الفهرس 
CHAPTER I: INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Recent evidence suggests that more nurses lead to better patient outcomes. Projected long-term shortages will create greater cost and quality challenges. Nursing shortage is one of the barriers that need awareness and intervention from all health care parties. Although nurses provide 24 hours a day of patients care; without a sufficient number of nurses to staff hospitals, patient care will suffer. Healthcare organizations should worry about the satisfaction of their consumers and be trained and learn how to maintain or retain a sufficient number of nurses to maintain high quality nursing care. The impact of nursing shortage on quality of nursing services and patients care was considered broadly in western literature; but there are no studies that discuss the relationship between nursing shortage and patients outcome in Egypt. This study was conducted to study the relationship between nurses’ shortage and patient outcome at Menoufyia University Hospitals. The study was conducted at selected critical care units and inpatient departments at Menoufyia University Hospitals. Descriptive correlational research design was used in conducting this study. The subjects of the study consisted of two groups; the first group included 120 nurses selected by simple random sample. The second group included 150 patients that fulfilled the inclusion criteria (full conscious, stay at least three days in the hospital prior to data collection, and at least, twelve years old). Data were collected using nursing shortage knowledge questionnaire administered to nurses to assess their knowledge about nursing shortage, patient satisfaction scale to assess patient satisfaction with nursing care provided, and formula for calculating the nurse to patient ratios to determine the degree of nurses’ shortage at the selected setting. Tools were tested for validity and reliability and administered to subjects. The knowledge questionnaire was self administered to nurses after explaining the purpose of the study. Patient satisfaction scale was self administered to patients who are able and can read and write while unable and illiterate patients were interviewed by the researcher after explaining the purpose of the study and gaining their acceptance. Data were analyzed using the appropriate tests. The results of the present study revealed that: The study included 120 nurses. More than half of them were from inpatient units. The majority of nurses were females The majority of nurses working at critical care units had 5-10 years of experience, while the highest percentage of nurses working at inpatient units had more than 10 years of experience. The highest percentage of nurses was married Additionally, the highest percentage of nurses working at critical care units had associate nursing degree, while the highest percentage of nurses working at inpatient units had a nursing diploma The nurse to patient ratios were lower than the standardized ratios at most of the units. The nurse to patient ratios were higher at critical care units than at inpatient units A highly statistically significant difference was found between the mean value of nurse to patient ratio at critical care units and inpatient units at morning and evening shifts The highest percentage of nurses agreed on organizational factors and educational factors as contributing to nursing shortage Furthermore, considerable percentage of nurses agreed on social factors as contributing to nursing shortage. Low percentage of nurses agreed on personal factors as contributing to nursing shortage High percentage of nurses at critical care units and at inpatient units agreed that nursing shortage has great impact on patient care and on nurses. The majority of nurses working at critical care units and at inpatient units agreed that the total current employer effort to improve recruitment of nurses was not enough. The most important strategies to solve the problem of nursing shortage from nurses opinion were; improving working environment, improving status of nurses in hospital environment, , clear plan for nurses’ distribution all over the country, improving wages and benefits, increasing capacity to educate and train nurses, encouraging both sex to enter the field of nursing, overtime should be voluntary not under pressure , paying for over time regularly, and increasing the pay for over time regularly. The study included 150 patients; the highest percentage of them was from inpatient units. The highest percentage of patients at critical care units was males while the highest percentage of patients at inpatient units was females. The highest percentage of patients at critical care units had basic education, while the highest percentage of patients at inpatient units had secondary education. The majority of patients were dissatisfied with the five dimensions of nursing care. The highest percentage of patients at critical care units and inpatient units was dissatisfied with psychological support and keeping privacy and health education Total patients’ satisfaction at critical care units and at inpatient units was low. A highly statistically significant difference was revealed between the total mean score of patients’ satisfaction at critical care units and inpatient units The highest percentage of patient dissatisfaction with nursing care was at the orthopedic department, the medical department, the urology department, then at surgical ICU and cardiac catheterization ICU A significant positive correlation was found between patient satisfaction and nurse to patient ratio at the morning and evening shifts. In conclusion, it is expected that solving the problem of nursing shortage would improve patient outcome. It is recommended that hospital administrators, accrediting agencies, insurers, and regulators should take actions to ensure that an adequate nursing staff is available to protect patients and to improve the quality of care. Hospitals and health care agencies should work to improve the working environment and improve the status of nurses in hospitals in order to improve recruitment and retention of nurses. Their should be a plan for distribution of nurses allover the country and inside hospitals. Hospitals and media should work together to improve the image of nursing. Ongoing monitoring of patient satisfaction specific to nursing services should be done regularly.