Exploring the Association Between Patient-Nurse Ratio and Nurses' Occupational Stressors: A Cross-Sectional Study

Background: The patient-nurse ratio significantly influences nursing workloads, but its specific relationship with nurses' occupational stressors is poorly understood. Aim: This study aimed to examine the association between patient-nurse ratio and occupational stressors among nurses, highlighting understaffing as a potential driver of stress in clinical environments. Methods: A self-administered questionnaire was distributed to full-time nurses in the medical and surgical wards of accredited hospitals. Data collected included the average daily patient-nurse ratio, subscale scores from the Nurses' Occupational Stressor Scale (NOSS), and demographic and workplace variables such as sex, age, educational attainment, marital status, hospital ownership, unit type, major shift in the past 3 months, work tenure, sleeping hours, and weekly working hours. Logistic regression models and restricted cubic splines were used to analyze associations between the average daily patient-nurse ratio and elevated nursing stressors. The study followed the STROBE guidelines for cross-sectional research. Results: Among the 996 nurses surveyed, a higher average daily patient-nurse ratio was significantly associated with increased stress levels across all subscales of the NOSS. Restricted cubic spline analysis revealed that a lower average daily patient-nurse ratio corresponded to reduced probabilities of encountering higher stressors related to work demands, insufficient support from coworkers or caregivers, organizational challenges, and difficulty taking leave. Conversely, higher average daily patient-nurse ratios were linked to greater stress probabilities in all measured domains. Conclusion: This study demonstrates that higher average daily patient-nurse ratios significantly increase occupational stress among nurses. Reducing the patient-nurse ratio may mitigate these stressors and improve the overall well-being of nursing staff.