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.     

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.     

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.     

Outcomes of variation in hospital nurse staffing in English hospitals: cross-sectional analysis of survey data and discharge records

CONTEXT: Despite growing evidence in the US, little evidence has been available to evaluate whether internationally, hospitals in which nurses care for fewer patients have better outcomes in terms of patient survival and nurse retention. OBJECTIVES: To examine the effects of hospital-wide nurse staffing levels (patient-to-nurse ratios) on patient mortality, failure to rescue (mortality risk for patients with complicated stays) and nurse job dissatisfaction, burnout and nurse-rated quality of care. DESIGN AND SETTING: Cross-sectional analysis combining nurse survey data with discharge abstracts. PARTICIPANTS: Nurses (N=3984) and general, orthopaedic, and vascular surgery patients (N=118752) in 30 English acute trusts. RESULTS: Patients and nurses in the quartile of hospitals with the most favourable staffing levels (the lowest patient-to-nurse ratios) had consistently better outcomes than those in hospitals with less favourable staffing. Patients in the hospitals with the highest patient to nurse ratios had 26% higher mortality (95% CI: 12-49%); the nurses in those hospitals were approximately twice as likely to be dissatisfied with their jobs, to show high burnout levels, and to report low or deteriorating quality of care on their wards and hospitals. CONCLUSIONS: Nurse staffing levels in NHS hospitals appear to have the same impact on patient outcomes and factors influencing nurse retention as have been found in the USA.     

Mobbing among care workers in nursing homes: A cross-sectional secondary analysis of the Swiss Nursing Homes Human Resources Project

BackgroundAs a category of bullying, mobbing is a form of violence in the workplace that damages the employing organization as well as the targeted employee. In Europe, the overall prevalence of mobbing in healthcare is estimated at 4%. However, few studies have explored mobbing among long-term care workers.ObjectivesThis study aims to examine the frequency of mobbing in Swiss nursing homes and its relationships with care workers’ (i.e. registered nurse, licensed practical nurse, assistant nurse, nurse aide) health status, job satisfaction, and intention to leave, and to explore the work environment as a contributing factor to mobbing.DesignA cross-sectional, multi-center sub-study of the Swiss Nursing Homes Human Resource Project (SHURP).SettingNursing homes in Switzerland’s three language regions.ParticipantsA total of 162 randomly selected nursing homes with 20 or more beds, including 5311 care workers with various educational levels.MethodControlling for facility and care worker characteristics, generalized estimation equations were used to assess the relationships between mobbing and care workers’ health status, job satisfaction, and intention to leave as well as the association of work environment factors with mobbing.ResultsIn Swiss nursing homes, 4.6% of surveyed care workers (n = 242) reported mobbing experiences in the last 6 months. Compared to untargeted persons, those directly affected by mobbing had higher odds of health complaints (Odds Ratios (OR): 7.81, 95% CI 5.56–10.96) and intention to leave (OR: 5.12, 95% CI 3.81–6.88), and lower odds of high job satisfaction (OR: 0.19, 95% CI 0.14–0.26). Odds of mobbing occurrences increased with declining teamwork and safety climate (OR: 0.41, 95% CI 0.30–0.58), less supportive leadership (OR: 0.42, 95% CI 0.30–0.58), and higher perceived inadequacy of staffing resources (OR: 0.66, 95% CI 0.48–0.92).ConclusionsMobbing experiences in Swiss nursing homes are relatively rare. Alongside teamwork and safety climate, risk factors are strongly associated with superiors’ leadership skills. Targeted training is necessary to sensitize managers to mobbing’s indicators, effects and potential influencing factors.     

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.     

The influence of nurses' working motivation and job satisfaction on intention to quit: an empirical investigation in Taiwan

The present era of cost-containment pressures indicates that nursing executives have to ensure that, their nurses have a work environment with the work characteristics known to be linked to job satisfaction and good outcomes. The research hypothesis investigated here was: the higher nurses’ levels on general job satisfaction, overall satisfaction with their professional role, and general job happiness, the lower their intention to quit would be. The controlling variables included demographic characteristics, working motivation, and nine job satisfaction subscales. This study was conducted in 3 hospitals located in southern Taiwan. All nurses working for these 3 hospitals were the target subjects. The overall response rate (648 completed questionnaires) was 82%. The nurses’ Job Satisfaction and the perceptual degree of its importance questionnaire was used. Ordinal logistics regression analyses were utilized. General job satisfaction, general job happiness, satisfaction with salary and promotion, institution, educational background, and age of nurses’ youngest child were proved to be significant predictors of nurses’ intention to quit. Suggestions for future studies and administrative strategies in decreasing nurses’ intention to quit were discussed.     

专业护理实践环境与护士组织承诺的相关性研究

目的描述三级医院专业护理实践环境以及护士组织承诺的现状,并分析两者之间的相关性。方法运用护士实践环境量表和中国职工组织承诺量表对连云港市两所三级医院的279名护士进行调查。结果护士实践环境量表总分（2.64±0.47）分,护士组织承诺总分（2.76±0.53）分。一般资料中影响专业护理实践环境的因素有科室、工作目的 ;影响护士组织承诺的因素有岗位年限、工作目的。专业护理实践环境与护士组织承诺呈正相关（P〈0.01）。结论采取针对性的措施,提升专业护理实践环境水平,同时提升护士的职业使命感,是提高护士组织承诺的有效举措。     

The relationship between nurse staffing and patient outcomes: a case study

Background

Research has shown a direct relationship between staffing levels and patient outcomes for specific nurse-sensitive indicators, with lower patient to nurse ratios (i.e. less patients per nurse) associated with better outcomes.

Objectives

To explore the relationship between nurse staffing characteristics (the nursing hours worked by permanent and temporary staff and nurse hours per patient day) and patient outcomes: pressure sores, patient falls, upper gastrointestinal bleed, pneumonia, sepsis, shock and deep vein thrombosis.

Design

A case study using retrospective hospital data, at ward level.

Setting

A tertiary cardio-respiratory NHS Trust in England, comprising two hospitals.

Participants

All patients, including day cases, who were admitted to either hospital as an in-patient over 12 months.

Methods

Data were extracted from corporate hospital systems. The clinical areas were categorised as lower dependency, i.e. wards, or critical care which included ICU and high dependency units. The relationship between nurse staffing characteristics and patient outcomes was assessed using either a Poisson or negative binomial regression model as appropriate. We sought to establish whether the outcomes were affected by the nurse hours per patient day, the permanent nurse hours worked as a percentage of the total hours, and the permanent nurse hours worked as a percentage of the permanent and bank hours combined.

Results

In the lower dependency category wards there was only a weak association demonstrated between nurse staffing and the majority of the outcomes. The results from the high dependency critical care areas showed few significant results with only the rate of sepsis being significantly reduced as the ratio of permanent staff hours increased.

Conclusions

The study demonstrated the possibility of using existing hospital data to examine the relationship between nurse staffing and patient outcomes, however the associations found were weak and did not replicate reliably the findings from previous work.     

Predictors of occupational stress and well-being in First-Line Nurse Managers: A cross-sectional survey study

BackgroundFirst-line nurse managers have a pivotal role in the organization of health care but have to deal with significant job-related issues and problems in a changing and challenging health care environment. As their new roles are complex and often unclear, it might be expected that these professionals are at risk for occupational stress.ObjectivesThe objective of this study is to analyze and describe relationships between job characteristics, and also interdisciplinary conflicts with physicians as potential predictors of occupational well-being (job satisfaction, psychosomatic distress, turnover intention, work engagement and burnout).Designthis study had a cross-sectional design and used a web-based survey.MethodsThis study was conducted in 2015 in 11 Belgian (Flemish) hospitals. All First-line nurse managers were eligible (N = 481) and 318 respondents (66.1%) agreed to take part in the survey. A hierarchical regression analyses was applied to analyze relationships between predictors and outcomes.Resultsjob demand and job control measures were predictive of all outcomes. Collaboration with doctors only predicted job satisfaction and turnover intention. Social support from management was predictive of turnover intention. Social support from colleague- first-line nurse managers was not predictive. Social support from the staff members (team) was however a strong predictor of all stress outcomes.ConclusionsJob demands, job control and social support of the team and management were all important predictors of occupational well-being in first-line nurse managers. All of these variables can be influenced by hospital management to improve the work conditions of this professional group in order to retain their workforce.     

Clinical teaching practices of nurse educators at a public college of nursing in South Africa: A survey study

Standardisation of clinical teaching practices by nurse educators for undergraduate students is vital, especially within large nursing education institutions distributed over multiple campuses. This quantitative study investigated current clinical teaching practices of nurse educators at a Public College of Nursing in South Africa. A total of n = 68 nurse educators were selected from 5 campuses over a two-month period (April–May 2016), using convenience sampling. Data was collected with a structured questionnaire, the design of which was informed by the Dundee Three Circle Outcomes Model for Clinical Teaching. The results showed that 37% (n = 25) of the nurse educators had above 10 years of clinical teaching experience. Of the 66% (n = 45) who had formal education on clinical teaching practices, 49% (n = 33) received in-service education. Most nurse educators were willing to share amongst colleagues documents they used for clinical teaching, to promote standardisation of teaching practices. Further, they evidenced best clinical practices regarding planning for assessment and clinical placement of students. However, there were significant variations in the majority (seven) of the nine investigated clinical teaching practices among participants. In-service education was positively correlated to best clinical teaching practices (Chi square (d.f. = 2, n = 68) = 7.24; p = .027; V = 0.33 Medium).     

Job demands-resources, burnout and intention to leave the nursing profession: A questionnaire survey

Objectives

The aims of the paper are to examine the role of burnout in the relationship between stress factors related to nurses’ work and social environment and intention to leave the profession and to investigate the nature of the relationship between burnout and intention to leave the nursing profession.

Background

A postulate of the job demands-resources model is that two distinct yet related processes contribute to the development of burnout. The energetic process originates from demands and is mainly centered on emotional exhaustion; the motivational process originates from resources and is mainly centered on depersonalization. Moreover, we postulated that the two components of burnout are linked indirectly to intention to leave the profession via psychosomatic complaints, associated with the energetic process, and via professional commitment, associated with the motivational process.

Method

The research model was tested on cross-sectional data collected in 2005 from 1636 registered nurses working in hospitals who responded to a self-administrated questionnaire.

Results

Demands are the most important determinants of emotional exhaustion and indirectly induce depersonalization via emotional exhaustion, whereas resources mainly predict depersonalization. Moreover, emotional exhaustion and depersonalization are linked to psychosomatic complaints and professional commitment, which are in turn associated with intention to leave the profession.

Conclusion

The results suggest that a dual strategy is needed in order to retain nurses within the profession: a decrease in job demands, coupled with an increase in available job resources. In particular, nurses’ tasks and role should be restructured to reduce work overload and increase the meaning of their work.     

The role of work environment in keeping newly licensed RNs in nursing: A questionnaire survey

Background

In prior studies, newly licensed registered nurses (RNs) describe their job as being stressful. Little is known about how their perceptions of the hospital work environment affect their commitment to nursing.

Objectives

To assess the influence of hospital work environment on newly licensed RN's commitment to nursing and intent to leave nursing.

Design

Correlational survey.

Settings

Newly licensed RNs working in hospitals in Florida, United States.

Participants

40% random sample of all RNs newly licensed in 2006.

Methods

The survey was mailed out in 2008. Dependent variables were indicators of professional commitment and intent to leave nursing. Independent variables were individual, organizational, and work environment characteristics and perceptions (job difficulty, job demands and job control). Statistical analysis used ordinary least squares regressions. Level of significance was set at p < 0.05.

Results

Job difficulty and job demand were significantly related to a lower commitment to nursing and a greater intent to leave nursing, and vice versa for job control. The strongest ranked of the job difficulties items were: incorrect instructions, organizational rules, lack of supervisor support, and inadequate help from others. Workload and other items were significant, but ranked lower. The strongest ranked of the job pressure items were: “having no time to get things done” and “having to do more than can be done well.” The strongest ranked of job control items were “ability to act independent of others.” Nurses with positive orientation experiences and those working the day shift and more hours were less likely to intend to leave nursing and more likely to be committed to nursing. Significant demographic characteristics related to professional commitment were race and health.

Conclusions

Negative perceptions of the work environment were strong predictors of intent to leave nursing and a lower commitment to nursing among newly licensed RNs. These results indicate that retention of newly licensed RNs in nursing can be improved through changes in the work environment that remove obstacles to care-giving, increase resources and autonomy, and reduce workload and other job pressure factors.     

Role stress and personal resources in nursing: A cross-sectional study of burnout and engagement

Background

The experience of role stress has been linked to burnout as an important job stressor, but the impact of this stressor in the context of engagement (characterized by vigor, dedication, and absorption) has not yet been sufficiently studied among nurses. Personal resources also appear to influence the process of burnout and engagement.

Objectives

This study examines the influence of role stress and personal resources (optimism, hardy personality and emotional competence) in nursing on burnout and engagement dimensions.

Design and results

Cross-sectional data from 508 nurses from general hospitals in Madrid (Spain) showed that both role stress and personal resources were related to burnout and engagement dimensions, although role stress was more closely related to nursing burnout, whereas personal resources were more closely related to nursing engagement. In addition, optimism as a personal resource, showed a moderator effect on exhaustion and the three dimensions of engagement.

Conclusions

The study provides additional support about role stress as an important predictor of burnout and engagement in nursing, even after controlling for personal resources and socio-demographic variables.     

The effect of digitalization on the career intentions of nursing students: A cross-sectional study

AimWe investigate how the confirmation of expectations about digital technology in the workplace affects the career intentions of nursing students. We also explore the role of task fit in mediating (1) digital technology satisfaction and job satisfaction and (2) digital technology satisfaction and career intentions.BackgroundThe turnover of graduating geriatric nursing students is very high and rising. To support the work of nursing staff, elderly care institutions are beginning to adopt digital technologies that aid in nursing tasks. However, it is unclear whether students’ perceptions of those digital technologies have an impact on their career intentions.DesignThis is a cross-sectional study.MethodsWe recruited 549 geriatric nursing students. Data were collected from December 2022 to March 2023. The questionnaire included seven sections: expectation confirmation, perceived usefulness, perceived safety, digital technology satisfaction, task fit, job satisfaction and career intentions. The validity and reliability of the model were confirmed.ResultsThe results show that the confirmation of students’ expectations for the digital technology used in elderly care services has a positive impact on their career intentions. However, the results do not confirm the impact of perceived security on digital technology satisfaction, or the effect of job satisfaction on career intentions.ConclusionElderly care institutions and educators should monitor the current state of the digital work environment to ensure that it can adequately support students in their work. They should ensure the use of advanced and appropriate technology tools in teaching and clinical environments to provide a richer and more vivid learning experience. These initiatives can support nursing students in their transition from school to practice and increase their willingness to stay in the profession.     

The impact of social support upon intention to leave among female nurses in Europe: Secondary analysis of data from the NEXT survey

Objectives

This study examined the importance of one's social work environment in the light of prevention of premature leave from the nursing profession. A research model with social support (from direct supervisor and close colleagues) as predictor and intention to leave as the dependent variable has been tested, while controlling for job satisfaction and age. Moreover, we have studied the impact of nurses’ age upon the prevalence of social support from both parties.

Participants

Data were obtained from 17,524 registered female nurses working in hospitals throughout Europe (Belgium, Germany, Finland, France, Italy, The Netherlands, Poland, and Slovakia).

Results

Our findings indicated that a lack of job satisfaction is an important risk factor in the light of nurses’ turnover as for most countries the intention to leave cannot be buffered by social support from one's close colleagues. However, in general, social support from one's direct superior appeared to contribute negatively to the intention to leave the profession, over and above job satisfaction and age. As regards age effects, in line with our expectation, we have found a significant negative relationship between age and social support from close colleagues, while the hypothesis regarding the relationship between age and supervisory support could not be confirmed.

Conclusions

Given its importance in the light of preventing premature leave, we advocate not to neglect the possible positive effects of social support from important key figures like nurses’ direct supervisor and close colleagues. It is necessary for health care institutions to carefully pay attention to finding opportunities to obtain more social support for all staff members. In Section 5, limitations and practical implications of this study are dealt with.