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Journal Article


Nurses' Reports on Hospital Care in Five Countries

The Issue

Inadequate numbers of hospital nursing staff, uneven quality of care, and high levels of nurse dissatisfaction have been thought to be uniquely American problems, stemming from the advent of managed care. But the authors of this article, based on a Commonwealth Fund–supported study, reported that nurses not only in the United States but also in four other countries with distinctly different health care systems—Canada, England, Scotland, and Germany—all described similar shortcomings.

What the Study Found

 The extensive survey of more than 43,000 nurses in over 700 hospitals in five countries revealed the following:

  • High levels of job dissatisfaction and emotional exhaustion among nurses, and their consequent intent to leave. In the U.S., 41 percent of Pennsylvania hospital nurses reported being dissatisfied with their job. Rates in the other countries ranged from 32.9 percent (Canada) to 17.4 percent (Germany). Particularly striking was the discontent among younger nurses, boding ill for the future.
  • Negative perceptions of staffing adequacy and workforce management policies. Only 30 percent to 40 percent of nurses thought there were enough registered nurses to provide high-quality patient care. And in each of the five countries, fewer than half the nurses thought hospital management was responsive to their concerns and provided them with opportunities to participate in decision-making.
  • Time spent performing functions that did not require professional training, while activities requiring nursing "skills and expertise were often left undone."
  • Perceived deterioration in the quality of care provided at their institutions, including the discharge of patients insufficiently prepared to manage their care at home.


Based on their study, the authors urge that the seemingly universal "deficiencies in hospital organization, work design, and care" must be corrected so as "to ensure an adequate nurse workforce and acceptable quality of care."

Publication Details



L. H. Aiken, S. P. Clarke, D. M. Sloane et al., "Nurses' Reports on Hospital Care in Five Countries," Health Affairs, May/June 2001 20(3):43–53.