Nasra Hussain O AlSomali
Background: Ensuring high-quality nursing care requires effective workforce management, particularly in acute care environments where nurses provide continuous monitoring and manage patients with complex healthcare needs. Staffing conditions and workload demands may influence nurses’ ability to deliver safe, efficient, and patient-centered care. However, limited evidence is available regarding the combined influence of nursing staff-to-patient ratios and perceived workload on nursing care quality in tertiary healthcare settings in Saudi Arabia. Aim: This study aimed to investigate the relationship between nursing staff-to-patient ratios, perceived workload, and quality of nursing care among acute care nurses in a tertiary healthcare hospital in Saudi Arabia. Methods: A quantitative cross-sectional study was conducted among 512 registered nurses at King Fahad Medical City, Riyadh, Saudi Arabia. Participants were recruited through proportionate stratified random sampling from different acute care units. Data were collected using structured questionnaires assessing nurse staffing ratio, perceived workload, and quality of nursing care. Statistical analysis was performed using IBM SPSS Statistics version 29.0. Descriptive statistics, Pearson’s correlation analysis, and multiple linear regression analysis were applied, with statistical significance established at p < 0.05. Results: The majority of participants were female (78.7%), aged 26–50 years (74.6%), and held a bachelor’s degree in nursing (92.6%). Participants reported moderate levels of nursing staff-to-patient ratio (M = 2.95, SD = 1.160), perceived workload (M = 2.91, SD = 1.074), and quality of nursing care (M = 2.90, SD = 1.112). Multiple linear regression analysis showed that nursing staff-to-patient ratio and perceived workload significantly predicted quality of nursing care, explaining 42.0% of the variance in care quality (R² = 0.420; Adjusted R² = 0.418; F(2,509) = 183.91, p < 0.001). Perceived workload demonstrated the strongest predictive effect (β = 0.547, p < 0.001), followed by nursing staff-to-patient ratio (β = 0.338, p < 0.001). Conclusion: The findings demonstrate that workforce-related factors, particularly workload demands and staffing conditions, play an important role in influencing nursing care quality. While maintaining appropriate staffing levels is essential, healthcare organizations should also implement strategies to monitor workload distribution, strengthen managerial support, and optimize nursing resources. These approaches may contribute to improved patient safety, enhanced care outcomes, and sustainable nursing workforce development.