for tests’)	Cross-sectional		*
	Bekker et al., 2015 [84]	High occurrence of non-nursing tasks (‘Cleaning patients’ rooms and equipment’)	Cross-sectional		*
	Liu et al., 2018 [69]	Fewer non-professional tasks	Cross-sectional	*
Case mix	Kalisch et al., 2011 [36]	Case mix index	Cross-sectional			*
Shift	Blackman et al., 2014 [55]	Shift time (antemeridian versus post)	Cross-sectional		*
	Blackman et al., 2018 [56]	Morning shifts (compared with afternoon shifts)	Cross-sectional	*
	Kalisch et al., 2011 [43]	Working day shifts (compared with night shifts)	Cross-sectional		*
	Kalisch et al., 2011 [43]	Night shift workers (compared with day shift workers)	Cross-sectional	*
	Kalisch et al., 2013 [37]	RNs who worked night shifts (compared with day shifts)	Cross-sectional	*
	Knopp-Sihota et al., 2015 [31]	Most frequently worked evening and night shifts versus morning shifts	Cohort		*
	Saqer et al., 2018 [78]	Nurses working in mixed (day and night) shift schemes	Cross-sectional		*
Overtime	Blackman et al., 2019 [11]	Undertake extra shifts (from never to up to 20)	Cross-sectional		*
	Chapman et al., 2016 [57]	Nurses working overtime for 5–12 h and > 12 h (compared with staff who did not work any overtime hours)	Cross-sectional		*
	Cho et al., 2016 [65]	Overtime (RNs worked beyond the contracted hours)	Cross-sectional		*
	Nelson, 2017 [44]	Working > 12 h of overtime (also for licensed staffing)	Cross-sectional		*
	Phelan et al., 2018 [75]	Nurses who worked more than 39 h a week (correlation with educational nursing duties)	Cross-sectional	*
Work environment	Blackman et al., 2019 [11]	Dissatisfied working as a team	Cross-sectional		*
	Bragadòttir et al., 2016 [76]	Better nursing teamwork	Cross-sectional	*
	Bragadòttir et al., 2016 [76]	Increased teamwork	Cross-sectional	*
	Chapman et al., 2016 [57]	Higher teamwork score (Nursing Teamwork Survey)	Cross-sectional	*
	Kalisch & Lee, 2010 [38]	Higher teamwork overall scores	Cross-sectional	*
	Nelson, 2017 [44]	Better nursing teamwork (also for licensed staffing)	Cross-sectional	*
	Zúñiga et al., 2015 [60]	Higher teamwork and safety climate (correlated to rationing in the subscales activities of daily living and caring, rehabilitation, and monitoring	Cross-sectional	*
	Kalisch & Lee, 2010 [38]	Nursing Teamwork Survey subscale: higher trust	Cross-sectional	*
	Kalisch & Lee, 2010 [38]	Nursing Teamwork Survey subscale: higher team orientation	Cross-sectional	*
	Kalisch & Lee, 2010 [38]	Nursing Teamwork Survey subscale: higher backup behaviour	Cross-sectional	*
	Kalisch & Lee, 2010 [38]	Nursing Teamwork Survey subscale: higher sharing of mental model	Cross-sectional	*
	Kalisch & Lee, 2010 [38]	Nursing Teamwork Survey subscale: better team leadership	Cross-sectional	*
	Ausserhofer et al., 2014 [71]	More favourable work environments	Cross-sectional	*
	Ball et al., 2014 [64]	Better practice environment	Cross-sectional	*
	Duffy et al., 2018 [45]	Positively rated work environment	Cross-sectional	*
	Kim et al., 2018 [66]	Better nursing work environment	Cross-sectional	*
	Kim et al., 2018 [66]	Higher nursing work environment subscale scores (nurse participation in hospital affairs; nursing foundations for quality of care; nurse manager ability, leadership, and support of nurses; staffing and resource adequacy; collegial nurse–physician relations)	Cross-sectional	*
	Liu et al., 2018 [69]	Better work environment	Cross-sectional	*
	Papastavrou et al., 2014 [8]	Higher rating of Revised Professional Practice Environment subscales: Internal Work Motivation, Leadership and Autonomy, Staff Relations with Physicians, Teamwork and Communication About Patients	Cross-sectional	*
	Park et al., 2018 [46]	Good environment units (compared with poor environment units)	Cross-sectional	*
	Smith et al., 2018 [49]	A one standard deviation increases in the nurse work environment	Cross-sectional	*
	Smith et al., 2018 [49]	Better nurse work environment and higher collective efficacy	Cross-sectional	*
	Hessels et al., 2015 [29]	Higher PES-NWI composite score	Cross-sectional	*
	Hessels et al., 2015 [29]	Higher score on each of the five dimensions of the practice environment of PES-NWI	Cross-sectional	*
	Smith et al., 2018 [49]	Higher PES-NWI composite score	Cross-sectional	*
	Blackman et al., 2014 [55]	More communication issues	Cross-sectional		*
	Castner et al., 2014 [41]	More RN communication problems	Cross-sectional		*
	Palese et al., 2015 [77]	Communication tensions between RNs and NAs	Cross-sectional		*
	Duffy et al., 2018 [45]	Better collegial relationships as measured with the PES-NWI	Cross-sectional	*
	Hessels et al., 2015 [29]	PES-NWI subscale: better collegial nurse physician relationships	Cross-sectional	*
	Park et al., 2018 [46]	Higher nurse–physician relations score	Cross-sectional	*
	Vryonides et al., 2016 [62]	Better instrumental ethical climate score	Cross-sectional		*
	Vryonides et al., 2016 [62]	Better independence ethical climate score	Cross-sectional		*
	Vryonides et al., 2016 [62]	Better caring ethical climate score	Cross-sectional	*
	Vryonides et al., 2016 [62]	Better rules ethical climate score	Cross-sectional	*
	Vryonides et al., 2016 [62]	Better law and code ethical climate score	Cross-sectional	*
	Coleman, 2018 [47]	Higher nursing incivility scores	Cross-sectional		*
	Coleman, 2018 [47]	Higher supervisor total nursing incivility score	Cross-sectional		*
	Coleman, 2018 [47]	Higher patient/family/visitor’s incivility scores	Cross-sectional		*
	Coleman, 2018 [47]	Higher workplace incivility	Cross-sectional		*
	Menard, 2014 [52]	Higher nursing incivility score	Cross-sectional		*
	Menard, 2014 [52]	Higher supervisor total nursing incivility score	Cross-sectional		*
	Menard, 2014 [52]	Higher workplace incivility	Cross-sectional		*
	Menard, 2014 [52]	Higher patient/family/visitor scores (PES-NWI)	Cross-sectional		*
	Duffy et al., 2018 [45]	Better foundations for quality as measured with the PES-NWI	Cross-sectional	*
	Hessels et al., 2015 [29]	PES-NWI subscale: higher nursing foundations for quality of care	Cross-sectional	*
	Duffy et al., 2018 [45]	Better nurse participation as measured with the PES-NWI	Cross-sectional	*
	Hessels et al., 2015 [29]	PES-NWI subscale: higher nurse participation in hospital affairs	Cross-sectional	*
	Duffy et al., 2018 [45]	Better leadership and support as measured with the PES-NWI	Cross-sectional	*
	Hessels et al., 2015 [29]	PES-NWI subscale: better nurse manager leadership, higher ability, higher support of nurses	Cross-sectional	*
	Bekker et al., 2015 [84]	More independence at work	Cross-sectional	*
	Castner et al., 2014 [41]	More RN supply problems	Cross-sectional		*
	Piscotty et al., 2014 [53]	Higher nursing care reminders usage	Cross-sectional	*
	Piscotty et al., 2014 [53]	Higher scores on the Impact of Healthcare Information Technology Scale	Cross-sectional	*
	Smith et al., 2018 [49]	A one standard deviation increases in collective efficacy	Cross-sectional	*
	White et al., 2019 [54]	Higher burnout among RNs	Cross-sectional		*
	Ball et al., 2014 [64]	Better nurse perception of the quality of nursing care	Cross-sectional	*
	Labrague et al., 2019 [31]	Higher scores on the Caring Behaviour Inventory	Cross-sectional	*
	Ball et al., 2014 [64]	Better nurses overall grading of patient safety on their unit/ward	Cross-sectional	*
	Kim et al., 2018 [66]	Better patient safety culture	Cross-sectional	*
	Schubert et al., 2013 [59]	A more favourably estimated ‘patient safety climate’ at the hospital level	Cross-sectional	*
	Castner et al., 2014 [41]	More RN errors of commission	Cross-sectional	*
	Zúñiga et al., 2015 [60]	Higher teamwork and safety climate (correlated to rationing in the subscales activities of daily living and caring, rehabilitation, and monitoring)	Cross-sectional	*
Delivery Care System	Saqer et al., 2018 [78]	Team nursing vs total patient care	Cross-sectional		*
Ward, unit	Bragadòttir et al., 2016 [76]	Medical and surgical units (compared with ICUs)	Cross-sectional		*
	Coleman, 2018 [47]	Medical/surgical units versus emergency department, surgical operating room, and obstetrics	Cross-sectional		*
	Papastavrou et al., 2014 [8]	Surgical departments (compared with medical wards)	Cross-sectional	*
	Castner et al., 2014 [41]	Critical care units (compared with other units)	Cross-sectional	*
	Kalisch et al., 2013 [37]	RNs who worked in rehabilitation (versus ICU)	Cross-sectional		*
	Hernández-Cruz et al., 2017 [79]	Inpatient service (compared with the emergency department)	Cross-sectional		*
	Blackman et al., 2019 [11]	Type of residence (e.g., low care, dementia only)	Cross-sectional		*
Location of the hospital/ facility	Blackman et al., 2014 [11]	Metropolitan work site (versus rural)	Cross-sectional		*
	Knopp-Sihota et al., 2015 [33]	The location of the facility (urban versus rural)	Cohort		*
	Knopp-Sihota et al., 2015 [33]	Health care aides: urban versus rural	Cohort		*
	Blackman et al., 2018 [56]	Region of work (e.g., comparison among Australian areas)	Cross-sectional	*
	Knopp-Sihota et al., 2015 [33]	Working in a given province	Cohort	*
	Knopp-Sihota et al., 2015 [33]	Health care aides: province (e.g., Saskatchewan versus others)	Cohort		*
	Kalisch & Lee, 2012 [48]	Magnet unit staff (compared with non-Magnet hospitals)	Cross-sectional	*
	Blackman et al., 2019 [11]	Size of the residence (e.g., beds)	Cross-sectional		*
	Knopp-Sihota et al., 2015 [33]	Beds (small [up to 79] versus medium [up to 120] versus large [< 120])	Cohort	*
	Knopp-Sihota et al., 2015 [33]	Health care aides: small nursing homes	Cohort		*
	Blackman et al., 2019 [11]	Residence owner (e.g., private)	Cross-sectional		*
	Knopp-Sihota et al., 2015 [33]	Not for profit (versus profit)	Cohort	*
	Nelson, 2017 [44]	Higher bed occupancy rate	Cross-sectional		*
	Knopp-Sihota et al., 2015 [33]	The organisational context (lower context versus higher context)	Cohort		*
	Knopp-Sihota et al., 2015 [33]	Health care aides who work on a unit with a lower organisational context	Cohort		*
Nurse level
Age	Al-Kandari et al., 2009 [80]	Increased age of nurses	Cross-sectional	*
	Higgs et al., 2016 [58]	Medical care nurses aged > 50 years	Cross-sectional		*
	Kalisch et al., 2011 [43]	Older nurses	Cross-sectional		*
	Palese et al., 2015 [77]	Older nursing staff	Cross-sectional	*
	Phelan et al., 2018 [75]	35–44-year-old age bracket (compared with the 25–34-year-old bracket)	Cross-sectional		*
	Saqer et al., 2018 [78]	Increased age (regarding the perceived level of MNC)	Cross-sectional	*
	Knopp-Sihota et al., 2015 [33]	Increased age	Cohort		*
	Phelan et al., 2018 [75]	Younger community nurses	Cross-sectional		*
	Knopp-Sihota et al., 2015 [33]	Younger health care aides	Cohort		*
	Phelan et al., 2018 [75]	Community nurses aged 35–44 years (compared with those aged 25–34 and 55–64 years)	Cross-sectional		*
	VanFosson et al., 2018 [39]	Between-nurse factors (compared with within-nurse factors)	Cross-sectional		*
Gender	Ausserhofer et al., 2014 [71]	Female nurses	Cross-sectional	*
	Kalisch et al., 2011 [43]	Female nurses	Cross-sectional		*
	Saqer et al., 2018 [78]	Female gender	Cross-sectional	*
	Chapman et al., 2016 [57]	Male nurses (versus female nurses)	Cross-sectional	*
	Drach-Zahavy & Srulovici, 2019 [67]	In the path analysis, MNC has emerged as directly influenced by gender	Cross-sectional		*
	Drach-Zahavy & Srulovici, 2019 [67]	Significant correlations between MNC and gender (p = 0.05)	Cross-sectional		*
	Papastavrou et al., 2016 [85]	Staff gender	Cross-sectional			*
Professional experience	Ausserhofer et al., 2014 [71]	Nurses with more professional experience	Cross-sectional	*
	Castner et al., 2014 [41]	More RN experience	Cross-sectional		*
	Kalisch & Lee, 2010 [38]	Staff with 5–10 years of experience and those with > 10 years of experience (compared with those with ≤ 6 months experience)	Cross-sectional		*
	Kalisch et al., 2011 [36]	Experience > 5 years	Cross-sectional			*
	Kalisch et al., 2011 [43]	Experienced nurses	Cross-sectional		*
	Kalisch et al., 2013 [37]	RNs who had ≥ 2 years of role experience (compared with ≤ 6 months)	Cross-sectional		*
	Kim et al., 2018 [66]	Greater clinical experience	Cross-sectional	*
	Blackman et al., 2017 [73]	Less clinical experience	Cross-sectional		*
	Chapman et al., 2016 [57]	Staff with ≤ 6 months of experience (compared with ≥ 10 years)	Cross-sectional	*
	Kalisch et al., 2011 [43]	Staff with fewer years of experience	Cross-sectional	*
	Palese et al., 2015 [77]	Lower experience in the medical unit	Cross-sectional		*
	Phelan et al., 2018 [75]	Community nurses with < 5 years of experience (correlation with e.g., initial client needs assessments, follow-up visits after a re-assessment, liaising with other professionals)	Cross-sectional		*
Education	Blackman et al., 2019 [11]	Role in residents’ care (RNs versus PNs)	Cross-sectional		*
	Bragadòttir et al., 2016 [76]	RNs (versus PNs)	Cross-sectional		*
	Higgs et al., 2016 [58]	Critical care nurses who had worked for a longer time as a RN	Cross-sectional		*
	Kalisch et al., 2011 [43]	RNs (versus NAs)	Cross-sectional		*
	Orique et al., 2016 [40]	More advanced job title (RNs versus NAs)	Cross-sectional	*
	Chapman et al., 2016 [57]	Enrolled nurses (compared with RNs)	Cross-sectional	*
	Friese et al., 2013 [51]	Nursing assistant as a job title in oncologic units	Cross-sectional	*
	Kalisch & Lee, 2010 [38]	NAs (compared with nurses)	Cross-sectional	*
	Kalisch et al., 2011 [43]	NAs (versus RNs)	Cross-sectional	*
	Griffiths et al., 2018 [32]	Effect of health care assistant staff is stronger (regarding RN staffing)	Cohort	*
	Blackman et al., 2018 [56]	Region of qualification (e.g., comparison among Australian areas)	Cross-sectional	*
	Bekker et al., 2015 [84]	More educational opportunities	Cross-sectional	*
	Kalisch et al., 2013 [34]	Receiving education with didactic presentations, scenarios including role playing (simulation), debriefing, and discussion	Quasi-experimental	*
Absenteeism	Kalisch et al., 2011 [43]	Those who missed more shifts in the past 3 months (compared with those who did not miss any shifts)	Cross-sectional		*
	Kalisch et al., 2011 [43]	Nursing staff who missed ≥ 2 shifts in the past 3 months (compared with those who did not miss any shifts)	Cross-sectional		*
	Kalisch et al., 2011 [36]	Absenteeism	Cross-sectional			*
	Kalisch et al., 2013 [37]	RNs who missed any workdays (compared with those who did not miss any)	Cross-sectional		*
Part time or full time	Ausserhofer et al., 2014 [71]	Part-time nurses	Cross-sectional	*
	Phelan et al., 2018 [75]	Community nurses working less than 39 h a week (correlation with child health promotion)	Cross-sectional	*
	Palese et al., 2015 [77]	Working in a full-time position	Cross-sectional		*
	Srulovici et al., 2017 [68]	Employment status (full-time versus part-time)	Cross-sectional	*
Professional satisfaction	Bekker et al., 2015 [84]	Greater satisfaction with current job	Cross-sectional	*
	Orique et al., 2016 [40]	Greater satisfaction with current position	Cross-sectional	*
	Siqueira et al., 2017 [35]	Greater satisfaction with position/role	Cross-sectional	*
	Siqueira et al., 2017 [35]	Greater satisfaction with teamwork	Cross-sectional	*
	Siqueira et al., 2017 [35]	Greater satisfaction with profession	Cross-sectional	*
	Knopp-Sihota et al., 2015 [33]	Greater satisfaction in their career	Cohort		*
	Blackman et al., 2014 [55]	Greater dissatisfaction in current job	Cross-sectional		*
	Papastavrou et al., 2016 [85]	Less job satisfaction	Cross-sectional		*
	White et al., 2019 [54]	Greater job dissatisfaction among RNs	Cross-sectional		*
	Knopp-Sihota et al., 2015 [33]	Job satisfaction (no versus yes)	Cohort		*
	Knopp-Sihota et al., 2015 [33]	Health care aides less satisfied with their job	Cohort		*
	Blackman et al., 2014 [55]	Higher intention to leave	Cross-sectional		*
	Nelson, 2017 [44]	Plans to leave (also for licensed staffing)	Cross-sectional		*
	Hogh et al., 2018 [30]	Copenhagen Psychosocial questionnaire: higher exposure to bullying (time 1)	Cohort		*
	Zander et al., 2014 [81]	Higher degree of emotional exhaustion	Cross-sectional		*
	Knopp-Sihota et al., 2015 [33]	Higher Maslach Burn Out Inventory scores	Cohort		*
	Knopp-Sihota et al., 2015 [33]	Health care aides who report higher levels of exhaustion and cynicism	Cohort		*
	Hogh et al., 2018 [30]	Copenhagen Psychosocial questionnaire: Affective organisational commitment	Cohort			*
	Zúñiga et al., 2015 [60]	Greater work stress due to workloads	Cross-sectional		*
	Zúñiga et al., 2015 [60]	Greater work stress due to conflict and lack of recognition	Cross-sectional		*
	Zúñiga et al., 2015 [60]	Greater work stress due to lack of preparation	Cross-sectional	*
	Dhaini et al., 2017 [61]	Physical and mental health factors (presence of joint pain, tiredness, headache)	Cross-sectional		*
	Knopp-Sihota et al., 2015 [33]	Higher Short Form-8 Physical Health scores	Cohort		*
	Knopp-Sihota et al., 2015 [33]	Higher Short Form-8 Mental Health	Cohort		*
	Knopp-Sihota et al., 2015 [33]	Health care aides who have lower efficacy and worse self-reported physical and mental health	Cohort		*
	Drach-Zahavy & Srulovici, 2019 [67]	Higher conscientiousness	Cross-sectional	*
	Drach-Zahavy & Srulovici, 2019 [67]	Higher agreeableness	Cross-sectional	*
	Drach-Zahavy & Srulovici, 2019 [67]	Higher neuroticism	Cross-sectional		*
	Smith et al., 2018 [49]	Higher scores on the Collective Efficacy Beliefs Scale index	Cross-sectional	*
Personal accountability	Drach-Zahavy & Srulovici, 2019 [67]	Higher personal accountability	Cross-sectional	*
Personal accountability	Srulovici et al., 2017 [67]	Higher personal and ward accountability (focal and incoming nurse)	Cross-sectional	*
Country of origin	Blackman et al., 2017 [73]	Nurses’ country of origin (Australia versus Italy)	Cross-sectional		*
Patient level
Clinical instability	Al-Kandari et al., 2009 [80]	More unstable patients assigned (adequate documentation)	Cross-sectional		*
	Al-Kandari et al., 2009 [80]	Higher patient death rate	Cross-sectional		*
	Ball et al., 2014 [64]	More patients requiring frequent monitoring	Cross-sectional		*

Abbreviations: ICU Intensive care unit, MNC Missed nursing care, NA Nursing assistant, NCP Nursing care plans, PES-NWI Practice Environment Scale-Nursing Work Index, PN Practical nurse, RN Registered nurse, ↓ = decrease, ↑ = increase, ≈ no significant findings, no associations/correlations, no clear conclusions

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