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The Impact of Nurse-to-Patient Ratios on Nurses' Burnout, Job Dissatisfaction, and Intention-to-Leave: A Systematic Review and Meta-Analysis.

Wael Ahmed M Alhazmi·Montaha Mohamed Ibrahim·Manal S A Hakami·Ragaa Gasim Ahmed Mohmmed·Eltayeb Mohammed Awadalkareem·Sahar Ahmed Mohamed·Amaal Samir Abdelmaksoud·Amal Abdelgadir Mohamed·Safiyah Hakami·Hanan Ahmed Mesawa·Daniel Mon Mamanao·Hammad Ali Fadlalmola
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Abstract

BACKGROUND: Adequate nurse staffing is essential for ensuring workforce well-being and patient safety. Imbalanced nurse-to-patient ratios contribute to burnout, job dissatisfaction, and turnover, which compromise care quality. OBJECTIVE: This systematic review and meta-analysis evaluated the impact of nurse-to-patient ratios on nurse burnout, job dissatisfaction, intention-to-leave, and patient outcomes. METHODS: A systematic search of PubMed, Scopus, and Web of Science identified cross-sectional studies examining nurse-to-patient ratios and related outcomes. RESULTS: Eighteen studies involving 183 876 nurses from 4085 hospitals were included. Higher nurse-to-patient ratios increased the odds of burnout (OR: 1.08), job dissatisfaction (OR: 1.10), and intention-to-leave (OR: 1.09). Each additional patient per nurse increased mortality and readmission risks by 7% to 8%, with decreased perceived care quality. CONCLUSION: Higher nurse-to-patient ratios adversely affect nurses and patients. Ensuring adequate staffing is critical to prevent burnout and maintain safe, high-quality care.

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HumansBurnout, ProfessionalJob SatisfactionPersonnel TurnoverNursing Staff, HospitalPersonnel Staffing and SchedulingCross-Sectional Studiesburnoutintention-to-leavejob dissatisfactionmental healthmeta-analysisnurse staffingnursessystematic reviewturnoverJournal ArticleSystematic ReviewMeta-Analysis

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Wael Ahmed M Alhazmi, Montaha Mohamed Ibrahim, Manal S A Hakami, Ragaa Gasim Ahmed Mohmmed, Eltayeb Mohammed Awadalkareem, Sahar Ahmed Mohamed, Amaal Samir Abdelmaksoud, Amal Abdelgadir Mohamed, Safiyah Hakami, Hanan Ahmed Mesawa, Daniel Mon Mamanao, Hammad Ali Fadlalmola. 2026-03-23. The Impact of Nurse-to-Patient Ratios on Nurses' Burnout, Job Dissatisfaction, and Intention-to-Leave: A Systematic Review and Meta-Analysis.. https://doi.org/10.1097/ncq.0000000000000953

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