This document provides an overview of a research study that examines the relationship between nurse job satisfaction, nurse-patient ratios, and nurse fatigue. It includes an introduction that outlines the background, problem statement, purpose, significance and research questions. It also presents hypotheses and a brief literature review. The methodology chapter describes the research design, sample, instruments and data analysis plan. Results, discussion and conclusions chapters are also outlined. The document provides a framework to guide the proposed empirical study on the key factors relating to nurse fatigue.

1. JOB SATISFATION AND NURSE PATIENT RATIO
24
Table of Contents
Chapter 1: Introduction1
Background of the Problem1
Problem Statement1
Purpose of the Study1
Nature of the Study1
Significance of the Study1
Research Questions1
Hypotheses1
Brief Review of the Literature2
Conceptual Framework2
Assumptions, Limitations, and Delimitations2
Definition of Terms3
Conclusion3
Chapter 2: Literature Review4
Historical Development of the Topic4
Contemporary Perspectives4
Historical Development of the Theory4
Importance of the Study and Implication for Practice4
Directions for Future Research5
Summary5
Chapter 3: Research Method6
Research Design6
Appropriateness of Design6
Procedure6
The Role of the Researcher6
Research Questions6
Hypotheses6
Population and Sample6
Geographic or Virtual Location6
Instrumentation6

2. Data Collection6
Data Analysis7
Human Participants and Ethics Precautions7
Validity and Reliability7
Contribution to Social, Practice, or Organizational Change7
Summary7
Chapter 4: Results8
General Description of the Participants8
Research Questions8
Sample Size8
Pilot Tests8
Data Collection8
Unit of Analysis and Measurement8
Data Analysis8
Coding and Codebook Generation8
Qualitative Results8
Results of Hypothesis Tests9
Between Group Differences9
Outliers9
Validity and Reliability9
Summary9
Chapter 5: Discussion, Conclusions, and Recommendations10
Ethical Dimensions10
Limitations10
Overview of the Population and Sampling Method10
Data Collection and Analysis10
Summary of Findings10
Explanation of Findings10
Recommendations11
Reflecting Upon the Study11
Suggestions for Future Research11
Implications for Social, Practice, or Organizational Change11
Conclusions11
References12
Appendix A: Tables13
Appendix B: Figures15

3. Table of Tables
Table A1: This is an Example APA Table in Appendix A and
Uses the APA Table
Title Style14
Table of Figures
Figure B1. This is an example APA figure using the APA
Caption Style. Neo meets the Architect while seeking the
Source.16
JOB SATISFATION AND NURSE PATIENT RATIO
i
Chapter 1: Introduction
Fatigue in nurses have been a factor that has always come with
very many consequences in the medical world such as poor
decision making that has not only led to negligence in the
hospital but also inappropriate administration of prescribed
medicine leading to, at worst, death of patients. We are to see
how nurse’s fatigue relates to job satisfaction and nurse to
patient ratio.
Background of the Problem
Nurses who are dissatisfied in their jobs always lack mental
strength or the motivation for that matter to endure the ever-
demanding requirements that are accompanied by the nursing
career. This lack of interest of interest may make them work
without much care in their job which results to dissatisfaction
among patients (Chang, Chiu, Lin, & Lee,2009). Nurse to
patient ratio has been a major topic of focus among stakeholders
of healthcare institutions. An appropriate nurse to patient ratio
is required to see that healthcare facilities run smoothly as far
as taking care of both in-patient and out-patient clients in the
medical facilities is concerned.

4. Workers fatigue has been related to many job related problems
such as high stress levels and depression among employees.
Among nurses, there has been evidence to show that nurse to
patient ratio and dissatisfaction of the nurses in their jobs are
the major factors that have led to fatigue among the nurses
(Schwab, Meyer, Geffers & Gastmeier, 2012).
Healthcare institutions have always been faced by the burden of
operating in a cost effective manner and at the same time are
required give their best in terms of the quality of services they
offer. In an attempt to meet operating effectively in terms of
cost, they end up compromising on nurse to patient ratio that
may lead to them unearthing other unforeseen consequences.
Fatigue has been seen to compromise patient safety in terms of
improper communication between nurses and patients,
medication faults and poor and incorrect administration of
medicine and prescriptions (Shekelle, 2013).
Problem Statement
A lot of research has indicated that as nurse to patient ratio
spike. Also, there is an increase in nurses getting emotionally
tired and also getting more dissatisfied in their jobs which
eventually leads to fatigue. Pressure exerted on the
management of health care institutions to operate cost
effectively have seen them allocate many patients to be attended
to by one nurse as a means of cost reduction. This has in turn
lowered nurse outcomes and motivation in doing their jobs and
have also increased mortality rate among patients. Most
research on nurse to patient ratio and how it relates to fatigue
among employees have majorly focused on hospital setting
leaving out other institution such as nursing homes for both the
elderly and kids with disabilities. There is need to further
studies beyond hospitalized setting to other nursing institutions.
Purpose of the Study
The purpose of this study is to show the relationship that exists
between nurse to patient ratio and job satisfaction with fatigue
among nurses. Nurse-patient ratio and job satisfaction evidently
play key roles in fatigue among nurses. Most studies have

5. focused on nurses in hospital setting. These studies however
extend the scope to include nurses in nursing homes that care
for the elderly and children with various disabilities to see if
indeed there exist a relationship among these factors.
Significance of the Study
The importance of fatigue as a topic of study has been inspired
by the need for every citizen to receive only the best of services
from both the private and public sector on healthcare, a field
that has the most stakes on the well-being of peoples as far as
their health is concerned. Fatigue among nurses has a direct link
on how they relate with their patient and studies have shown
that with an increase of an additional patient to a nurse, there is
a significant increase in fatigue and job dissatisfaction
experienced by the nurse (Poghosyan, Clarke, Finlayson, &
Aiken,2010). With increase in the number of patients a single
nurse attends to, their ability to maintain a healthy relationship
with the patient diminishes (Spetz, Donaldson, Aydin, & Brown,
2008). Nurses who see themselves as having adequate number
of patients to handle have indicated lower levels of fatigue and
are generally satisfied with their jobs. Patient have felt
dissatisfied with services offered in health institutions where
nurses claimed to having been overwhelmed and that they were
experiencing fatigue. These patients felt reluctant to recommend
their family and friends to attend these hospitals that nurses
were dissatisfied with their work.
Shortage of nursed have plagued the country and fatigue of
nurses on the rise, retention of nurses at their work places is
also becoming a major problem that need to be dealt with by
creating conducive environment for these nurses to work in so
the they can feel satisfied in their jobs which will trickle down
to patients feel satisfied with these services they get at the
healthcare institutions. There is a projection that the shortage of
nurses might increase with an excess of one million by the year
2020 (Chang, Ma, Chiu, Lin & Lee, 2009).
Restructuring of hospitals and nursing institutions in the past
have on changes being made in the administration of these

6. institutions and allocation of doctors leaving out addition of
more nurses a matter they consider trivial but is of major
importance and may result into grave problems if not taken
seriously.
Intervention should be made to curb fatigue among nurses but
before we arrive at that it better we understand the root causes
of fatigue that will make it easy in dealing with the problem.
Research Questions
This dissertation will seek to answer a number of questions.
These questions form the make foundation of the research
paper. These research questions include but not limited to:
· Is there a relationship between job satisfaction and the level of
fatigue among nurses in their working area?
· Is there an association between nurse to patient ratio and level
of fatigue among nurses in their working area?
· What are the factors to be taken into consideration so as to
curb fatigue among nurses and the consequences it brings?
Numerous past research papers have indicated that as nurse to
patient ratio increase, nurses start to get emotionally exhausted
and also get more dissatisfied in their jobs which ultimately
leads to fatigue (Spetz, Donaldson, Aydin, & Brown, 2008).
Pressure exerted on the administrators of the health care
institutions to operate cost effectively have seen them have
nurses handle more than adequate number of patients as a means
of cost reduction. This has in turn lowered patient safety
outcomes and reduced motivation for nurses in doing their jobs
and have also increased mortality rate among patients (Shekelle,
2013).
Most research on nurse to patient ratio and how it relates to
fatigue among employees have majorly focused on hospital
setting leaving out other institution such as nursing homes for
both the elderly and kids with disabilities. There is need to
further studies beyond hospitalized setting to other nursing
institutions. This study attempts to examine all these factors so
as to adequately answer the stated research questions.
The study also tries to examine and answer questions to whether

7. there are other factors that may result to fatigue among nurses
and the best way to minimize these factors conclusively.
Nature of the Study
This study will be of descriptive research design. This approach
is suitable because of the need to describe the relationship
between nurse to patient ratio and job satisfaction with fatigue
in nurses. For purposes of this study, the independent variables
will be nurse to patient ratio and job satisfaction whereas the
dependent variable will be nurse fatigue. The study will analyse
these factors using descriptive evidence.
Linear regression model is used to demonstrate whether there is
a relationship between the response variable (nurse-fatigue) and
the deterministic variable (nurse-patient ratio and job
satisfaction). The study makes use of data collected by use of a
questionnaire. The group that is going to be the point of focus
are the nurses. The questionnaires are going to be given out to
nurses in hospitalized setup and nursing homes for the elderly
and children with various kinds of disability. Closed ended
questions of quantitative design will be the major point of focus
but a few open-ended questions of qualitative nature will be
added to shed more light into this inquiry. The questions will be
created in such a way that they simple but offer a depth of
information. Leading questions in the questionnaire will be
avoided so as to escape bias from the response given by the
target nurses.
The data collected from the questionnaire will measure the
level of job satisfaction among the nurse and the nurse to
patient ratios.
The sample will be obtained using convenience sampling where
the nurses that will be present at the identified homes and
hospitals will be issued with questionnaires using no order.
Convenience sampling is a method non- probabilistic sampling
where the respondents are selected due to the ease if their
accessibility and nearness to the researcher (Emerson, 2015).
The chi squared test of association is going to be the statistical
analysis to be used in this study to see if there is a relationship

8. that exist between. Chi square is a nonparametric statistic in
which cases are classified into a set of categories (Franke &
Christie2012). This analysis will enable all the variables in the
data be compares to see if a relationship exists between them
Hypotheses
This paper is based on the following hypotheses:
· H01: There is no relationship between job satisfaction and
fatigue in nurses
· H11: There is a relationship between job satisfaction and
fatigue in nurses
· H02: There is no relationship between nurse to patient ratio
and fatigue in nurses
· H12: There is a relationship between nurse to patient ratio and
fatigue in nurses
Brief Review of the Literature
The reason for this study is to determine the relationship
between nurse to patient ratios and job satisfaction with nurse-
fatigue. It has been made clear that these two factors play a role
in fatigue in hospital setups, although whether they have an
effect on other institutions such as nursing homes for the
elderly and children with disabilities is a topic yet to be
advanced. The review of literature will help appreciate the work
already done in this area and also give insights on how go about
the study as well as expanding our knowledge on this field
generally.
Context of the problem Comment by Author: This subsection
had no citations in the literature…and it should be aligned left
(the heading that is)
The survey attempts to determine the relationship between the
three variables under study: patient to nurse ratio, job
satisfaction and nurse-fatigue. A lot of research have indicated
that as patient to nurse ratio rise, nurses tend to get emotionally
tired and more dissatisfied in their jobs which eventually leads
to fatigue. Pressure exerted on the management of health care
institutions to operate cost effectively have seen them have
many patients assigned to one nurse as a means of cutting on

9. cost and expenditures. This has in turn lowered nurse outcomes
and motivation in doing their jobs and have also increased
mortality rate among patients.
Most research on nurse to patient ratio and how it relates to
fatigue among employees have majorly focused on hospital
setting leaving out other institution such as nursing homes for
both the elderly and kids with disabilities hence the need to
further studies beyond hospitalized setting to other nursing
institutions.
Contribution of the study to literature Comment by Author:
Please use proper headings…
Not one citation in this subsection
This study addresses fatigue among nurses in their places of
work and the factors that lead to this fatigue while not limiting
itself solely on hospital setups but broadening the scope outside
hospitals to even focus on nursing homes. The issue of nurse
fatigue is prevalent in the nursing profession and should not be
ignored or taken lightly for that matter by stakeholders in
healthcare.
Although there has been a growing body of evidence which
suggests that high patient to nurse ratios are related to
unpleasant patient and nurse outcomes, rising mortality among
patients, increased stress levels among nurses and
dissatisfaction in their jobs, health institutions are still reluctant
to embrace these truths due to the financial cost that they come
with (Patterson, 2011).
Contribution to the context of the problem Comment by
Author: Please use the proper caps for this heading…this
section is better
Fatigue in nurses as a topic of study has been motivated by the
basic need for every person to receive only the best of services
from both the private and public sector on healthcare, a field
that has the most stakes on the well-being of peoples as far as
their health is concerned. Fatigue among nurses has a direct
link on how they relate with their patient and studies have
shown that with an increase in-patient per nurse ratio, there is a

10. significant increase in fatigue and job dissatisfaction
experienced by the nurses. This in turn reduces their ability to
maintain a healthy relationship with the patient (Poghosyan,
Clarke, Finlayson, & Aiken,2010).
Nurses who see themselves as having the right number of
patients to care for have indicated lower levels of fatigue and
are generally satisfied with their jobs (Spetz, Donaldson, Aydin,
& Brown, 2008). Equally, patient have shown signs of
dissatisfaction with services offered in health institutions where
nurses registered to having been overwhelmed and that they
were fatigued. These patients felt reluctant to recommend their
family and friends to attend these hospitals that nurses were
dissatisfied with their work.
Shortage of nurses has been a major issue of concern. To add to
that, fatigue as also seen to it that retention of nurses at their
work places to be a major problem that needs to be dealt with.
There should be conducive environment for these nurses to
work in so the they can feel satisfied in their jobs which will
trickle down to patients feel satisfied with these services they
get at the healthcare institutions. There is a projection that the
shortage of nurses might increase with an excess of one million
by the year 2020 (AACN,2011). This calls for more studies in
this area so as to avert the problem before it gets worse.
Similar and related studies Comment by Author: Again,
please use proper headings
Nurse to patient ratios, job satisfaction and fatigue among
nurses at work has been a subject for discussion for many
scholars and researchers. This section reviews some of these
studies and indicating their contribution to the knowledge of the
subject.
According to (Teeter, 2014), by use of convenience sampling
and correlation studies, he established that the increase in
patients per nurse ratios and job satisfaction are the principal
causes of nurse burnout. He portrayed that some measure of job
satisfaction subscales were better predictors of job satisfaction
in general and that there is a positive correlation between

11. patient to nurse ratio and job satisfaction.
In an attempt to establish relationship between patient to nurse
ratios and safety outcomes for patients (RinaldiFuller, 2008), he
determined that nursing care have critical impact on patient
safety and suggested that hospital to staff their hospitals with a
lower patient to nurse ratio as an attempt to improve safety
outcomes in patients. In his study, RinaldiFuller equates a
richer staffing mix and lower patient to nurse ratio with quality
of care in hospitals and that understaffing does indeed affect
negatively the quality of health care patients get.
According to (Patterson, 2011), high patient to nurse ratio cause
negative outcomes for both patients and staff and that there is a
strong correlation between patient morality and low staffing
levels. His findings suggested that patients in the wards with
worst staffing ratios had a 31% bigger mortality risk. He also
demonstrated that nurses who were in institution with bad
staffing ratios experienced the most job dissatisfaction. Those
with the highest number of patients were likely to suffer from
job related burnout and more likely to be dissatisfied with their
jobs.
Maben J et al (2007) in his study showed that nurses joined
their careers with strong ideals but just after about two years
they felt disillusioned and that what they believed in and the
standards they held so dearly they felt difficult to preserve. Due
to burnout, many nurses felt the need to exchange jobs or worst
still, even decide to leave the nursing profession entirely. With
better staffing ratios, he said would lower job dissatisfaction
and burnout among nurses.
Gap in the literature Comment by Author: Not one citation in
the literature
In the review of most literature it has been established that most
studies have focused on nurses in hospital settings leaving a
whole lot of gap in institutions in setups outside hospitals. This
study however extends the scope to include nurses in nursing
homes that care for the elderly and children with various
disabilities to see if indeed there exist a relationship among

12. these factors which will in turn increase and create a wealth of
knowledge in this subject matter.
It is evident from the literature review that several studies have
been undertaken to investigate the relationship that exist in job
satisfaction, patient to nurse ratio and fatigue among nursed.
Most of the studies have shown a strong association between
these variables whereas some studies failed to find significant
evidence to show the relationships. The difference in finding
can be attributed to the differences in the methodologies used
by different researchers.
Conceptual Framework
Text goes here.
Framework
Text goes here. Illustration appears in the correct appendix.
Assumptions, Limitations, and Delimitations
Text goes here.
Assumptions
Text goes here.
Limitations
Text goes here.
Delimitations
Text goes here.
Definition of Terms
Jargon. The meaning goes here.
Conclusion
This chapter included an outline of this study, background of
the problem, and research questions. An in-depth review of the
literature follows in Chapter 2, which will expound upon the
development and significance of the study and its literature.
Chapter 3 includes a discussion on the methodology of the data
collection. In Chapter 4, the results and analysis of the study
will be presented. Finally, Chapter 5 consists of commenting
on the study combined with suggestions for future studies
stemming from this research effort.

13. Chapter 2: Literature Review
Introduce the literature review.
Historical Development of the Topic
Introduce the historical development of the topic. Be sure to
use level 2 headings as needed.
Summary
Text goes here.
Contemporary Perspectives
Introduce the contemporary perspectives relevant to the study.
Be sure to use level 2 headings as needed.
Summary
Text goes here.
Historical Development of the Theory
Introduce the historical development of the theory. Be sure to
use level 2 headings as needed.
Summary
Text goes here.
Importance of the Study and Implication for Practice
Text goes here.
Contribution to the Literature
Text goes here.
Contribution to the Practice
Text goes here.
Directions for Future Research
Text goes here.
Summary
Text goes here.
Chapter 3: Research Method
Text goes here.
Research Design
Text goes here.
Appropriateness of Design
Text goes here.
Procedure
Text goes here.

14. The Role of the Researcher
Text goes here.
Research Questions
Text goes here.
Hypotheses
Text goes here.
Population and Sample
Text goes here.
Geographic or Virtual Location
Text goes here.
Instrumentation
Text goes here.
Data Collection
Text goes here.
Data Analysis
Text goes here.
Human Participants and Ethics Precautions
Text goes here.
Validity and Reliability
Text goes here.
Contribution to Social, Practice, or Organizational Change
Text goes here.
Summary
Text goes here.
Chapter 4: Results
Text goes here.
General Description of the Participants
Text goes here.
Research Questions
Text goes here.
Sample Size
Text goes here.
Pilot Tests
Text goes here.

15. Data Collection
Text goes here.
Unit of Analysis and Measurement
Text goes here.
Data Analysis
Text goes here.
Coding and Codebook Generation
Text goes here.
Qualitative Results
Text goes here.
Themes Confirming the Literature
Text goes here.
Novel Themes Emerging from the Study
Text goes here.
Results of Hypothesis Tests
Text goes here.
First Hypothesis Test
Text goes here.
Second Hypothesis Test
Text goes here.
Between Group Differences
Text goes here.
Outliers
Text goes here.
Validity and Reliability
Text goes here.
Summary
Text goes here.
Chapter 5: Discussion, Conclusions, and Recommendations
Text goes here.
Ethical Dimensions
Text goes here.
Limitations

16. Text goes here.
Overview of the Population and Sampling Method
Text goes here.
Data Collection and Analysis
Text goes here.
Summary of Findings
Text goes here.
Explanation of Findings
Text goes here.
Research Question 1
Text goes here.
Research Question 2
Text goes here.
Findings of the Hypothesis Tests
Findings of the first hypothesis. Text goes here.
Findings of the second hypothesis. Text goes here.
Open-Ended Questions
Text goes here
Open-ended Question 1. Text goes here.
Open-ended Question 2. Text goes here.
Potential Errors
Text goes here.
Summary
Text goes here.
Recommendations
Text goes here.
Reflecting Upon the Study
Text goes here.
Suggestions for Future Research
Text goes here.
Implications for Social, Practice, or Organizational Change
Text goes here.
Conclusions
Text goes here.
References

17. Chang, W. Y., Ma, J. C., Chiu, H. T., Lin, K. C., & Lee, P. H.
(2009). Job satisfaction and perceptions of quality of patient
care, collaboration and teamwork in acute care
hospitals. Journal of advanced nursing, 65(9), 1946-1955.
Emerson, R. W. (2015). Convenience sampling, random
sampling, and snowball sampling: How does sampling affect the
validity of research?. Journal of Visual Impairment & Blindness
(Online), 109(2), 164.
Franke, T. M., Ho, T., & Christie, C. A. (2012). The chi-square
test: Often used and more often misinterpreted. American
Journal of Evaluation, 33(3), 448-458.
Poghosyan, L., Clarke, S. P., Finlayson, M., & Aiken, L. H.
(2010). Nurse burnout and quality of care: Cross‐national
investigation in six countries. Research in nursing &
health, 33(4), 288-298.
Schwab, F., Meyer, E., Geffers, C., & Gastmeier, P. (2012).
Understaffing, overcrowding, inappropriate nurse: ventilated
patient ratio and nosocomial infections: which parameter is the
best reflection of deficits?. Journal of Hospital Infection, 80(2),
133-139.
Shekelle, P. G. (2013). Nurse–Patient Ratios as a Patient Safety
StrategyA Systematic Review. Annals of Internal
Medicine, 158(5_Part_2), 404-409.
Spetz, J., Donaldson, N., Aydin, C., & Brown, D. S. (2008).
How many nurses per patient? Measurements of nurse staffing
in health services research. Health Services
Review. Annals of Internal Research, 43(5p1), 1674-1692.
Appendix A: Tables
Table A1
This is an Example APA Table in Appendix A and Uses the
APA Table Title Style
Category
Very Important

18. Heading 1
Heading 2
First category
4.0
16
Second category
3
43.6
Third category
88
67.9*
Notes. The values denoted by an asterisk (*) are important
because they have a particular quality.
Appendix B: Figures
Figure B1. This is an example APA figure using the APA
Caption Style. Neo meets the Architect while seeking the
Source. Notice the caption is not emphasized!