***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives : To describe ( 1 ) the extent to which acute and intensive care units use the elements of nursing models ( team , functional , primary , total patient care , patient-focused care , case management ) and ( 2 ) the deployment of non-unit-based personnel re sources . Background : The lack of current data -based behavioral descriptions of the extent to which elements of nursing models are implemented makes it difficult to determine how work models may influence outcomes . Methods : Nurse managers of 56 intensive care units and 80 acute care adult units from 40 r and omly selected US hospitals participated in a structured interview regarding ( 1 ) day-shift use of patient assignment behaviors associated with nursing models and ( 2 ) the availability and consistency of assignment of non-unit-based support personnel . Results : No model was implemented fully . Almost all intensive care units reported similar assignment behaviors except in the consistency of patient assignment . Non-intensive care units demonstrated wide variation in assignment patterns . Patterns differed intrainstitutionally . There were large differences in the availability and deployment of non-unit-based supportive re sources . Conclusions : Administrators must recognize the differences in work models within their institutions as a part of any quality improvement effort . Attempts to test new work models must be rigorous in the measurement of their implementation AIM To examine factors within the nursing work environment that may affect  nurse outcomes .  BACKGROUND Primary data were acquired from unit managers and staff nurses on the study units . Secondary data were collected from health records administrative data bases . The sample included adult medical and surgical units within all 19 teaching hospitals in Ontario , Canada . METHODS A cross-sectional study design was employed in this study . A r and om sampling process was used to recruit the number of nurses ( n = 1,116 ) required to provide a statistically adequate sample for the survey . RESULTS Perceptions of the quality of care at the unit level were found to have a statistically significant positive influence on nurses ' job satisfaction , and a statistically significant negative influence on nurses ' job pressure and job threat . CONCLUSIONS The results of this study underscore the importance of examining the environment in which nurses ' work as a potential factor that influences outcomes experienced by patients and nurses BACKGROUND Recently , restructuring of the nursing workforce has been undertaken in a number of countries in an effort to provide efficient and cost-effective services to users . This often takes the form of the introduction of unregulated workers to carry out support roles with registered nurses . However , these changes have not been evaluated for efficacy or impact on nurses , patients or the health care system . PURPOSE The purpose of this study was to determine the relationship between staff mix models comprising regulated staff ( Registered Nurses and Registered Practical Nurses ) or regulated and unregulated staff ( Registered Nurses and unregulated workers ) , and nursing and quality outcomes . METHODS This comparative correlational study was conducted in a r and om sample of 30 adult , acute care patient units within eight hospitals located in Toronto , Canada . Registered Nurses employed on 30 r and omly selected hospital units , grouped by the two staff mix models ( 15 units per group ) , were surveyed using previously vali date d instruments to measure role conflict , role ambiguity , job satisfaction , perceived effectiveness of care and perceived quality of care . RESULTS Results indicated that Registered Nurses in this study experienced high levels of role conflict , regardless of the type of staff mix model within which they worked . Registered Nurses on units employing both Registered Nurses and unregulated workers reported higher levels of job satisfaction . On units employing both Registered Nurses and unregulated workers , Registered Nurses perceived that the quality of care was lower . CONCLUSIONS Staff mix model was related to Registered Nurses ' perceptions of the quality of patient care . It was also evident that other variables within the work environment might have more influence on the outcomes examined than the independent variable of staff mix The employment of  unlicensed personnel in Canadian acute care hospitals has been undertaken without clear evidence of outcomes for patients , caregivers , and hospital organizations . This quasi-experimental evaluation study was completed in a metropolitan Toronto acute care hospital to examine the effects of a new nursing care delivery system which included  unlicensed assistive personnel .  Most of the expected benefits of the newly implemented nursing care delivery system did not material ize leading to the conclusion that the employment of unlicensed assistive personnel in acute care hospital systems may not offer additional benefits for patients , caregivers , or hospital organizations . The processes and results of this study provide useful information for nurse administrators who are seeking effective and innovative care delivery systems that are design ed to optimize patient , caregiver , and hospital outcomes Background This systematic review set out to examine the impact , if any , of  nursing workload and staffing  on creating and maintaining healthy work environments . For the purpose s of this review , the term ‘ healthy work environment ’ was defined as ‘ … a practice setting that maximizes the health and well‐being of nurses , quality patient outcomes and organizational performance ’ . This definition identifies nurse , patient and organisational outcomes as indicators of the establishment and maintenance of a healthy work environment . Objectives The review sought to determine the impact of : Patient characteristics , nurse characteristics , system characteristics and system processes on workload , scheduling and concepts of productivity and utilisation Workload , scheduling and concepts of productivity and utilisation on the quality of outcomes for clients , nurses and the system/organisation Search strategy The search strategy sought to find both published and unpublished studies and papers written in the English language . A three‐step search strategy approach was used . An initial limited search of MEDLINE and CINAHL data bases was undertaken to identify optimal search terms followed by an analysis of the text words contained in the title and abstract , and of the index terms used to describe the article . A second extensive search using all identified keywords and index terms was then undertaken . The third step consisted of a search of the reference lists of all identified reports and articles for additional studies . Selection criteria Types of studies : This review considered research papers that addressed the appropriateness and effectiveness of workload and staffing concepts in fostering a healthy work environment in healthcare . The types of papers to be considered included : meta‐ analysis , r and omised controlled trials , quasi‐r and omised controlled trials , cohort studies , case‐control studies , descriptive studies and correlational studies . Types of participants : The review considered all participants involved or affected by workload and staffing concepts within the nursing workforce in a healthcare environment , including staff and patients . System and policy issues were also considered . Types of interventions : All workload and staffing strategies that impact on the work environment , patient and nurse outcomes were considered in this review . Types of outcome measures : Outcomes of interest were categorised into four groups : nursing staff outcomes , patient outcomes , organisational outcomes and system outcomes . Data collection and analysis Following assessment of method ological quality , data were extracted using data extraction tools based on the work of the Cochrane Collaboration and the Centre for Review s and Dissemination . Statistical pooling was not possible and findings were presented in narrative form . Results Of the 2162 papers identified in the search , 171 were selected for full paper retrieval and assessed independently by two review ers for method ological quality . A total of 40 papers were included in the review : one systematic review ; one cohort study ; and 38 correlational descriptive studies . Results were summarised in narrative form . The evidence suggests strong correlations between patient characteristics and work environments ; and workload and staffing and the quality of outcomes for clients , nurses and the system/organisation . This gave rise to a number of recommendations for practice and for further research , such as : A greater proportion of regulated staffing ( i.e. registered nurses , enrolled nurses , practical or vocational nurses ) is associated with improved outcomes related to the Functional Independence Measure score , the Short Form Health Survey ( SF‐36 ) vitality score , patient satisfaction with nursing care , patient adverse events ( including atelectasis , decubitus ulcers , falls , pneumonia , postsurgical and treatment infection and urinary tract infections ) An increase in the number of registered nurse hours available is associated with improved patient outcomes in relation to falls , pneumonia , pressure ulcers , urinary tract infection , length of stay and postoperative infection A study was conducted in a Dutch hospital to evaluate the effects of the implementation of a Dutch form of Primary Nursing on nurses ' well-being in the work situation . The variables used as indicators of well-being at work were job satisfaction , experienced job significance , health complaints and absenteeism . The study included three measuring periods : one pre-intervention ( t1 ) and two post-intervention periods ( t2 , 8 months after t1 , and t3 , 14 months after t1 ) . Primary Nursing was implemented in group 1 ( consisting of two nursing units ) after t1 . At this time no changes were introduced into group 2 ( three nursing units ) but after t2 . Primary Nursing was also implemented in group 2 . The research variables were measured by means of question naires . The results of the study indicate that most of the expected effects of Primary Nursing did not occur . Some method ological and practical explanations for this outcome are given Abstract A  nursing job satisfaction question naire was design ed by a project group of nurses seeking a suitable job satisfaction measure to track as an outcome in a large Sydney hospital-wide models of nursing care project . Existing tools were rejected by the group as overly lengthy , US-biased and over-using respondent assessment of the character of the work environment as a proxy for job satisfaction , or happiness at work . A one-page , 14-item tool was developed after instrument review ing and facilitated groupwork . The tool reduces to three measurable domains : intrinsic , extrinsic and relational job satisfaction . Exploratory factor analysis ( n = 220 responses ) confirmed the validity of this ‘ three-way ’ conceptualisation of nursing job satisfaction . Internal consistency analysis on a larger sample of responses ( n = 459 ) yielded high Cronbach ’s Alpha values for all three domains and for the total overall , suggesting a stable and reliable measure . The NWSQ is short , one page , sensibly worded for Australian conditions and yields scoring against three vali date d domains . It holds significant potential utility as a st and ard metric for prospect i ve ward-based or institution-wide performance trending BACKGROUND As the European population ages , the dem and for nursing care increases . Yet , a shortage of nurses at the labour market exists or is predicted for most European countries . There are no adequate solutions for this shortage yet , and recruitment of future nurses is difficult . Therefore , retaining nurses for the profession is urgent . OBJECTIVE To determine factors associated with nurses ' intention to leave the profession across European countries . DESIGN A multi-country , multi-centre , cross-sectional analysis of survey data . SETTING 2025 surgical and medical units from 385 hospitals in ten European countries that participated in the RN4Cast study . Hospital selection was based on a stratified r and omised selection procedure . PARTICIPANTS All nurses from the participating medical and surgical hospital wards received a survey . 23,159 nurses ( 64 % ) returned the survey . METHODS The nurse survey included questions about intention to leave the profession , nurse characteristics , factors related to work environment , patient-to-nurse staffing ratio , burnout and perceived quality and safety of care . Multilevel regression analyses with ' intention to leave the profession ' as dependent variable were conducted for all 10 countries combined as well as per country . RESULTS Overall , 9 % of the nurses intended to leave their profession . This varied from 5 to 17 % between countries . Seven factors were associated with intention to leave the profession at European level : nurse-physician relationship ( OR 0.86 ; 95%CI 0.79 - 0.93 ) , leadership ( OR 0.78 ; 95 % CI 0.70 - 0.86 ) , participation in hospital affairs ( 0.68 ; 95%CI 0.61 - 0.76 ) , older age ( OR 1.13 ; 95%CI 1.07 - 1.20 ) , female gender ( OR 0.67 ; 95%CI 0.55 - 0.80 ) , working fulltime ( OR 0.76 ; 95%CI 0.66 - 0.86 ) and burnout ( OR 2.02 ; 95%CI 1.91 - 2.14 ) . The relevance of these factors differed for the individual countries . Nurse perceived staffing adequacy , patient-to-nurse staffing ratio , perceived quality and safety of care and hospital size were not associated with intention to leave at a European level . CONCLUSION Burnout is consistently associated with nurses ' intention to leave their profession across the 10 European countries . Elements of work environment are associated with intention to leave the nursing profession but differ between countries , indicating the importance of national context s in explaining and preventing nurses ' intention to leave their profession Abstract Agreement was reached with 12 acute medical and surgical wards/units at Sydney ’s Prince of Wales Hospital to participate in a trial of team nursing ( TN ) . Six units employed action research principles to undertake a change to a team nursing model and six remained with the pre-existing individual patient allocation ( IPA ) model . Task-based teaming was widely discarded by the team nursing units in favour of allocating patients within the team and introducing more supportive and communicative processes aim ed at fostering responsibility sharing . Localised team-based models of care arose in the change wards and were outlined , implemented and refined using social action research principles . A 12-month prospect i ve experimental comparison of job satisfaction and staff retention between the TN and IPA groups indicated statistically significant job satisfaction benefits and practically important staff retention benefits associated with moving away from an IPA model of nursing care delivery towards a team-based model of care delivery . Perhaps not surprisingly , job satisfaction gains were most marked among new graduate nurses , who reported real benefits from a teaming inspired shift in model of care in the acute inpatient environment 
    Output:
    
Some differences in job satisfaction were however observed within different subgroups of nurses .
There were no statistically significant differences in either stress or job tension .
Due to the limited number of quantitative studies identified for inclusion in this systematic review it is not possible to determine whether organizing nursing work in a team nursing or total patient care model is more effective in terms of staff wellbeing in acute care setting s. Neither a team nursing or total patient care model had a significant influence on nurses '  overall job satisfaction , stress levels or staff turnover .
This review demonstrates the need for further quantitative studies of these models of care that are well design ed with sufficient sample sizes to allow for attrition of participants , and that explore the impact each model has on  nurse 's wellbeing , in particular , studies that address burnout and absenteeism .