Organizational determinants of work outcomes and quality care ratings among Army Medical Department registered nurses

Influence of the work environment of nurses on the 30-day mortality of patients hospitalized in Polish hospitals. cross-sectional studies

BACKGROUND

An optimal work environment for nurses is characterized primarily by appropriate staffing, good team relations, and support from the management staff. These factors are consistently associated with a positive assessment of patient safety by a hospital's employees and a reduction in hospital mortality rates.

AIM

To understand the relationships between the work environment as perceived by nurses on the 30-day mortality of patients treated in Polish hospitals.

BACKGROUND

An optimal work environment for nurses is characterized primarily by appropriate staffing, good team relations, and support from the management staff. These factors are consistently associated with a positive assessment of patient safety by a hospital's employees and a reduction in hospital mortality rates.

MATERIAL AND METHODS

The analysis used discharge data from 108,284 patients hospitalized in internal medicine and surgery departments in 21 hospitals (with 24/7 operations) in Poland. Administrative data included coded data to estimate 30-day mortality. A Nurses' satisfaction questionnaire, including the PES-NWI scale and the SAQ questionnaire, was used to assess the work environment of nurses (n = 1,929). Correlations between variables were assessed using the Pearson coefficient. The analysis used a Poisson regression model, which belongs to the class of generalized linear models.

RESULTS

A lower 30-day mortality rate amongst patients was found among those treated in hospitals where the personnel feel that they may question the decisions or actions of their superiors regarding the care provided (r = - 0.50); nurses are informed about changes introduced on the basis of reports about negligence and mistakes (r = - 0.50); the ward nurse is a good manager (r = - 0.41); nurses receive timely information from the head of the department that may have an impact on their work (r = - 0.41).

CONCLUSIONS

Factors related to care during hospital stay such as the organization of care at the ward level, analysis of care errors, the number of staff providing direct patient care, informing nurses about mistakes without punishment, and the possibility of nurses challenging the decisions or actions of superiors, which concerns care providing, affect the 30-day mortality of patients after the end of hospitalization in Polish hospitals.

Recommendations From a Systematic Review of Leadership Development to Support a New Nursing Practice Model

OBJECTIVE

To develop a new nursing practice model for use within the US military, researchers aimed to create evidence-based recommendations for nursing leadership development based on current literature.

BACKGROUND

The role of nursing leadership has many implications, including better nurse and patient outcomes. Therefore, an actionable compilation of recommendations informing how to develop effective nurse leaders could be helpful for current and aspiring nurse leaders.

METHODS

Researchers conducted a systematic literature review of 5 databases searching for relevant articles published from 2001 to 2020.

RESULTS

Seventy-eight articles were synthesized to develop a list of 5 broad yet actionable recommendations for leadership development.

CONCLUSIONS

Leadership development is essential for current and future nurse leaders. The recommendations identified from this review can assist in developing leaders. Leaders can use these recommendations to guide leadership training initiatives, engage in self-development, or begin succession planning.

Modernizing Measure of the Nurse Work Environment

BACKGROUND

Research has established a relationship between favorable nurse work environments and better nurse, patient, and organizational outcomes. However, the instrument most frequently used to measure the nurse work environment, the Practice Environment Scale of the Nursing Work Index (PES-NWI), has not had its items significantly re-evaluated since the 1980s.

OBJECTIVE

We sought to examine the psychometric properties of an updated PES-NWI and create an instrument suitable for further testing and refinement to measure the present-day nurse work environment. Specifically, we sought to establish construct, structural, discriminative, and concurrent validity. For reliability, we desired to establish interrater reliability and internal consistency reliability.

METHODS

We administered a modified PES-NWI to a national sample of direct-care hospital nurses (n = 818) in the United States. We then assessed the psychometric properties of the instrument.

RESULTS

While the modified PES-NWI displayed adequate validity and reliability properties, further testing and refinement of the instrument is necessary.

CONCLUSIONS

With this updated measure of the nurse work environment, researchers and hospital leaders can identify modifiable opportunities for improvement in contemporary hospital nurse work environments which may enhance nurse and patient outcomes.

Relational Coordination as a Predictor of Job Satisfaction and Intent to Stay Among Nurses and Physicians in the Military Health System

INTRODUCTION

Job satisfaction and retention of military and civilian nurses and physicians who work in military treatment facilities (MTFs) are critical to maintaining quality of care and operational readiness. Civilian nurses and physicians working in MTFs supplement staffing for active duty military nurses and physicians and support operational readiness when military nurses and physicians deploy in wartime crises or humanitarian efforts. Decreased retention of military and civilian nurses and physicians can negatively impact operational readiness and patient care outcomes. Although several factors (e.g., burnout, pay, and leadership) influence job satisfaction and retention among nurses and physicians in both military and civilian healthcare settings, high-quality communication and relationships between nurses and physicians are associated with better job satisfaction and retention. However, little is known about how high-quality communication and relationships affect job satisfaction and retention among nurses and physicians in MTFs. Relational coordination (RC) is a process of high-quality communication supported by relationships of shared knowledge, shared goals, and mutual respect among members of the healthcare team. By strengthening RC, hospital leaders can more effectively achieve desired outcomes. The purpose of this study was to explore how RC influences job satisfaction and intent to stay among nurses, residents, and physicians in an Army hospital, and whether job satisfaction mediated the relationship between RC and intent to stay.

MATERIALS AND METHODS

We conducted an exploratory, cross-sectional study in a 138-bed MTF in the southeastern USA and invited a convenience sample of military and civilian nurses, residents, and physicians to complete a 47-item survey on RC, job satisfaction, and intent to stay. We used Pearson's correlation to explore relationships between RC, job satisfaction, and intent to stay and then employed multiple regression to explore whether RC predicts job satisfaction and intent to stay, after controlling for professional role, demographic characteristics, and other covariates. Furthermore, we explored whether job satisfaction mediates the relationship between RC and intent to stay.

RESULTS

Two hundred and eighty-nine participants completed the survey. Seventy percentage of respondents were civilian, were Caucasian (61%), and had a mean age of 40 years old. The RCs within roles (β = 0.76, P < .001) and between roles (β = 0.46, P < .001) were both positively associated with job satisfaction. RCs within roles was associated with higher intent to stay (β = 0.38, P = .005). Civilian nurses and physicians reported higher intent to stay, followed by officers and enlisted service members. Job satisfaction mediated the relationship between RC within roles and intent to stay.

CONCLUSION

Our findings suggest that RC is a powerful workplace dynamic that influences job satisfaction and intent to stay, for nurses, residents, and physicians in MTFs. Specifically, we found that RC was positively associated with job satisfaction and intent to stay and that job satisfaction mediates the relationship between RC and intent to stay. We recommend that hospital leaders in MTFs explore interventions to strengthen RC among health professionals by including relational, work process and structural interventions as part of their strategy for retaining military healthcare professionals.

The impact of professional role and demographic characteristics on job satisfaction and retention among healthcare professionals in a military hospital

BACKGROUND

Job satisfaction is significantly associated with retention. Although several factors are associated with job satisfaction and retention (pay, leadership, mentorship), the association of demographic characteristics has been understudied in the literature.

PURPOSE

To explore whether professional role and demographic characteristics are associated with job satisfaction and intent to stay among nurses and physicians in a military medical center.

METHODS

We conducted a descriptive, exploratory, cross-sectional study, and collected data via surveys. We used multiple regression to evaluate study variables.

RESULTS

Two hundred and eighty-nine participants completed the survey. Professional role and demographic characteristics were not associated with job satisfaction. Professional role, race, and education were associated with intent to stay for military respondents. Physicians (β = 0.53, p = .0259) and Caucasians (β = -0.55, p = .0172) reported lower intent to stay; respondents with graduate degrees reported higher intent to stay (β = 2.47, p = .0045). Professional role and demographic characteristics were not associated with intent to stay for civilians.

CONCLUSION

Job satisfaction and retention of nurses and physicians are critical to the quality of care. Civilian and military healthcare leaders should focus on interventions that enhance job satisfaction and retention as a strategy to improve patient and staff outcomes alike.

Comparing the Nurse Work Environment, Job Satisfaction, and Intent to Leave Among Military, Magnet®, Magnet-Aspiring, and Non-Magnet Civilian Hospitals

OBJECTIVE

This study aimed to compare the nurse work environment, job satisfaction, and intent to leave (ITL) among military, Magnet®, Magnet-aspiring, and non-Magnet civilian hospitals.

BACKGROUND

The professional nurse work environment is an important, modifiable, organizational trait associated with positive nurse and patient outcomes; creating and maintaining a favorable work environment should be imperative for nursing leaders.

METHODS

Secondary data from the Army Nurse Corps and the National Database of Nursing Quality Indicators included the Practice Environment Scale of the Nursing Work Index (PES-NWI) and single-item measures of job satisfaction and ITL.

RESULTS

Magnet and military hospitals had identical PES-NWI composite scores; however, statistically significant differences existed among the subscales. Military nurses were the most satisfied among all groups, although this difference was not statistically significant, yet their ITL was highest.

CONCLUSIONS

Favorable work environments may exist in other organizational forms besides Magnet; however, the specific components must be considered.

Identifying Potentially Preventable Reasons Nurses Intend to Leave a Job

OBJECTIVE

The aim of this study was to describe the relationships between intent to leave, reasons nurses intend to leave, and the nursing work environment in military hospitals.

BACKGROUND

Intention to leave is a precursor of nurse turnover. The reasons nurses intend to leave may be influenced by leader interventions and potentially preventable.

METHODS

This descriptive, correlational secondary analysis included 724 nurse survey responses from 23 US Army hospitals. Bivariate correlations and predictive modeling techniques were used.

RESULTS

Forty-nine percent of nurses indicated they intended to leave, 44% for potentially preventable reasons. Dissatisfaction with management and the nursing work environment were the top potentially preventable reasons to leave. Nurses who intended to leave for potentially preventable reasons scored aspects of the nursing work environment significantly lower than those intending to leave for nonpreventable reasons.

CONCLUSIONS

Identifying potentially preventable reasons in conjunction with intent to leave can provide leaders opportunities to intervene and influence turnover intention.

Development and Psychometric Validation of the Brief Nurses' Practice Environment Scale and Its Relation to Burnout Syndrome and Job Satisfaction: A Study in Spanish Nurses

Introduction: Nursing environment is a vast concept that traditionally has included a wide range of job characteristics and has been related to burnout and job satisfaction. For its measurement, the Practice Environment Scale of the Nursing Work Index (PESNWI) stands out. However, shorter instruments are needed. The purpose of the study is to develop and test the Brief Nurses' Practice Environment (BNPE) Scale.

Methods: The BNPE Scale was developed and tested in a sample of 210 Spanish nurses (data collection 2018).

Results: Cronbach's alpha was 0.702. The confirmatory factor analysis (CFA), with an excellent fit, offered evidence of internal validity. Regarding validity, the BNPE Scale predicted both burnout and job satisfaction. Finally, evidence pointed out a cutoff score of <12 for low levels of practice environment and a cutoff score of >15 for higher levels in practice environment.

Conclusions: The BNPE Scale is a short, easy-to-use measure that could be employed in major batteries assessing the quality of healthcare institutions.

Exploring competencies of military nurses in general hospitals in China: a qualitative content analysis

BACKGROUND

Military nurses should possess the competency to provide quality care in both clinical and military nursing contexts. This study aimed to identify the competencies of military nurses in general hospitals.

METHODS

A qualitative study was carried out using a qualitative content analysis. We purposefully sampled and interviewed 21 nurses in general hospitals in China.

RESULTS

The data analysis revealed 40 competencies, which were categorised into four main categories according to the Onion Model. These categories were motive (mission commitment), traits (perseverance, flexibility, etc.), self-identity of dual roles (obedience, empathy, etc.), as well as knowledge, skills and abilities (clinical and military nursing knowledge and skills, basic nursing ability, professional development ability, leadership and management ability).

CONCLUSIONS

Existing knowledge of competencies of military nurses in general hospitals is limited. A detailed exploration of this topic can provide guidance for recruitment, competency assessment, and competency building.

Validation of the Psychometric Properties of the Practice Environment Scale of Nursing Work Index in Primary Health Care in Portugal

Studies related to the work environment in primary health care are scarce in the literature. The present study aimed to validate the psychometric properties of the Practice Environment Scale of Nursing Work Index (PES-NWI) in primary health care (PHC) and to evaluate its construct validity through exploratory and confirmatory factor analyses in a sample of Portuguese nurses. A quantitative, cross-sectional, and validation study design was implemented. Methods: The sample consisted of 1059 nurses from the PHC units of all 55 health center groups (HCGs) in mainland Portugal, 15 health centers in the Autonomous Region of Madeira, and 6 health centers in the Autonomous Region of the Azores. The study tested different structural models using exploratory and confirmatory factor analysis techniques. The reliability of the scale was tested by determining Cronbach’s alpha coefficient. Results: The internal consistency of the PES-NWI was 0.91. Exploratory and confirmatory factor analyses were performed on the PES-NWI model in PHC with five factors: NPOA, NFQC, NMALSN, SRA, and CNPR. The results show that the scale presents acceptable fit quality indexes in the final factorial solution and adequate convergent validity. Conclusion: The PES-NWI in PHC has an adequate, robust, and reliable five-factor structure. The scale is valid and can be used in clinical practice, nursing management, and PHC research.

The organisational context of nursing practice in hospitals in China and its relationship with quality of care, and patient and nurse outcomes: A mixed-methods review

BACKGROUND

Achieving high-quality care and retention of nurses are major concerns for nurse leaders in hospitals. The organisational context is theorised to influence the quality of care and patient and nurse outcomes. This review focuses on China where the healthcare system is different from most Western countries in terms of government healthcare expenditure, public health insurance and healthcare delivery system.

OBJECTIVES

To explore the organisational context of nursing practice in hospitals in China and its relationship with quality of care, patient outcomes (patient adverse events, safety and satisfaction) and nurse outcomes (burnout, job satisfaction and intention to leave).

DESIGN

A mixed-methods review.

DATA SOURCES

The electronic databases PubMed, EMBASE, CINAHL, PsycINFO and China Academic Journals Database were used.

METHODS

This review was conducted using the SALSA (Search, Appraisal, Synthesis and Analysis) framework. Quality assessment was conducted using the Joanna Briggs Institute (JBI) critical appraisal checklists for cross-sectional studies and qualitative research. A narrative synthesis was conducted and was supported by tabulation of study data. The PRISMA guidelines were used for this review.

RESULTS

Twenty-three articles met the inclusion criteria and were retrieved, analysed and synthesised. This review supports the link between organisational context, quality of care, and patient and nurse outcomes in the Chinese healthcare system. Aspects of organisational context warrant attention including nurse staffing levels, the shortage of nurses, a lack of nurse participation in hospital affairs and support for the professional development of nurses.

CONCLUSIONS

The findings suggest that tailored interventions are needed to improve the organisational context of nursing practice in Chinese hospitals and, in particular, to address the nurse workforce issues and organisational leadership and support. The unique policy context of the Chinese healthcare system should be considered when developing these interventions.

RELEVANCE TO CLINICAL PRACTICE

Recognising the importance of the organisational context, it is imperative that nurse leaders make every effort to legislate for safe nurse staffing and to establish a caring culture to improve quality of care and nurse and patient outcomes.

Sociodemographic and occupational aspects associated with burnout in military nursing workers

ABSTRACT Objectives: to analyze association between burnout and sociodemographic and occupational features of military nursing workers. Methods: a cross-sectional study, developed in five military hospitals of the Army of Rio Grande do Sul State, among 167 workers from military nursing from December 2015 to May 2016. Sociodemographic and occupational questionnaires and the Maslach Burnout Inventory were applied. For the analysis, it was used descriptive statistics, Chi-Square Test and Poisson Regression. Results: the majority of participants were female; temporary military personnel, nursing technicians, with a median age of 34 years old. Burnout was related to the variables: Military Health Organization, time of practice in military nursing and accomplishment of leisure activities. Conclusions: burnout assessment may contribute to the Brazilian Army Command in organizing plans for prevention and handling of occupational diseases in military nursing, improving quality of life at work.

Evidence Relating Health Care Provider Burnout and Quality of Care: A Systematic Review and Meta-analysis

BACKGROUND

Whether health care provider burnout contributes to lower quality of patient care is unclear.

PURPOSE

To estimate the overall relationship between burnout and quality of care and to evaluate whether published studies provide exaggerated estimates of this relationship.

DATA SOURCES

MEDLINE, PsycINFO, Health and Psychosocial Instruments (EBSCO), Mental Measurements Yearbook (EBSCO), EMBASE (Elsevier), and Web of Science (Clarivate Analytics), with no language restrictions, from inception through 28 May 2019.

STUDY SELECTION

Peer-reviewed publications, in any language, quantifying health care provider burnout in relation to quality of patient care.

DATA EXTRACTION

2 reviewers independently selected studies, extracted measures of association of burnout and quality of care, and assessed potential bias by using the Ioannidis (excess significance) and Egger (small-study effect) tests.

DATA SYNTHESIS

A total of 11 703 citations were identified, from which 123 publications with 142 study populations encompassing 241 553 health care providers were selected. Quality-of-care outcomes were grouped into 5 categories: best practices (n = 14), communication (n = 5), medical errors (n = 32), patient outcomes (n = 17), and quality and safety (n = 74). Relations between burnout and quality of care were highly heterogeneous (I2 = 93.4% to 98.8%). Of 114 unique burnout-quality combinations, 58 indicated burnout related to poor-quality care, 6 indicated burnout related to high-quality care, and 50 showed no significant effect. Excess significance was apparent (73% of studies observed vs. 62% predicted to have statistically significant results; P = 0.011). This indicator of potential bias was most prominent for the least-rigorous quality measures of best practices and quality and safety.

LIMITATION

Studies were primarily observational; neither causality nor directionality could be determined.

CONCLUSION

Burnout in health care professionals frequently is associated with poor-quality care in the published literature. The true effect size may be smaller than reported. Future studies should prespecify outcomes to reduce the risk for exaggerated effect size estimates.

PRIMARY FUNDING SOURCE

Stanford Maternal and Child Health Research Institute.

Rationing of Nursing Care and Its Relationship with Nurse Staffing and Patient Outcomes: The Mediation Effect Tested by Structural Equation Modeling

Purpose: The purpose of this study is to test the mediation effect of rationing of nursing care (RONC) and the relationship this has between nurse staffing and patient outcomes. Methods: The analytic sample included 7802 nurse surveys and 5430 patient surveys. Three patient outcome indicators, nurse staffing, RONC, and confounding factors were considered in the model pathways. Results: The hypothesized model was shown to be statistically significant. In the model, nurses who were in the units with lower nurse-to-patient ratios reported higher scores on RONC, which meant that an increased level of withheld nursing care or a failure to carry out nursing duties was apparent. Nurses who reported a higher score on RONC, scored poorly on the quality assessment and were more frequently involved in patient adverse events. Nurse staffing influenced quality assessments and patient adverse events through RONC. In units with poorer nurse-reported quality assessments or more frequently patient adverse events, patient-reported dissatisfaction scores were higher. Conclusions: The results suggest that a lack of nurse staffing leads to RONC, which leads to poorer patient outcomes. These results are seen when considering the evaluations completed by both nurses and patients. The relationship between staffing numbers and patient outcomes explains the mediating role of RONC.

Practice Environment Scale of the Nursing Work Index: A Reliability Generalization Meta-Analysis

A healthy work environment is a critical factor in nurse satisfaction, retention, and patient outcomes. The Practice Environment Scale of the Nursing Work Index (PES-NWI) is the most commonly used instrument to measure the nursing practice environment. This study uses meta-analysis to examine the reliability generalization of the PES-NWI. A meta-analysis of 51 studies representing a total of 80,563 subjects was conducted. The mean score reliability for the PES-NWI based on 38 studies ( n = 68,278) was .922 ( p < .05). The Mean Weighted Effect Size was stronger for studies conducted in the United States versus non-U.S. (.946 vs. .907). For studies rated high and moderate quality, the mean score reliability was .911 and .946, respectively. Scores on the PES-NWI are reliable for measuring the nursing practice environment across samples in the United States and non-U.S. countries.

Reliability and validity of the practice environment scale of the nursing work index for Japanese hospital nurses

AIMS

The aim of this study was to examine the reliability and validity of the Practice Environment Scale of the Nursing Work Index (PES-NWI) for hospital nurses in Japan.

DESIGN

A cross-sectional mail survey.

METHODS

Participants in this study were 1,219 full-time ward nurses from 27 hospitals in Japan, using 31 items of the Japanese version of the PES-NWI questionnaire, from December 2008-March 2009. Construct validity, criterion-related validity and internal consistency of the PES-NWI were tested.

RESULTS

The PES-NWI showed reliable internal consistency. The five-factor structure was supported by confirmatory factor analysis. The PES-NWI correlated significantly with job satisfaction, burnout and the nurses' intention to stay on the job, supporting criterion-related validity.

Factors Associated with Emotional Exhaustion in South Korean Nurses: A Cross-Sectional Study

OBJECTIVE

We examined associations between emotional exhaustion and selected sociodemographic and psychological factors among nurses in inpatient and outpatient nursing units at a university hospital in South Korea.

METHODS

The participants were 386 nurses who completed the Maslach Burnout Inventory, a measure of emotional exhaustion. Psychological characteristics were evaluated, including hardiness, self-esteem, experience of trauma, resilience, perceived stress, and social support. Correlation analyses examined the relationships between emotional exhaustion with sociodemographic, occupational, and psychological characteristics. Linear regression was used to evaluate the associations between emotional exhaustion and the assessed characteristics.

RESULTS

Higher emotional exhaustion scores were associated with greater depression, anxiety, traumatic experience, and perceived stress. Exhaustion was inversely associated with hardiness, self-esteem, resilience, and quality of life. The regression analysis indicated that gender, marriage, resilience, depression, perceived stress, and secondary traumatic stress were significantly associated with emotional exhaustion.

CONCLUSION

This study showed that psychological characteristics, such as resilience, depression, and secondary traumatic experiences, may cause emotional exhaustion. Understanding the needs of people with distinct demographic and psychological characteristics offers valuable direction for the development of intervention programs to prevent burnout among nurses.

The Effects of Nursing Satisfaction and Turnover Cognitions on Patient Attitudes and Outcomes: A Three-Level Multisource Study

OBJECTIVE

To explore antecedents and outcomes of nurse self-reported job satisfaction and dissatisfaction-based turnover cognitions, theorizing (using Self-Determination Theory) that leaders can foster work conditions that help fulfill innate needs, thereby fostering satisfaction of nurses and patients, and reducing adverse events.

DATA SOURCES/STUDY SETTING

Primary and secondary data were collected within a 4-month period in 2015, from 2,596 nurses in 110 Army treatment facilities (hospitals and clinics) across 35 health care systems.

DATA COLLECTION/EXTRACTION

We collected individual nurse responses to the Practice Environment Scale-Nursing Work Index, in addition to aggregated archival data from the same timeframe, including both facility-level patient satisfaction records (the Army Provider Level Satisfaction Survey) and health care system-level adverse events records (provided by the Army Programming, Analysis, and Evaluation office).

PRINCIPAL FINDINGS

Five predictors of nurse satisfaction and turnover cognitions emerged-supportive leadership, staffing levels, nurse-physician teamwork, adoption of nursing care practice, and advancement opportunities. Aggregated nurse satisfaction was the most consistent predictor of both patient satisfaction and adverse events.

CONCLUSION

These findings provide evidence of the importance of nurse attitudes in improving perceived and actual performance across facilities and health care systems; in addition to practical steps, managers can take to improve satisfaction and retention.

Organizational Factors and Burnout of Perioperative Nurses

BACKGROUND

Knowing the organizational factors that predict burnout in perioperative nurses is paramount for improving the care of patients and promoting nurses' psychosocial well-being and health.

OBJECTIVE

To determine the influence of organizational factors of the perioperative nurse's work environment on the three burnout dimensions: emotional exhaustion, despersonalization, and personal accomplishment.

METHOD

A cross-sectional study was conducted among 136 nurses in a perioperative care unit at a university hospital in Barcelona, Spain. Data were collected using a demographic data form, and the Spanish versions of the Practice Environment Scale of the Nursing Work Index and Maslach Burnout Inventory.

RESULTS

Findings showed emotional exhaustion in 43% (56) of nurses, depersonalization in 21% (28), and reduced personal accomplisment in 53% (69). The degree of general burnout was moderate.The work environment was considered unfavourable as only one factor of five was favourable (Nursing foundations of quality care). Multiple regression analyses showed three organizational factors were associated with all three dimensions of burnout: "Nurse manager ability, leadership, and support of nurses"; "Staffing and resources adequacy"; and "Nursing foundations of quality care".

CONCLUSIONS

In this study three organizational factors played a significant role in predicting burnout among perioperative nurses. We recommend hospital management implement policies to improve these organizational factors. Promoting positive leadership styles, providing necessary resources, and creating a positive climate in the work environment could increase psychosocial wellbeing and decrease burnout among perioperative nurses.

Relationships between Army nursing practice environments and patient outcomes

Favorable nursing practice environments have been associated with lower patient mortality, failure to rescue, nurse-administered medication errors, infections, patient complaints, and patient falls. Favorable environments have also been associated with higher nurse-reported care quality and patient satisfaction in civilian hospitals. However, limited information exists on the relationship between favorable nursing practice environments and positive outcomes in military facilities. Using 4 years of secondary data collected from 45 units in 10 Army hospitals, generalized estimating equations were used to test the associations between nurses' scores on the Practice Environment Scale of the Nursing Work Index (PES-NWI) and patient outcomes of falls with and without injury, medication administration errors with and without harm, and patient experience. Four significant associations were found between the PES-NWI subscales and the patient outcomes under study. The Staffing and Resource Adequacy subscale was significantly associated with patient falls, the Collegial Nurse Physician Relations subscale was significantly associated with the rate of nurse-administered medication errors, and the Nursing Foundations for Quality Care and Collegial Nurse Physician Relations subscales were both significantly associated with patient experience with nursing care. As in civilian hospitals, favorable nursing practice environment was associated with improved patient outcomes within these military nursing units.

A program evaluation of the Patient CaringTouch System: A pre- and postimplementation assessment

BACKGROUND

The Patient CaringTouch System (PCTS) is an innovative, strategic and patient-centric framework developed by the Army Nurse Corps for nursing care delivery that is designed to reduce nursing care variation and improve patient and nurse outcomes.

PURPOSE

This manuscript describes a program evaluation of the PCTS.

METHODS

A pre and post design was used to describe changes in patient and nursing measures following PCTS implementation.

DISCUSSION

Overall there was a good uptake of the PCTS; however, concurrent with initiation of the PCTS, declines in staffing levels and increases in patient acuity were noted. Medication administration error rates declined, but fall with injury rates increased. Pain reassessment following pain medication administration improved, as did several aspects of the nursing practice environment. Nurses' job dissatisfaction and intent to leave increased; however, potentially preventable losses decreased.

CONCLUSIONS

The program evaluation results will be used to target areas for improvement so that the PCTS may be sustained.

Exploring experiences of the quality of nursing care among patients, nurses, caregivers and physicians in a haemodialysis department

BACKGROUND AND OBJECTIVES

Providing high-quality care to patients undergoing haemodialysis (HD) is a priority for nurses. The present study was conducted to explore the experiences of the quality of nursing care among patients, nurses, caregivers and physicians in an HD department in Iran.

METHODS

This was a qualitative study, set in the HD department of Kowsar Hospital in Semnan, Iran. A total of 20 participants (patients, caregivers, nurses and doctors) were selected and were invited to semi-structured interviews with open-ended questions. The data obtained were analysed using conventional content analysis.

FINDINGS

The analysis of the data led to the extraction of four themes: maintaining health, person/client, nursing responsibility and environment.

CONCLUSION

The findings of the present study showed that maintaining health, person/client interaction, nursing responsibility and environment are four important nursing metaparadigms that affect the quality of nursing care in HD departments.

Effects of nurse work environment on job dissatisfaction, burnout, intention to leave

BACKGROUND

The nursing shortage is a critical issue in many countries. High turnover rates among nurses is contributing to the shortage, and job dissatisfaction, intention to leave, and burnout have been identified as some of the predictors of nurse turnover. A well-established body of evidence demonstrates that the work environment for nurses influences nurse job dissatisfaction, intention to leave, and burnout, but there never has been a study undertaken in Thailand to investigate this relationship.

OBJECTIVES

To investigate how work environment affects job dissatisfaction, burnout, and intention to leave among nurses in Thailand.

METHODS

The study used a cross-sectional survey to collect data from 1351 nurses working in 43 inpatient units in five university hospitals across Thailand. The participants completed the Practice Environment Scale of the Nursing Work Index, the Maslach Burnout Inventory, and measures of job dissatisfaction and intention to leave. Logistical regression models assessed the association between work environment and nurse-reported job dissatisfaction, burnout, and intent to leave.

RESULTS

Nurses working in university hospitals with better work environments had significantly less job dissatisfaction, intention to leave, and burnout.

CONCLUSION

The nurse work environment is a significant feature contributing to nurse retention in Thai university hospitals.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Improving the work environment for nurses may lead to lower levels of job dissatisfaction, intention to leave, and burnout. Focusing on these nurse outcomes can be used as a strategy to retain nurses in the healthcare system. Addressing the challenges of poor work environments requires coordinated action from policymakers and health managers.

Job satisfaction, work environment and intention to leave among migrant nurses working in a publicly funded tertiary hospital

AIM(S)

This study sought to explore the job satisfaction level of migrant nurses working in a multicultural society and, more specifically, the relationship between their job satisfaction levels, work environment, their intentions to leave and the predictors of their intentions to leave.

BACKGROUND

Nursing shortages have led to the increasing trend of employing migrant nurses, which necessitated studies examining nurses' migration.

EVALUATION

A cross-sectional, correlational design using a stratified random sample was conducted on 495 migrant nurses working in a tertiary public-funded hospital in Singapore.

RESULTS

The results showed that migrant nurses were satisfied with their jobs; with job satisfaction negatively correlated with work environment. Interestingly, pre-existing groups of Chinese migrant nurses did not help newly arrived Chinese migrant nurses to assimilate better. Predictors of migrant nurses' intentions to leave included having supportive nurse managers and nursing practice environment.

CONCLUSIONS

The presence of a supportive work environment is essential to retain migrant nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

Health administrators need to empower nursing managers with skills to implement career development plans as part of hospitals' retention strategies for migrant nurses. Information should also be provided during recruitment campaigns to enable migrant nurses to make informed choices.

Organizational climate and employee mental health outcomes: A systematic review of studies in health care organizations

BACKGROUND

In recent years, the high prevalence of mental health problems among health care workers has given rise to great concern. The academic literature suggests that employees' perceptions of their work environment can play a role in explaining mental health outcomes.

PURPOSES

We conducted a systematic review of the literature in order to answer the following two research questions: (1) how does organizational climate relate to mental health outcomes among employees working in health care organizations and (2) which organizational climate dimension is most strongly related to mental health outcomes among employees working in health care organizations?

METHODOLOGY/APPROACH

Four search strategies plus inclusion and quality assessment criteria were applied to identify and select eligible studies. As a result, 21 studies were included in the review. Data were extracted from the studies to create a findings database. The contents of the studies were analyzed and categorized according to common characteristics.

FINDINGS

Perceptions of a good organizational climate were significantly associated with positive employee mental health outcomes such as lower levels of burnout, depression, and anxiety. More specifically, our findings indicate that group relationships between coworkers are very important in explaining the mental health of health care workers. There is also evidence that aspects of leadership and supervision affect mental health outcomes. Relationships between communication, or participation, and mental health outcomes were less clear.

PRACTICAL IMPLICATIONS

If health care organizations want to address mental health issues among their staff, our findings suggest that organizations will benefit from incorporating organizational climate factors in their health and safety policies. Stimulating a supportive atmosphere among coworkers and developing relationship-oriented leadership styles would seem to be steps in the right direction.

Nurse perceptions of organizational culture and its association with the culture of error reporting: a case of public sector hospitals in Pakistan

Background

There is an absence of formal error tracking systems in public sector hospitals of Pakistan and also a lack of literature concerning error reporting culture in the health care sector. Nurse practitioners have front-line knowledge and rich exposure about both the organizational culture and error sharing in hospital settings. The aim of this paper was to investigate the association between organizational culture and the culture of error reporting, as perceived by nurses.

Methods

The authors used the “Practice Environment Scale-Nurse Work Index Revised” to measure the six dimensions of organizational culture. Seven questions were used from the “Survey to Solicit Information about the Culture of Reporting” to measure error reporting culture in the region. Overall, 309 nurses participated in the survey, including female nurses from all designations such as supervisors, instructors, ward-heads, staff nurses and student nurses. We used SPSS 17.0 to perform a factor analysis. Furthermore, descriptive statistics, mean scores and multivariable logistic regression were used for the analysis.

Results

Three areas were ranked unfavorably by nurse respondents, including: (i) the error reporting culture, (ii) staffing and resource adequacy, and (iii) nurse foundations for quality of care. Multivariable regression results revealed that all six categories of organizational culture, including: (1) nurse manager ability, leadership and support, (2) nurse participation in hospital affairs, (3) nurse participation in governance, (4) nurse foundations of quality care, (5) nurse-coworkers relations, and (6) nurse staffing and resource adequacy, were positively associated with higher odds of error reporting culture. In addition, it was found that married nurses and nurses on permanent contract were more likely to report errors at the workplace.

Conclusion

Public healthcare services of Pakistan can be improved through the promotion of an error reporting culture, reducing staffing and resource shortages and the development of nursing care plans.

Exploring the Impact of Toxic Attitudes and a Toxic Environment on the Veterinary Healthcare Team

The objective of this qualitative study was to compare veterinarians' and Registered Veterinary Technicians' (RVT's) perceptions of the veterinary healthcare team with respect to the impact of toxic attitudes and a toxic environment. Focus group interviews using a semi-structured interview guide and follow up probes were held with four veterinarian groups (23 companion animal veterinarians) and four Registered Veterinary Technician groups (26 RVTs). Thematic analysis of the discussions indicated both veterinarian and RVT participants felt team members with manifestations of toxic attitudes negatively impacted veterinary team function. These manifestations included people being disrespectful, being resistant to change, always wanting to be the "go to person," avoiding conflict, and lacking motivation. When conflict was ignored, or when people with toxic attitudes were not addressed, a toxic environment often resulted. A toxic environment sometimes manifested when "broken communication and tension between staff members" occurred as a result of employees lacking confidence, skills, or knowledge not being managed properly. It also occurred when employees did not feel appreciated, when there was difficulty coping with turnover, and when there were conflicting demands. The presence of people manifesting a toxic attitude was a source of frustration for both veterinarian and RVT participants. Prompt and consistent attention to negative behaviors is recommended to reduce the development of a toxic environment.

Nurses' Practice Environment and Their Job Satisfaction: A Study on Nurses Caring for Older Adults in Shanghai

AIM

To examine the job satisfaction of nurses who are caring for older adults in healthcare settings in Shanghai, and to explore the underlying factors in order to explain and predict nurses' job satisfaction.

BACKGROUND

China has the largest elderly population in the world, and its population is aging rapidly. Studies on job satisfaction of nurses providing care for the elderly in China can help to identify problem areas and develop strategies for the improvement of nurses' working conditions. However, to date, this subject matter has not been thoroughly studied in the Chinese context. Previous studies in other countries show that many factors impact nurses' job satisfaction, with the practice environment being a critical factor. There is a serious nursing shortage in China, especially in the big cities such as Shanghai. Given the increasing care demand of the aging population, learning about the job satisfaction level among nurses who are caring for older adults can provide essential information to help attract and retain nurses in this specialty area.

METHODS

A cross-sectional survey was conducted among 444 nurses in 22 elderly care institutions in Shanghai. The Chinese version of the Index of Work Satisfaction (IWS) and the Nursing Practice Environment Scale were instruments used. Inferential statistical tests used to analyze the data included Spearman correlation analysis, one-way analysis of variance, and hierarchical regression tests.

RESULTS

The average overall IWS (part B) score was 135.21 ± 19.34. Personality, job and organizational characteristics were found to be the most influential factors, and the practice environment was identified as having the strongest impact on job satisfaction (Beta = 0.494).

CONCLUSION

Job satisfaction level among nurses who are caring for older adults in Shanghai is moderate, but the data suggest that this could be greatly increased if the nursing practice environment was improved.

Evaluation of Elements of the Nursing Worklife Model Using Unit-Level Data

The practice environment is important to nurse satisfaction and patient outcomes. Laschinger and Leiter posited causal relationships by development and testing of the Nursing Worklife Model (NWLM). Using a secondary analysis of unit-level data (N = 3,203; medical, surgical, medical-surgical, critical-care, and step-down units) from the 2011 National Database for Nursing Quality Indicators®, hypothesized pathways of the NWLM were tested using structural equation modeling. Practice Environment subscales developed by Lake were used to operationalize model variables with job enjoyment being the outcome variable. Positive pathways identified in the original causal model were supported. However, using an iterative process, additional pathways were identified that improved model fit (comparative fit index = 0.99; root mean square error of approximation = 0.06; standardized root mean square residual = 0.002). Nurse manager ability, leadership, and support had direct links to job enjoyment as well as other elements of the model. Development of nurse managers is important to the retention of clinical nurses in the hospital setting.

Methodological considerations when translating "burnout"

No study has systematically examined how researchers address cross-cultural adaptation of burnout. We conducted an integrative review to examine how researchers had adapted the instruments to the different contexts. We reviewed the Content Validity Indexing scores for the Maslach Burnout Inventory-Human Services Survey from the 12-country comparative nursing workforce study, RN4CAST. In the integrative review, multiple issues related to translation were found in existing studies. In the cross-cultural instrument analysis, 7 out of 22 items on the instrument received an extremely low kappa score. Investigators may need to employ more rigorous cross-cultural adaptation methods when attempting to measure burnout.

Study of adaptation and validation of the Practice environment scale of the nursing work index for the portuguese reality

Objective: Testing the psychometric properties of the Portuguese version of the Practice Environment Scale of the Nursing Work Index. Method: A descriptive, analytical and cross-sectional study, for the cross-cultural adaptation and validation of the psychometric properties of the scale. The study participants were 236 nurses from two hospitals in the regions of Lisbon and Vale do Tejo. Results: The 0.92 Cronbach’s alpha was obtained for overall reliability and support of a five-dimension structure. Conclusion: The excellent quality of adjustment of analysis confirms the validity of the adapted version to hospital care settings, although there was no total coincidence of items in the five dimensions


Using evidence-based leadership initiatives to create a healthy nursing work environment

In an effort to create a healthy nursing work environment in a military hospital Intermediate Care Unit (IMCU), a facility-level Evidence Based Practice working group composed of nursing.Stakeholders brainstormed and piloted several unit-level evidence-based leadership initiatives to improve the IMCU nursing work environment. These initiatives were guided by the American Association of Critical Care Nurses Standards for Establishing and Sustaining Healthy Work Environments which encompass: (1) skilled communication, (2) true collaboration, (3) effective decision making, (4) appropriate staffing, (5) meaningful recognition, and (6) authentic leadership. Interim findings suggest implementation of these six evidence-based, relationship-centered principals, when combined with IMCU nurses' clinical expertise, management experience, and personal values and preferences, improved staff morale, decreased staff absenteeism, promoted a healthy nursing work environment, and improved patient care.

The relationship between individualized care and the practice environment: an international study

BACKGROUND

Previous research studies have found that the better the quality of practice environments in hospitals, the better the outcomes for nurses and patients. Practice environment may influence nurses' ability to individualize care but the detailed relationship between individualized care and the professional practice environment has not been investigated widely. Some evidence exists about the association of practice environments with the level of individualization of nursing care, but this evidence is based on single national studies.

OBJECTIVES

The aim of this study was to determine whether nurses' views of their professional practice environment associate with their views of the level of care individualization in seven countries.

DESIGN

This study had an international, multisite, prospective, cross-sectional, exploratory survey design.

SETTINGS

The study involved acute orthopedic and trauma surgical inpatient wards (n=91) in acute care hospitals (n=34) in seven countries, Cyprus, Finland, Greece, the State of Kansas, USA, Portugal, Sweden, and Turkey.

PARTICIPANTS

Nurses (n=1163), registered or licensed practical, working in direct patient care, in orthopedic and trauma inpatient units in acute care hospitals in seven countries participated in the study.

METHODS

Self-administered questionnaires, including two instruments, the Revised Professional Practice Environment and the Individualized Care Scale-Nurse (Individualized Care Scale-Nurse A and B) were used for data collection. Data were analyzed statistically using descriptive statistics, simultaneous multiple regression analysis, and generalized linear model.

RESULTS

Two regression models were applied to assess the predictive validity of the Revised Professional Practice Environment on the Individualized Care Scale-Nurse-A and B. The results showed that elements of the professional practice environment were associated with care individualization. Internal work motivation, cultural sensitivity, control over practice, teamwork, and staff relationship with physicians were predictors of support (Individualized Care Scale-A) for and the delivery (Individualized Care Scale-B) of individualized care.

CONCLUSIONS

The results of this study provide evidence that environment aspect could explain variations in care individualization. These findings support the assertion that individualized care needs to be understood in a broader context than the immediate nurse-patient relationship and that careful development of the care environment may be an effective way to improve care quality and outcomes.