Abstract
Aim: To explore the mechanisms through which nurse practice environment dimensions, such as nurse–physician relationship, nurse management at the unit level and hospital management and organizational support, are associated with job outcomes and nurse-assessed quality of care. Mediating variables included nurse work characteristics of workload, social capital, decision latitude, as well as work engagement dimensions of vigor, dedication and absorption.Background: Understanding how to support and guide nurse practice communities in their daily effort to answer complex care most accurate, alongside with the demand of a stable and healthy nurse workforce, is challenging.Design: Cross-sectional survey.Method: Based on earlier empirical findings, a structural equation model, designed with valid measurement instruments, was tested. The study population included registered acute care hospital nurses (N = 1201) in eight hospitals across Belgium.Results: Nurse practice environment dimensions predicted nurses’ ratings of job outcome variables as well as quality of care. Features of nurses’ work characteristics, e.g., perceived workload, decision latitude, social capital, and the three dimension of work engagement, played mediating roles between nurse practice environment and outcomes. A revised model, using various fit measures, explained 60% of job outcomes and 47% of nurse-assessed quality of care.Conclusion: The findings in this study show that nurse work characteristics as workload, decision latitude, and social capital, alongside with nurse work engagement (e.g., vigor, dedication, and absorption) influence nurses’ perspective of their nurse practice environment, job outcomes, and quality of care. The results underline aspects to considerate for various stakeholders, such as executives, nurse managers, physicians, and staff nurses, in setting up and organizing health care services.
Highlights
Stress and well-being in staff nurses are relevant indicators of nurses’ working conditions, the inter-personal mono- and interdisciplinary relationships with colleagues, with patients and the quality of care nurses provide
The findings in this study show that nurse work characteristics as workload, decision latitude, and social capital, alongside with nurse work engagement influence nurses’ perspective of their nurse practice environment, job outcomes, and quality of care
The results underline aspects to considerate for various stakeholders, such as executives, nurse managers, physicians, and staff nurses, in setting up and organizing health care services
Summary
Stress and well-being in staff nurses are relevant indicators of nurses’ working conditions, the inter-personal mono- and interdisciplinary relationships with colleagues, with patients and the quality of care nurses provide. International insights and empirical studies show the importance of balanced, healthy and supportive nurse practice environments and psychosocial work environments to achieve and sustain stable and high performance nurse workforces (Rafferty et al, 2001; Estabrooks et al, 2002; Choi et al, 2004; Vahey et al, 2004; Gunnarsdóttir et al, 2007; Li et al, 2007; Leiter and Maslach, 2009; Schubert et al, 2009; Kowalski et al, 2010) These types of nurse practice environments are characterized by high levels of job satisfaction and engagement, relatively low levels of stress, burnout and turnover rates, as well as favorable scores on quality of care and patient safety indicators as mortality, co-morbidity, and serious adverse events (Tourangeau et al, 2005; Laschinger and Leiter, 2006; Aiken et al, 2008; Friese et al, 2008). Understanding how to support and guide nurse practice communities in their daily effort to answer complex care most accurate, alongside with the demand of a stable and healthy nurse workforce, is challenging
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