The relationship between nurse practice environment,nurse work characteristics,burnout and job outcome and quality of nursing care: A cross-sectional survey

Aim

To explore the mechanisms through which nurse practice environment dimensions are associated with job outcomes and nurse-assessed quality of care. Mediating variables tested included nurse work characteristics of workload, social capital, decision latitude, as well as burnout dimensions of emotional exhaustion, depersonalization, and personal accomplishment.

Background

Acute care hospitals face daily challenges to their efforts to achieve nurse workforce stability, safety, and quality of care. A body of knowledge shows a favourably rated nurse practice environment as an important condition for better nurse and patient outcome variables; however, further research initiatives are imperative for a clear understanding to support and guide the practice community.

Design

Cross-sectional survey.

Method

Grounded on previous empirical findings, a structural equation model designed with valid measurement instruments was tested. The study population was registered acute care nurses (N = 1201) in two independent hospitals and one hospital group with six hospitals in Belgium.

Results

Nurse practice environment dimensions predicted job outcome variables and nurse ratings of quality of care. Analyses were consistent with features of nurses’ work characteristics including perceived workload, decision latitude, and social capital, as well as three dimension of burnout playing mediating roles between nurse practice environment and outcomes. A revised model adjusted using various fit measures explained 52% and 47% of job outcomes and nurse-assessed quality of care, respectively.

Conclusion

The study refines understanding of the relationship between aspects of nursing practice in order to achieve favourable nursing outcomes and offers important concepts for managers to track in their daily work. The findings of this study indicate that it is important for clinicians and leaders to consider how nurses are involved in decision-making about care processes and tracking outcomes of care and whether they are able to work with physicians, superiors, peers, and subordinates in a trusting environment based on shared values. The involvement of nurse managers at the unit level is especially critical because of associations with nurse work characteristics such as decision latitude and social capital and outcome variables. Further practice and research initiatives to support nurses’ involvement in decision-making process and interdisciplinary teamwork are recommended.     

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 association of Chinese hospital work environment with nurse burnout,job satisfaction,and intention to leave

The purpose of this study was to describe nurse burnout, job satisfaction, and intention to leave and to explore the relationship of work environment to nursing outcomes in a sample of 9,698 nurses from 181 hospitals in China. Nurses reported moderate levels of emotional exhaustion and depersonalization and high levels of reduced personal accomplishment. Nearly one-fifth of the nurses reported high levels of burnout on all three dimensions. Forty-five percent of the nurses were dissatisfied with their current job; these nurses were most dissatisfied with their salary. Five percent of nurses reported an intention to leave. Nurses reporting mixed and good work environments were less likely to report high burnout, job dissatisfaction, and intention to leave compared with those in poor work environments. The results suggest that high burnout and low job satisfaction are prominent problems for Chinese nurses, and improving work environment might be an effective strategy for better nursing outcomes in Chinese hospitals.     

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.     

Relationship of job satisfaction with perceived organizational support and quality of care among South Korean nurses: A questionnaire survey

Background

The International Hospital Outcomes Study found that organizational/managerial support for nursing has a pronounced effect on nurses’ job dissatisfaction, burnout and quality of care. However, these findings have not been validated in non-Western countries using the same study method and instrument.

Objectives

The objectives of this study were to: (a) examine associations between job satisfaction and burnout, organizational support and quality of care reported by South Korean nurses, (b) identify the best predictors of job satisfaction among South Korean nurses through multivariate modeling and (c) compare findings of this study with those from the International Hospital Outcomes Study.

Research method

This replication study used a cross-sectional survey design. The Pennsylvania Registered Nurse Survey used in the International Hospital Outcomes Study (IHOS) was administered to 496 registered nurses working at 23 acute hospitals in South Korea. A statistical model of job satisfaction was developed using logistic regression.

Results

Job dissatisfaction was positively correlated to total burnout scores (r = .42, p < .001) and lack of organizational support (r = .36, p < .001). Multivariate analysis found that job satisfaction was significantly associated at the level of 0.05 with total burnout scores, amount of organizational support and satisfaction with nurse identity, with odds ratios of .92 (p < .001), 1.04 (p < .01) and 11.93 (p < .001), respectively. Korean nurses reported low quality of care in their practice setting and were less confident in their patients’ ability of self-management after discharge. Yet despite a high patient-to-nurse ratio (22 patients per nurse), Korean nurses had a higher job satisfaction rate (68.8%) and lower burnout scores (35.7) than their counterparts in the International Hospital Outcomes Study.

Conclusion

The high patient-to-nurse ratio allows South Korean nurses to focus on more technical tasks that give less stress and have higher job satisfaction because of it. However, this also leads to the South Korean nurses having less confidence in their patient's ability to take care of themselves upon discharge. South Korean nurses should also be given opportunity to advance themselves professionally and be recognized for their abilities while being given more responsibility for the clinical decision making in their patient's care.     

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.     

The association between the practice environment and selected nurse educator outcomes in public nursing education institutions: A cross-sectional study

AimThe purpose of this study is to describe the association between the practice environment and nurse educator outcomes (burnout, engagement, incivility, job satisfaction and intention to leave) in public nursing education institutions in the Gauteng province of South Africa.BackgroundThe practice environment holds the most promise for recruiting and retaining a qualified and engaged nurse workforce; however, the association between the practice environment and nurse educator outcomes has been relatively unexplored.DesignCross-sectional design.MethodsThe Gauteng province was purposively selected, as it has the highest number of public nursing education institutions in South Africa. All-inclusive sampling was applied to public nursing educations institutions in Gauteng province (N = 6) and then to Heads of Department (N = 30; n = 17) and nurse educators (senior lecturers [N = 162; n = 45] and lecturers [N = 257; n = 80]). Data were collected during March to November 2018. The data were collected using the Practice Environment Scale of the Nursing Work Index; Maslach Burnout Inventory - Educators Survey; Utrecht Work Engagement Scale (UWES); Incivility in Nursing Education-Revised (INE-R); job satisfaction and Propensity to Leave Scale.ResultsThe results show that nurse educators are an aging population, with limited numbers having master’s and doctoral qualifications. The most job dissatisfaction is regarding wages (M=2.0; SD 1.07); appreciation, recognition and rewards for good work (M=2.1; SD 1.01); and opportunities for advancement (M=2.2; SD 1.01). The nurse educators do not experience their public nursing education institutions as having a positive practice environment. Nurse educators experienced high levels of work engagement, moderate levels of burnout and low levels of incivility, that were highly correlated with the subscale of foundations of quality outcomes. They experienced moderate levels of job satisfaction but did not intend to leave their places of employment, which was highly correlated with the subscale of manager’s ability, leadership and support.ConclusionsA positive practice environment improves nurse educator outcomes. The subscale of foundations of quality outcomes and manager’s ability, leadership and support had the most impact on nurse educator outcomes, thus quality teaching practices should be cultivated and recognised; and managers must have the necessary skill and knowledge to lead effectively, while also including nurse educators in decisions that impact them and involving them in the affairs of the nursing education institution. There is a shortage of qualified nurse educators globally and in South Africa and urgent attention must be given to factors that influence the recruitment and retention of nurse educators.Twitter abstractThe practice environment holds the most promise for recruiting and retaining a qualified and engaged nurse educator workforce, especially regarding foundations of quality outcomes and manager’s ability, leadership and support.     

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.     

Patient-centered care,nurse work environment and implicit rationing of nursing care in Swiss acute care hospitals: A cross-sectional multi-center study

BackgroundPatient-centered care is a key element of high-quality healthcare and determined by individual, structural and process factors. Patient-centered care is associated with improved patient-reported, clinical and economic outcomes. However, while hospital-level characteristics influence patient-centered care, little evidence is available on the association of patient-centered care with characteristic such as the nurse work environment or implicit rationing of nursing care.ObjectiveThe aim of this study was to describe patient-centered care in Swiss acute care hospitals and to explore the associations with nurse work environment factors and implicit rationing of nursing care.DesignThis is a sub-study of the cross-sectional multi-center “Matching Registered Nurse Services with Changing Care Demands” study.SettingWe included 123 units in 23 acute care hospitals from all three of Switzerland’s language regions.ParticipantsThe sample consisted of 2073 patients, hospitalized for at least 24 h and ≥18 years of age. From the same hospital units, 1810 registered nurses working in direct patient care were also included.MethodsPatients‘ perceptions of patient-centered care were assessed using four items from the Generic Short Patient Experiences Questionnaire. Nurses completed questionnaires assessing perceived staffing and resource adequacy, adjusted staffing, leadership ability and level of implicit rationing of nursing care. We applied a Generalized Linear Mixed Models for analysis including individual-level patient and nurse data aggregated to the unit level.ResultsPatients reported high levels of patient-centered care: 90% easily understood nurses, 91% felt the treatment and care were adapted for their situation, 82% received sufficient information, and 70% felt involved in treatment and care decisions. Higher staffing and resource adequacy was associated with higher levels of patient-centered care, e.g., sufficient information (β 0.638 [95%-CI: 0.30–0.98]). Higher leadership ratings were associated with sufficient information (β 0.403 [95%-CI: 0.03–0.77) and adapted treatment and care (β 0.462 [95%-CI: 0.04–0.88]). Furthermore, higher levels of implicit rationing of nursing care were associated with lower levels of patient-centered care, e.g., adapted treatment and care (β −0.912 [95%-CI: −1.50–0.33]).ConclusionOur study shows a negative association between implicit rationing of nursing care and patient-centered care: i.e.the lower the level of implicit rationing of nursing care, the better patients understood nurses, felt sufficiently informed and recognized that they were receiving highly individualized treatment. To improve patient-centered care, the nurse work environment and the level of implicit rationing of nursing care should be taken into consideration.     

Nursing practice environment,quality of care,and morale of hospital nurses in Japan

The purpose of this study was to describe Japanese hospital nurses' perceptions of the nursing practice environment and examine its association with nurse‐reported ability to provide quality nursing care, quality of patient care, and ward morale. A cross‐sectional survey design was used including 223 nurses working in 12 acute inpatient wards in a large Japanese teaching hospital. Nurses rated their work environment favorably overall using the Japanese version of the Practice Environment Scale of the Nursing Work Index. Subscale scores indicated high perceptions of physician relations and quality of nursing management, but lower scores for staffing and resources. Ward nurse managers generally rated the practice environment more positively than staff nurses except for staffing and resources. Regression analyses found the practice environment was a significant predictor of quality of patient care and ward morale, whereas perceived ability to provide quality nursing care was most strongly associated with years of clinical experience. These findings support interventions to improve the nursing practice environment, particularly staffing and resource adequacy, to enhance quality of care and ward morale in Japan.     

Burnout and job satisfaction of intensive care personnel and the relationship with personality and religious traits: An observational,multicenter, cross-sectional study

ObjectivesTo investigate if burnout in the Intensive Care Unit (ICU) is influenced by aspects of personality, religiosity and job satisfaction.Research methodologyCross-sectional study, designed to assess burnout in the ICU and to investigate possible determinants. Three different questionnaires were used: the Malach Burnout Inventory, the Eysenck Personality Questionnaire and the Spiritual/Religious Attitudes Questionnaire. Predicting factors for high burnout were identified by multivariate logistic regression analysis.Setting/ParticipantsThis national study was addressed to physicians and nurses working full-time in 18 Greek ICU departments from June to December 2015.ResultsThe participation rate was 67.9% (n = 149) and 65% (n = 320) for ICU physicians and nurses, respectively). High job satisfaction was recorded in both doctors (80.8%) and nurses (63.4%). Burnout was observed in 32.8% of the study participants, higher in nurses compared to doctors (p < 0.001). Multivariate analysis revealed that neuroticism was a positive and extraversion a negative predictor of exhaustion (OR 5.1, 95%CI 2.7–9.7, p < 0.001 and OR 0.49, 95%CI 0.28–0.87, p = 0.014, respectively). Moreover, three other factors were identified: Job satisfaction (OR 0.26, 95%CI 0.14–0.48, p < 0.001), satisfaction with current End-of-Life care (OR 0.41, 95%CI 0.23–0.76, p = 0.005) and isolation feelings after decisions to forego life sustaining treatments (OR 3.48, 95%CI 1.25–9.65, p = 0.017).ConclusionsPersonality traits, job satisfaction and the way End-of-Life care is practiced influence burnout in the ICU.