The practice environment of primary care nurses: A cross-sectional study of five health care districts in San Paulo, Brazil

Abstract

BackgroundPrimary care is a fundamental component of healthcare in Brazil. Often provided by nurses, little is known about the practice environment of nurses in primary care and if nurses are satisfied with their role in the primary care setting. ObjectiveThe purpose of this study was to determine if aspects of the primary care practice environment in Brazil are associated nurse reported outcomes of job satisfaction, intention to stay on the job, and the quality of care. DesignA cross-sectional survey that included a randomized cluster stratified sample of nurses who provided primary care services. Settings55 health centers within five health districts located in Campinas, São Paulo, Brazil. Participants148 primary care nurses who completed and returned a survey MethodsThe paper-based survey was made available to nurse participants. Nurses were queried on demographic and practice characteristics. Specific measures included the Practice Environment Scale-Brazilian, the job satisfaction subscale of the Safety Attitudes Questionnaire, and single items that assessed intention to stay on the job and the perceived quality of care. Generalized linear and Poisson regression models were used to estimates outcomes of interest. ResultsSlightly more than half (56.5%) of the nurses reported a favorable practice environment and they provided on average a high score of 75.29 (SD = 21.03) on job satisfaction. High scores were also reported on intention to stay on the job (mean = 8.08; SD = 2.91) and the quality of patient care (mean = 7.68; SD = 1.38). In a fully adjusted regression model, a favorable practice environment was significantly associated with a 2.15 (p <0.0001) increase in job satisfaction, a 1.72 (p = 0.0003) increase in the intention to stay on the job and a 1.16 (p < 0.001) increase in the nurse reported quality of patient care. ConclusionOverall, our sample of Brazilian nurses that work in primary care reported a favorable perception of their practice environment. This likely contributed to their high scores on intention to stay on the job and the overall quality of patient care. Nurse managers and administrators should focus their attention on aspects of the practice environment as a low cost means to attract and retain nurses in primary care and to improve the overall quality of care.