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There are however, relatively few studies that have examined the effects of the ratio of unlicensed staff compared to studies which have examined the effect of staffing levels and the ratio of registered nurses, and the results of these are inconclusive [ 2, 48- 51].
The purpose of the present study is twofold: 1) to assess the effect of ward leaders task- and relationship-oriented leadership styles on quality of care in nursing homes and 2) to assess the effect of staffing levels, ratio of registered nurses and ratio of unlicensed staff on quality of care in nursing homes.
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We then investigated a threshold effect of staffing level on the risk for late-onset VAP.
At last, it should be emphasized that the results concerning the effects of staffing levels and ratio of registered nurses on quality of care is ambiguous.
While numerous of studies have investigated the effects of staffing levels and staffing ratios on quality of care in nursing homes [ 1- 3], the number of studies investigating the effects of different ways of organizing care staff within a nursing home ward is relatively limited, both internationally [ 4, 5] and in Norway [ 6].
The report quotes the Royal Philharmonic Orchestra, which said cuts to culture budgets were having an adverse effect on staffing levels at regional venues with some "suffering a lack of expertise and knowledge of orchestral music".
Take, for example, the effect on staffing levels resulting from Japan's longstanding aversion to firing.
The lack of any significant positive effect for staffing levels or ratio of registered nurses on the quality of care indexes stands in contrast to most prior studies [ 10, 11].
Emergency departments have closed because of staffing levels.
Two of the studies found no significant relationship [ 33, 54], while one of the studies found a significant positive effect of increased staffing levels on quality of care [ 32].
The curve might flatten out, meaning that the positive effect of increased staffing levels and increased ratio of registered nurses on quality of care decreases above a certain level [ 13, 75].
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