Understaffing as a Two-Dimensional Phenomenon: A Cross-Sectional Study of Hospital Nurses' Manpower and Expertise Understaffing

Aim(s): To examine whether manpower and expertise understaffing are distinct, and whether they relate similarly to nursing stressors, burnout, job satisfaction and intentions to turnover. Design: A cross-sectional survey of hospital nurses nested within units was used. Methods: The sample included 402 nurses. Nurses provided ratings of the study's variables using validated self-report measures. The data were analysed both as multilevel and single-level data. Results: Manpower and expertise understaffing contributed unique explained variance to all of the examined outcomes. Nurses within the same units experience different understaffing levels. Expertise understaffing emerged as a significantly stronger predictor than manpower understaffing for three of the six of the outcome variables (illegitimate tasks, job satisfaction and turnover intentions). Conclusion: Manpower and expertise understaffing are distinct, and both are associated with nurse outcomes. Reporting Method: We have adhered to the STROBE guideline for cross-sectional studies. Implications for the Profession and/or Patient Care: Considering both manpower and expertise understaffing to maintain proper staffing levels in nursing units is crucial. Patient or Public Contribution: A Director of Patient Care Services from the hospital where the study was conducted is a member of the research team. This member contributed to designing and conducting the study as well as interpreting the results.