Hospital nurses' perceptions of respect and organizational justice

OBJECTIVE: To test an exploratory model of the antecedents and consequences of nurses' perceptions of respect in hospitals. BACKGROUND: Although nurses in hospital settings often state that they do not receive the respect they deserve for their contribution to patient care, there is little empirical research on this phenomenon. Interactional organizational justice theory framed the analysis. METHODS: A random sample of 285 staff nurses from Ontario teaching hospitals completed measures of interactional justice, structural empowerment, perceived respect, work pressures, emotional exhaustion, and work effectiveness. RESULTS: More than half of the nurses felt that managers did not show concern or deal with them in a sensitive and truthful manner regarding decisions affecting their jobs. The strongest predictors of perceptions of respect were interactional organizational justice, followed by structural empowerment and job stress resulting from lack of recognition, poor interpersonal relationships and heavy workload. Consequences of nurses' feelings of respect included greater job satisfaction, trust in management, and lower emotional exhaustion, as well as higher nurse ratings of quality of care and perceived staffing adequacy. CONCLUSIONS: A positive organizational environment increases nurses' perceptions of respect, resulting in positive outcomes for both the nurse and the organization.     

Nurses' work environment and nursing outcomes: a survey study among Finnish university hospital registered nurses

The aim was to assess the interrelationships between nurses' work environment and nursing outcomes. A cross-sectional survey of 664 registered nurses (RN) on 34 acute care inpatient hospital wards was used to measure nurses' perceptions. Patient data (n = 4045) consisting of a total patient satisfaction indicator were collected simultaneously with the nurse data during year 2005. RN's assessments of staffing adequacy, respect and relationships were the most important factors of work environment having an influence on job-related stress, job satisfaction, patient satisfaction and adverse events to patients and nurses. Some 77% of the RN reported adverse nurse events and 96% reported adverse patient events during a 3 month retrospective period. Ensuring sufficient and suitably qualified nurses' availability in delivering nursing care is an important management issue. Nurses are concerned about the quality of care, and the concerns perceived by nurses can influence their clinical work.     

Hospital nurses' work environment, quality of care provided and career plans

HINNO S., PARTANEN P. & VEHVILÄINEN‐JULKUNEN K. (2011) Hospital nurses' work environment, quality of care provided and career plans. International Nursing Review 58 , 255–262 Background: In several European countries, the availability of qualified nurses is insufficient to meet current healthcare requirements. Nurses are highly dissatisfied with the rising demands of the healthcare environment and increasingly considering leaving their jobs. Aim: The study aims to investigate the relationships between the characteristics of hospital nurses' work environment and the quality of care provided, and furthermore to examine Dutch nurses' career plans. Methods: A cross‐sectional, questionnaire survey of registered nurses (n = 334) working in the academic and district hospitals was conducted in 2005/2006. Previously validated questionnaires translated into the participants' language were used. Factor and regression analysis were used for data analysis. Results: Overall, nurses rated their work environment rather favourably. Five work environment characteristics were identified: support for professional development, adequate staffing, nursing competence, supportive management and teamwork. Significant relationships were found between nurses' perceptions of their work environment characteristics and quality of care provided and nurses' career plans. When work environment characteristics were evaluated to be better, nurse‐assessed quality of care also increased and intentions to leave current job decreased linearly. Conclusions: Study findings suggest that nurses' perceptions of their work environment are important for nurse outcomes in hospital settings. Further research is needed to explore the predictive ability of the work environment for nurse, patient and organizational outcomes in hospitals.     

Return to work among sickness-absent Danish employees: prospective results from the Danish Work Environment Cohort Study/National Register on Social Transfer Payments

This study investigates the determinants within socio-demography, health behaviour, employer characteristics, and psychosocial and physical work environment for return to work. In 2000, a total of 5357 employees were interviewed regarding age, gender, family status, education, health behaviour, employer characteristics and work environment. They were followed in a national register for 18 months in order to identify subjects with 2 weeks or more of sickness absence. They were followed for an additional 12 months in order to establish associations between baseline measurements and time to first return to work. A total of 930 (17.4%) employees experienced sickness absence in the 18 months after baseline. During the 12-month follow-up, 856 (92.0%) returned to work, the mean absence period being 6.6 weeks. Prolonged time to first return to work was associated with female gender, increased age, no post-school education, being employed by a public employer, working at a workplace with 20 or more employees, high emotional demands in work, high job insecurity and sedentary work. There were no associations between health behaviour variables and return to work. The study indicates a potential for promoting return to work through interventions targeting emotional job demands, job insecurity and decreasing the risks associated with sedentary work.     

Nursing unit teams matter: Impact of unit-level nurse practice environment,nurse work characteristics,and burnout on nurse reported job outcomes,and quality of care,and patient adverse events—A cross-sectional survey

Aim

To investigate the impact of nurse practice environment factors, nurse work characteristics, and burnout on nurse reported job outcomes, quality of care, and patient adverse events variables at the nursing unit level.

Background

Nurse practice environment studies show growing insights and knowledge about determining factors for nurse workforce stability, quality of care, and patient safety. Until now, international studies have primarily focused on variability at the hospital level; however, insights at the nursing unit level can reveal key factors in the nurse practice environment.

Design

A cross-sectional design with a survey.

Method

In a cross-sectional survey, a sample of 1108 nurses assigned to 96 nursing units completed a structured questionnaire composed of various validated instruments measuring nurse practice environment factors, nurse work characteristics, burnout, nurse reported job outcomes, quality of care, and patient adverse events. Associations between the variables were examined using multilevel modelling techniques.

Results

Various unit-level associations (simple models) were identified between nurse practice environment factors, nurse work characteristics, burnout dimensions, and nurse reported outcome variables. Multiple multilevel models showed various independent variables such as nursing management at the unit level, social capital, emotional exhaustion, and depersonalization as important predictors of nurse reported outcome variables such job satisfaction, turnover intentions, quality of care (at the unit, the last shift, and in the hospital within the last year), patient and family complaints, patient and family verbal abuse, patient falls, nosocomial infections, and medications errors.

Conclusion

Results suggested a stable nurse work force, with the capability to achieve superior quality and patient safety outcomes, is associated with unit-level favourable perceptions of nurse work environment factors, workload, decision latitude, and social capital, as well low levels of burnout. Nurses, physicians, nursing leaders, and executives share responsibility to create an environment supportive of interdisciplinary team development.     

Front-line management, staffing and nurse-doctor relationships as predictors of nurse and patient outcomes. a survey of Icelandic hospital nurses

Objective

To investigate aspects of nurses’ work environments linked with job outcomes and assessments of quality of care in an Icelandic hospital.

Background

Prior research suggests that poor working environments in hospitals significantly hinder retention of nurses and high quality patient care. On the other hand, hospitals with high retention rates (such as Magnet hospitals) show supportive management, professional autonomy, good inter-professional relations and nurse job satisfaction, reduced nurse burnout and improved quality of patient care.

Methods

Cross-sectional survey of 695 nurses at Landspitali University Hospital, Reykjavík. Nurses’ work environments were measured using the nursing work index—revised (NWI—R) and examined as predictors of job satisfaction, the Maslach burnout inventory (MBI) and nurse-assessed quality of patient care using linear and logistic regression approaches.

Results

An Icelandic adaptation of the NWI—R showed a five-factor structure similar to that of Lake (2002). After controlling for nurses’ personal characteristics, job satisfaction, emotional exhaustion and nurse rated quality of care were found to be independently associated with perceptions of support from unit-level managers, staffing adequacy, and nurse-doctor relations.

Conclusions

The NWI—R measures elements of hospital nurses’ work environments that predict job outcomes and nurses’ ratings of the quality of patient care in Iceland. Efforts to improve and maintain nurses’ relations with nurse managers and doctors, as well as their perceptions of staffing adequacy, will likely improve nurse job satisfaction and employee retention, and may improve the quality of patient care.     

Career success perception and work‐related behaviour of employees in geriatric care – a pilot study in a German geriatric care facility

Scand J Caring Sci; 2011; 25; 45–52
Career success perception and work‐related behaviour of employees in geriatric care – a pilot study in a German geriatric care facility Introduction: One of the job characteristics of geriatric care is the long‐term relationship of the employees to the elderly people they are interacting with. However, these relationships are characterised by the fact that despite of the care provided by the employees, the patients experience physical suffering during the relationship, which often ends with their deaths. Although that is to be expected in this profession, it can be interpreted as personal failure and may be a reason why employees in geriatric care feel exhausted and perceive strain and stress in the job. Aim: The objective of this study was to explore the influence of career success perceptions on geriatric care staffs’ coping and work‐related behaviour. Method: Data were collected in 2008 in a German geriatric care facility using the standardised psychometric questionnaire ‘AVEM’ (Occupational Stress and Coping Inventory) as well as a previously developed ranking of career success dimensions in geriatric care. The 69 employees, who participated were of various age groups, had different work experience and were working in distinct areas of expertise. Results: The results show that men experience higher success at work and have more career ambitions than women. Differences in age with regard to success perception at work could not be identified. However, there is an influence of the intensity of contact between patient and employees on the perception of career success. Also, a correlation between the career success dimension happiness in the job and work experience could be verified. Conclusion: The current results show no impact of subjective career success dimensions on work‐related coping behaviour. At the same time, the results point to differences in the relevance of subjective career success dimensions regarding the demographics of employees in geriatric care. Thus, demographics may be considered as health resources and can have positive health impacts for employees in caring‐professions.     

Healthcare restructuring: the impact of job change

Restructuring, particularly redeployment and job change, had a dramatic impact on the working conditions and practices of nursing personnel. This study was conducted to determine whether nurses (RNs and RPNs) who experienced job change perceived their work-lives differently than those who did not undergo job change and, whether nurses who experienced different types of job change (new role, new unit, or new hospital) varied in their perceptions. A questionnaire exploring themes relevant to redeployment was administered to all nurses (N = 3,408) in two large teaching hospitals that had undergone restructuring. The response rate was 50.7% (n = 1,728). Of the responses, 1,662 were used in the analysis. T-tests and ANOVAs were used to compare groups of nurses. Nurses who changed their jobs perceived their commitment to the organization, their work environment and quality of care differently than those who did not change jobs. Nurses with different types of job change differed in their organizational commitment, perceptions of work-related injuries, attitudes towards job change, need for orientation and new knowledge, and feelings about the health care team. Results will assist managers to address the specific needs of nurses with different experiences of job change in the restructured workplace.     

Burnout in psychiatric nursing

Burnout is a syndrome characterized by progressive physical and emotional exhaustion involving the development of negative job attitudes and perceptions and a loss of empathic concern for patients. It is caused by chronic emotional stress resulting from prolonged intensive involvement with people. If unchecked, burnout will lead to a deterioration in the quality and quantity of nursing care received by patients. This study examines staff burnout among 31 registered psychiatric nurses working in a variety of clinical areas in the hospital setting. The Staff Burnout Scale for Health Professionals (SBS-HP) was used to determine the relationship of SBS-HP scores to respondents age, sex, and area of work. A comparison is made between this study and current research.     

Physicians' assessments of their ability to provide high-quality care in a changing health care system

BACKGROUND: With the growth of managed care, there are increasing concerns but inconclusive evidence regarding deterioration in the quality of medical care. OBJECTIVES: To assess physicians' perceptions of their ability to provide high-quality care and explore what factors, including managed care, affect these perceptions. RESEARCH DESIGN: Bivariate and multivariate analyses of the Community Tracking Study Physician Survey, a cross-sectional, nationally representative telephone survey of 12,385 patient-care physicians conducted in 1996/1997. The response rate was 65%. PARTICIPANTS: Physicians who provide direct patient care for > or =20 h/wk, excluding federal employees and those in selected specialties. MEASURES: Level of agreement with 4 statements: 1 regarding overall ability to provide high-quality care and 3 regarding aspects of care delivery associated with quality. RESULTS: Between 21% and 31% of physicians disagreed with the quality statements. Specialists were generally 50% more likely than primary care physicians to express concerns about their ability to provide quality care. Generally, the number of managed care contracts, but not the percent of practice revenue from managed care, was negatively associated with perceived quality. Market-level managed care penetration independently affected physicians' perceptions. Practice setting affected perceptions of quality, with physicians in group settings less likely to express concerns than physicians in solo and 2-physician practices. Specific financial incentives and care management tools had limited positive or negative associations with perceived quality. CONCLUSIONS: Managed care involvement is only modestly associated with reduced perceptions of quality among physicians, with some specific tools enhancing perceived quality. Physicians may be able to moderate some negative effects of managed care by altering their practice arrangements.     

Medical emergency teams: a strategy for improving patient care and nursing work environments

AIM: This paper reports a study of nurses' perceptions about medical emergency teams and their impact on patient care and the nursing work environment. BACKGROUND: In many acute care hospitals, nurses can summon emergency help by calling a medical emergency team, which is a team of expert critical care professionals adept at handling patient crisis scenarios. Critical care nurses form the core of such teams. In addition, of all the healthcare professionals, nurses are the ones who most often need and call for medical emergency team assistance. METHODS: A simple anonymous questionnaire distributed amongst 300 staff nurses at two sites of an acute care teaching hospital in the United States of America in mid-January of 2005. RESULTS: A total of 248 nurses responded to the survey (response rate = 82.7%). Ninety-three per cent of the nurses reported that medical emergency teams improved patient care and 84% felt that they improved the nursing work environment. Veteran nurses (with at least 10 years of experience) and new nurses (<1 year's experience) were more likely to perceive an improvement in patient care than other nurses (P = 0.025). Nurses who had called a medical emergency team on more than one occasion were more likely to value their ability to call a team (P = 0.002). Nearly sixty-five per cent of respondents said they would consider institutional medical emergency team response as a factor when seeking a new job in the future. Only 7% suggested a change in the team response process, and 4% suggested a change in activation criteria. CONCLUSIONS: Most nurses surveyed had a favourable opinion of the medical emergency team. Our findings suggest that other institutions should consider implementing a medical emergency team programme as a strategy to improve patient care and nurse working environment.     

Hospital nurse practice environment, burnout, job outcomes and quality of care: test of a structural equation model

Title. Hospital nurse practice environment, burnout, job outcomes and quality of care: test of a structural equation model. Aim. The aim of the study was to investigate relationships between nurse practice environment, burnout, job outcomes and nurse‐assessed quality of care. Background. A growing line of work confirms that, in countries with distinctly different healthcare systems, nurses report similar shortcomings in their work environments and the quality of care in hospitals. Neither the specific work environment factors most involved in dissatisfaction, burnout and other negative job outcomes, and patient outcomes, nor the mechanisms tying nurse job outcomes to quality of care are well understood. Method. A Nurse Practice Environment and Outcome causal structure involving pathways between practice environment dimensions and outcome variables with components of burnout in a mediating position was developed. Survey data from 401 staff nurses across 31 units in two hospitals (including the Revised Nursing Work Index, the Maslach Burnout Inventory, and job outcome and nurse‐assessed quality of care variables) were used to test this model using structural equation modelling techniques. The data were collected from December 2006 to January 2007. Results. Goodness of fit statistics confirmed an improved model with burnout dimensions in mediating positions between nurse practice environment dimensions and both job outcomes and nurse‐assessed quality of care, explaining 20% and 46% of variation in these two indicators, respectively. Conclusion. These findings suggest that hospital organizational properties, including nurse–physician relations, are related to quality of care assessments, and to the outcomes of job satisfaction and turnover intentions, with burnout dimensions appearing to play mediating roles. Additionally, a direct relationship between assessments of care quality and management at the unit level was observed.     

The influence of work characteristics,emotional display rules and affectivity on burnout and job satisfaction: A survey among geriatric care workers

BackgroundPrevious studies have demonstrated that geriatric care employees are exposed to a large number of factors that can affect their levels of job satisfaction and occupational stress. Although working with elderly people is emotionally demanding, little research has been done on the role played by perceptions of emotional display rules, alongside more traditional work characteristics and individual factors, in the prediction of geriatric care employees’ wellbeing.ObjectivesThe aim of the present study was to examine the role played by work characteristics (job demands, job control, emotional display rules) and individual (affectivity) factors to predict job satisfaction and burnout among French geriatric care nurses.Method and participantsQuestionnaires were sent to 891 employees working in 32 geriatric care centers in France. A total of 371 valid questionnaires (response rate: 41.60%) were analyzed using structural equation modeling techniques.ResultsResults revealed two main processes of burnout and job satisfaction among women geriatric care workers, namely a salutogenic process and a pathogenic process. As expected, negative affectivity, low job status, perceived negative display rules and job demands are involved in the pathogenic process; while positive affectivity, perceived positive display rules and job control are implied in the salutogenic one. More specifically, as expected, negative affectivity is a positive predictor of burnout, both directly and indirectly through its impact on perceived negative display rules and job demands. Moreover, negative affectivity was negatively related to job satisfaction. Simultaneously, positive affectivity can predict job satisfaction, both directly and indirectly through its impact on perceived positive display rules and job control. Positive affectivity is also a negative predictor of burnout.ConclusionsPractical implications are discussed to support intervention programs that develop healthy workplaces, and also to inform nurses about how to manage emotional display rules in retirement homes.     

Workplace empowerment and magnet hospital characteristics: making the link

OBJECTIVE: To test a theoretical model linking nurses' perceptions of workplace empowerment, magnet hospital characteristics, and job satisfaction in 3 independent studies of nurses in different work settings. BACKGROUND: Strategies proposed in Kanter's structural empowerment theory have the potential to result in work environments that are described in terms of magnet hospital characteristics. Identifying factors that contribute to work conditions that attract and retain highly qualified committed nurses, such as those found in magnet hospitals, that can be put in place by nursing administrators is extremely important for work redesign to promote professional nursing practice. METHODS: Secondary analyses of data from 3 studies were conducted--2 of staff nurses and 1 with acute care nurse practitioners working in Ontario, Canada. The Conditions of Work Effectiveness Questionnaire-II, the NWI-R, and measures of job satisfaction were used to measure the major study variables.RESULTS The results of all 3 studies support the hypothesized relationships between structural empowerment and the magnet hospital characteristics of autonomy, control over practice environment, and positive nurse-physician relationships. The combination of access to empowering work conditions and magnet hospital characteristics was significantly predictive of nurses' satisfaction with their jobs. CONCLUSIONS/IMPLICATIONS: These findings suggest that nursing leaders' efforts to create empowering work environments can influence nurses' ability to practice in a professional manner, ensuring excellent patient care quality and positive organizational outcomes.     

Determinants of moral distress in medical and surgical nurses at an adult acute tertiary care hospital

AIM: To determine the prevalence and contributing factors of moral distress in medical and surgical nurses. BACKGROUND: Moral distress from ethical conflicts in the work environment is associated with burnout and job turnovers in nurses. METHOD: A prospective cross-sectional survey using the Moral Distress Scale tool was administered to medical and surgical nurses at an adult acute tertiary care hospital. RESULTS: The survey was completed by 260 nurses (92% response rate). The intensity of moral distress was uniformly high to situations related to physician practice, nursing practice, institutional factors, futile care, deception and euthanasia. Encounter frequencies for situations associated with futile care and deceptions were particularly high. Encounter frequencies increased with years of nursing experience and caring for oncology and transplant patients. CONCLUSION: Moral distress is common among nurses in acute medical and surgical units and can be elicited from different types of situations encountered in the work environment. Nursing experience exacerbated the intensity and frequency of moral distress. IMPLICATIONS FOR NURSING MANAGEMENT: Strategies aimed to minimize exposure to situations of moral distress and augment mechanisms mitigating its effect on nurses are necessary to enhance job satisfaction and retention.     

Decreasing Nurse Leader Work Role Overload Through Flexible Work Interventions

The nurse leader role is critical to ensure a quality work environment that influences clinical nurse satisfaction, decreased turnover, and patient outcomes. A primary source of stress in nurse leaders that contributes to burnout is organizational stress such as operational task-oriented activities. The purpose of this study was to evaluate how flexible workplace interventions influence nurse leaders perceptions of role overload and job satisfaction. It was found that flexible work interventions positively impact nurse leader satisfaction, perceived stress, and work role balance in an acute care hospital.     

Impact of recurrent changes in the work environment on nurses' psychological well-being and sickness absence

AIM: This paper is a report of a study of how the occurrence and appraisal of recurrent changes in the work environment of hospital nurses affect psychological well-being (i.e. job satisfaction, eustress and distress) and absence through illness. BACKGROUND: Many researchers have demonstrated the impact of major organizational changes on employees' psychological well-being, but only a few have focused on the permanent consequences in work conditions. In a contemporary healthcare setting, an increased number of recurrent operational changes has become a normal characteristic of nurses' work environment. Specific work situations have frequently been associated with occupational stress, whereas employees' appraisal of recurrent changes as stressors and their relation to psychological well-being and health outcomes (i.e. sickness absence) have been dismissed. METHODS: A cross-sectional questionnaire survey was conducted in 2003 with 2094 Registered Nurses in 10 general hospitals. Logistic regressions were used to investigate the impact on psychological well-being and prospectively measured rates of sickness absence (frequency and duration). RESULTS: The occurrence of changes in the work environment (in the past 6 months) had had a negative impact on staff psychological well-being. Nurses who had been confronted with changes scored statistically significantly higher for distress. Changes appraised as threatening were negatively related to job satisfaction and eustress, and positively related to distress and sickness absence (frequency and duration). Changes appraised as challenging were positively related to job satisfaction and eustress but had no impact on distress and sickness absence. CONCLUSION: Future research should take into consideration the impact of the occurrence and appraisal of recurrent changes in the work environment of healthcare employees (i.e. Registered Nurses) on psychological well-being and sickness absence. This should also be considered by managers when dealing with these nursing workforce issues.     

Practice environments and their associations with nurse-reported outcomes in Belgian hospitals: development and preliminary validation of a Dutch adaptation of the Revised Nursing Work Index

Aim

To study the relationship between nurse work environment, job outcomes and nurse-assessed quality of care in the Belgian context.

Background

Work environment characteristics are important for attracting and retaining professional nurses in hospitals. The Revised Nursing Work Index (NWI-R) was originally designed to describe the professional nurse work environment in U.S. Magnet Hospitals and subsequently has been extensively used in research internationally.

Method

The NWI-R was translated into Dutch to measure the nurse work environment in 155 nurses across 13 units in three Belgian hospitals. Factor analysis was used to identify a set of coherent subscales. The relationship between work environments and job outcomes and nurse-assessed quality of care was investigated using logistic and linear regression analyses.

Results

Three reliable, consistent and meaningful subscales of the NWI-R were identified: nurse-physician relations, nurse management at the unit level and hospital management and organizational support. All three subscales had significant associations with several outcome variables. Nurse-physician relations had a significant positive association with nurse job satisfaction, intention to stay the hospital, the nurse-assessed unit level quality of care and personal accomplishment. Nurse management at the unit level had a significant positive association with the nurse job satisfaction, nurse-assessed quality of care on the unit and in the hospital, and personal accomplishment. Hospital management and organizational support had a significant positive association with the nurse-assessed quality of care in the hospital and personal accomplishment. Higher ratings of nurse-physician relations and nurse management at the unit level had significant negative associations with both the Maslach Burnout Inventory emotional exhaustion and depersonalization dimensions, whereas hospital management and organizational support was inversely associated only with depersonalization scores.

Conclusion

A Dutch version of the NWI-R questionnaire produced comparable subscales to those found by many other researchers internationally. The resulting measures of the professional practice environment in Belgian hospitals showed expected relationships with nurse self-reports of job outcomes and perceptions of hospital quality.