A multilevel analysis of the relationships between the Practice Environment Scale of the Nursing Work Index and nursing outcomes. (original) (raw)
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Research in Nursing & Health, 2013
Few researchers have examined how the components of the Practice Environment Scale of the Nursing Work Index (PES-NWI) relate to nurses' well-being at multiple organizational levels. The objective of the study was to perform a multilevel assessment of the relationships of the PES-NWI subscales with three nurse outcomes: job satisfaction, emotional exhaustion, and turnover intentions. Additionally, we tested the multilevel factor structure of the PES-NWI. In a sample of 699 fulltime registered nurses in 79 units and 9 branches of a hospital system, relationships of the NWI with nurse outcomes were fairly consistent across levels of analysis. However, subscales contributed differently to the three outcomes, demonstrating the complexity of environmental influences on nurses' work experience.
Assessment of the nurses' work environment using the nursing work index scale
Cumhuriyet Medical Journal, 2016
One of the major reasons for the increase in nurse turnover rate in hospitals is the nurses' negative work environment. The negativity of the work environment reduces nurses' performance and adversely affects the quality of patient care and patient and health care workers safety. This present study was conducted to determine nurses' assessment of the work environments. Method: In this cross-sectional study, the study sample comprised 174 nurses who worked in Cumhuriyet University Hospital between October-November 2014, agreed to participate in the study and filled in the data collection forms completely. Data were collected with the sociodemographic characteristics questionnaire and the "Nursing Work Index-the Practice Environment Scale". Results: The mean age of the participating nurses was 32.09 ± 7:09. Of them, 86.8% were women, 64.9% were married, 74.7% had a graduate degree, 84.5% were permanently employed, 32.2% had a working experience in the profession less than 5 years and 79.9% were the members of a union or association. The total mean score obtained from the scale was X = 2.16 ± 0.49. Of the participants in the study, those who were male, contractual employees and/or members of a professional organization and whose length of service was under 5 years perceived their work environment more positively (p <0.05). No statistically significant relationship was determined between the total scores and variables 'age, education level, professional title, and average monthly income level' (p> 0.05). Conclusions: It was found that the participating nurses assessed the work environment as moderately whereas they perceived the "adequacy of manpower and other resources" subscale negatively.
Relationships among healthy work environments, nurse retention and nurses' job satisfaction
2013
Retention of nurses in the workplace is a primary focus of health care systems worldwide. When one nurse leaves a position in an acute care hospital, replacement costs range from 40,000−40,000-40,000−82,000 (Twibell et al., 2012). Research has suggested that nurses' job satisfaction and work environments may influence nurse retention. However, research has not yet clarified the relationships among healthy work environments, nurses' job satisfaction, and nurses' job retention in diverse geographic areas. The aim of this study was to explore the relationships among healthy work environments, nurses' job satisfaction, and nurses' job retention. The framework for the correlational study was based on structural contingency theory (Baernholdt & Mark, 2009). The convenience sample consisted of 300 registered nurses who worked in one of 20 hospitals in a midwestern health care system. Instrumentation included the Healthy Work Environment Assessment tool (American Association of Critical Care Nurses, 2010) and an organizational job satisfaction scale (Hinshaw & Atwood, 1984). Nurse retention was calculated from job turnover rates. Results will illuminate factors that may be related to nurse retention and provide guidance for nursing leaders who aim to improve retention, enhance nurses' job satisfaction, and support healthy work environments.
Journal of Clinical Nursing, 2010
Aim. To investigate impacts of practice environment factors and burnout at the nursing unit level on job outcomes and nurseassessed quality of care in acute hospital nurses. Background. Prior research has consistently demonstrated correlations between nurse practice environments and nurses' job satisfaction and health at work, but somewhat less evidence connects practice environments with patient outcomes. The relationship has also been more extensively documented using hospital-wide measures of environments as opposed to measures at the nursing unit level. Design. Survey. Method. Data from a sample of 546 staff nurses from 42 units in four Belgian hospitals were analysed using a two-level (nursing unit and nurse) random intercept model. Linear and generalised linear mixed effects models were fitted including nurse practice environment dimensions measured with the Revised Nursing Work Index and burnout dimensions of the Maslach Burnout Inventory as independent variables and job outcome and nurse-assessed quality of care variables as dependent variables. Results. Significant unit-level associations were found between nurse practice environment and burnout dimensions and job satisfaction, turnover intentions and nurse-reported quality of care. Emotional exhaustion is a predictor of job satisfaction, nurse turnover intentions and assessed quality of care as well besides various nurse work practice environment dimensions. Nurses 'ratings of unit-level management and hospital-level management and organisational support had effects in opposite directions on assessments of quality of care at the unit; this suggests that nurses' perceptions of conditions on their nursing units relative to their perceptions of their institutions at large are potentially influential in their overall job experience. Conclusion. Nursing unit variation of the nurse practice environment and feelings of burnout predicts job outcome and nursereported quality of care variables. Relevance to clinical practice. The team and environmental contexts of nursing practice play critical roles in the recruitment and retention of nurses, and as well as in the quality of care delivered. Widespread burnout as a nursing unit characteristic, reflecting a response to chronic organisational stressors, merits special attention from staff nurses, physicians, managers and leaders.
Impact of Work Environment on Nurses' Job Satisfaction and Well-Being
2014
In compliance with IRSST policy, the research results published in this document have been peer-reviewed. PEER REVIEW IRSST-Impact of Work Environment on Nurses' Job Satisfaction and Well-Being: Improving End-of-Life Care and Services i SUMMARY Because the population is aging, the demand for palliative care (PC) at the end of life (EoL) is on the rise, and healthcare services are organizing themselves accordingly. In Quebec, EoLPC is mainly found in combination with curative care. There are very few facilities dedicated to palliative care; instead, it is dispensed as part of home care or in the specialized wards of hospital centres, such as oncology or critical care, where nurses play a major role. Because of this organizational choice, nurses experience a very particular work context, since they have to take a mixed approach and dispense both curative care-which can be complex at times-and EoLPC, all under considerable time pressure. In hospitals, where the primary aim is to cure illness, death is often perceived as a failure. This is a source of occupational stress and dissatisfaction for nurses, who have to deal with death frequently, and sometimes the death is a difficult one. They can experience moral conflict and ethical suffering. In addition, there are other stress factors-such as intensification of work and lack of autonomy-that can affect their job satisfaction and well-being. Against a backdrop of labour shortages and increasing difficulty attracting and retaining nurses, these are very worrisome observations, since job dissatisfaction and high turnover could jeopardize the quality of healthcare. In light of these facts, it appears more and more imperative that nurses' job satisfaction and adaptability be taken into account in the organization of services and development of PC programs. The aim of our project is to improve the conditions in which EoLPC is dispensed. Five studies were conducted to identify problems in this sector of healthcare and to suggest avenues for action. STUDY 1. Study of stress factors in ICUs Objective: To describe the stressors experienced by nurses dispensing EoLPC in intensive-care units (ICUs) in various hospitals in Quebec. Method: We selected five ICUs in three regions of Quebec, taking care to ensure diversity in terms of location (urban or rural), organization of care and services (open or closed ICU) 1 and status (university-affiliated or not). We recruited a sample of 42 nurses (day, evening, night and rotating shifts). Ten focus groups were held. Observations: The stressors linked to EoLPC nursing in an ICU are numerous and can be grouped into three categories: organizational, professional and emotional. STUDY 2. Ergonomic study of EoL care in ICUs Objectives: To describe EoLPC services on the basis of direct observations in an ICU, and to explore the factors that influence job satisfaction for nurses. Method: Thirty shifts were observed in two of the five sites used in Study 1. Observations: The ergonomic study revealed several shortcomings in the dispensing of EoL care. The nurses seem to have little say in decisions, and the work is not organized with dying patients in mind. EoL care seems neglected; neither the protocols nor the resources (time, space, training) are adequate. The study also showed, however, that something that can be a source of difficulty can, under other conditions, become a source of job satisfaction. Impact of Work Environment on Nurses' Job Satisfaction and Well-Being: Improving End-of-Life Care and Services-IRSST STUDY 3. Study on moral stressors and ethical dilemmas in ICUs Objectives: To gain a deeper understanding of moral stressors, to identify ethical dilemmas and their connection with ethical suffering, and to better comprehend how such dilemmas are solved. Method: Individual interviews with 28 nurses (same selection criteria as in Study 1). Observations: The nurses reported the following moral stressors and ethical dilemmas: (a) what they perceive as futile medical care; (b) withdrawal of treatment and what they perceive as euthanasia; (c) being powerless to relieve someone's suffering; (d) failure to respect the patient's wishes; (e) lies about the patient's condition. This study highlights the nurse's solitude when faced with an EoL ethical dilemma. Nurses have no safe space for discussion that would enable them to restore meaning to their work, and so they retreat into silence that can last for years. In this way, ethical dilemmas lead to ethical suffering. STUDY 4. Study on conditions conducive to the resolution of ethical dilemmas Objective: To describe organizational practices that support the resolution of moral dilemmas, as seen from the perspective of managers. Method: Individual interviews, n=21 managers at the same sites as in studies 1 and 3. Observations: Analysis of the managers' discourse reveals their powerlessness and provides little in the way of possible solutions. Developing ethical skill through a systematic training program could be one avenue for attenuating work-related ethical suffering. STUDY 5. Study of a stress model for better understanding of nurses' job satisfaction and well-being Objectives: To improve the stress model (demands/resources) developed during previous research, and to determine whether this enriched model can explain the job satisfaction and distress experienced by nurses providing EoLPC. Method: Population-based, cross-sectional study of correlations. Inclusion criteria: Participants had to belong to the OIIQ (Ordre des infirmières et infirmiers du Québec), had to practise in the Province of Quebec, and had to be dispensing palliative care, either in palliative care settings, in people's homes, in oncology or in critical care (n=751). Observations: The enriched model supports the conclusions of the four qualitative studies described above. It incorporates several key concepts: recognition of the nurse's autonomy, the quality of teamwork, access to qualified human resources, and relief of the patient's and family's suffering. IRSST-Impact of Work Environment on Nurses' Job Satisfaction and Well-Being: Improving End-of-Life Care and Services 1
Journal of Nursing Scholarship
Globally, acute care nurses have high levels of burnout and report high intention to leave their organization (Elbarazi, Loney, Yousef, & Elias, 2017; Van Bogaert, Timmermans, et al., 2014). Burnout has been associated with lower ratings of nurse-reported quality of patient care (Van Bogaert, Kowalski, Weeks, van Heusden, & Clarke, 2013), increasing absenteeism, and turnover intention (Sasso et al., 2019). Thus, identification of factors influencing nurses' burnout and turnover intention is critical for enhancing the quality of patient care. Burnout among nurses and turnover intention seem to be driven by both individual and work-related factors. Evidence has shown that nurses are more likely to leave their job if they are male or if they hold a higher education degree (Delobelle et al., 2011). However, the evidence regarding the relationship between the level of education and nurse turnover intention is inconsistent. For example, Labrague, McEnoroe-Petitte, et al. (2018) found that nurses with a master's degree reported lower turnover intention than nurses with a
Nursing Practice Environment And Job Satisfaction From The Perspective of Staff Nurses
2017
Background: Nursing work environment is under the spotlight of international interest as it has been scientifically approved to help in providing opportunities to improve working conditions which play a major role in maintaining adequate level of staff, and other nurses' outcome such as job satisfaction and retention. Aim: This study aimed to examine the practice environment of nurses and the level of job satisfaction from the perspective of staff nurses. Method: Quantitative, cross-sectional descriptive correlational design was used in this study to examine the practice environment of nurses and the level of job satisfaction from the perspective of staff nurses at five governmental hospitals in Makkah. Data was collected using a Likert scale questionnaire using nursing practice environmentnurse work index (PES-NWI) and Mueller & McCloskey satisfaction scale (MMSS)from nurses(N=239). Results:The overall weighted mean of the nursing practice environment is 2.80. The highest weigh...
Effects of work environments on nurse and patient outcomes
Journal of Nursing Management, 2010
Aim To determine the relationship between nursesÕ perceptions of their work environment and quality/risk outcomes for patients and nurses in acute care settings. Background Nurses are leaving the profession as a result of high levels of job dissatisfaction arising from current working conditions. To gain organizational support for workplace improvements, evidence is needed to demonstrate the impact of the work environment on patient care. Method A multi-level design was used to collect data from nurses (n = 679) and patients n = 1005) within 61 medical and surgical units in 21 hospitals in Canada. Results Using multilevel structural equation modelling, the hypothesized model fitted well with the data [v 2 = 21.074, d.f. = 10, Comparative Fit Index (CFI) = 0.985, Tucker-Lewis Index (TLI) = 0.921, Root Mean Square Error of Approximation (RMSEA) = 0.041, Standardized Root Mean Square Residual (SRMR) 0.002 (within) and 0.054 (between)]
Journal of Health, Medicine and Nursing
During the new and modern era, the organizations are facing many challenge and diversity of workforces in the health care system because the nursing environment has energetic characteristics for nurses. In addition, nurses are exposed to an unfavorable environment that affects their practice. Therefore, the healthy nursing work environment is essential for increasing satisfaction of their professional nurses needs through attracting, retaining, and rendering quality of patient care in the hospitals. This study aims to investigate the perception of the nursing work environment on nurses' job outcomes at primary health care centers-Jeddah. A descriptive correlational namely cross-sectional design was employed to collect data using non-probability convenience sampling technique from a group of nurses who accept to participate in the study and working at three primary health care centers affiliated to the Ministry of National Guard in Jeddah region namely; Al-Bahra, Alwaha, and Al-Eskan. The questionnaires were administered to the nurses for data collection using socio-demographic characteristics, Revised Nurse Working Index (NWI-R), Nurses' job outcome was measured through of (a) job satisfaction, (b) intention to leave, and (c) quality of nursing care. Statistical analysis was done using SPSS 20.0. Also, data was analyzed by using descriptive statistics such as mean and standard deviation and inferential statistics such t-tests (two-tailed) and one way analysis of variance (ANOVA) and Pearson correlations were conducted to investigate the relationships of nursing work environments and the nurses job outcome. In this study the level of significant was set at 0.05.The present study finds that majority of the nurses had a highest percentage of nursing work environment dimensions. For achieving a high level of nursing work environment it is found that there is statistically significant relationship with nurses' job outcomes in term of job satisfaction. Most of the nurses were satisfied with the work and have the highest means scores in term of growth satisfaction, followed by Co-workers and supervision. Job security was reported to have lowest means scores by nurses. There was a significant relationship between socio-demographic variables with the nursing work environment and nurses' job outcomes in term of primary health care centers, educational qualification, and age group. This study recommended that Hospital administrators should advocate and support the policies and regulations that foster nurses' satisfaction by providing a strong nursing work environment and recognizing more productivity for delivering nursing care in primary health care settings