LAUSR

The reviewed paper details findings from a study using the Practice Environment Scale of the Nursing Work Index (PES-NWI) to measure care quality. A snapshot of nurses’ perceptions of their environment and comparison with known profiles from Magnet and other US hospitals were offered. The PES-NWI was used in the RN4CAST studies (Zander et al., 2016), therefore comparison with European data would have provided an informative context. Yet this study makes the case to attract attention to challenges that nursing faces in Greece and a baseline to enable tracking over time and interventions. The study found dissatisfaction with the extent to which nurses participated in policy decisions and governance and their career advancement; the lack of focus on care quality and nurses’ contribution to it; and leadership and staffing levels. Only collegial nurse–physician relationships were perceived to be of just an acceptable level. The levels of dissatisfaction were higher than their comparators. Nursing shortages threaten almost all European countries. Nurse vacancy rates in England are between 10% and 16% and there are 36,000 vacancies (Health Education England, 2017). In Greece, 1 in 3 full-time nursing positions are reported as vacant in state hospitals, and ratios of 1 nurse to 40 patients (Kolasa-Sikiaridi, 2017) (previously 1 to 9 or 10; Zander et al., 2016) show a decline due to prolonged austerity. Funding of public hospitals has been cut by more than 50% since 2009, and there has been an exodus of clinical staff and an increase in the use of public hospitals by the public (Karamanoli, 2015). According to the Organisation for Economic Co-operation and Development (2018) (latest data period 2013–2016), there were 3.2 nurses per 1000 inhabitants in Greece and 7.9 nurses per 1000 in the UK. The study confirmed staffing shortages and gave insight into implications: lack of opportunity to spend time with patients, to discuss patient care problems with other nurses, to provide quality patient care and to get the work done. Indeed, the concept of ‘missed care’ as a result of low staffing and its catastrophic impact on patient outcomes has