Nurse-assessed Quality Of Care Research Articles

Do hospitals attaining a public recognition for treating nurses fairly deliver better-quality health care? Evidence from cross-sectional analysis of California hospitals.

This study explored whether hospitals that allocate greater resources to their nursing staff provide better healthcare services than those that invest less in their nursing personnel. Cross-sectional logistic and tobit analyses. We examined a sample of 314 California hospitals in 2017. We obtained a hospital's public recognition for treating nurses fairly between 2015 and 2017 from Nurse.org, the largest online community of nurses. We derived a hospital's healthcare quality in 2018 from the 2019-2020 Best Hospitals rankings released by U.S. News, a well-known media company publishing independent healthcare assessments periodically. Our results showed that a nurse-friendly workplace was a crucial determinant of its overall healthcare quality. Healthcare administrators keen to enhance the quality of healthcare services should consider creating nurse-friendly workplaces. Furthermore, their evaluation of nurses' contributions to overall healthcare quality should not solely depend on the nurse-assessed quality of care, but rather comprise not only broad aspects of patient outcomes in primary care but also patient experiences, care-related factors and expert opinions. Our study helped address the overwhelmed healthcare system, whose long-running shortage of nurses has been exacerbated by the COVID-19 pandemic. Our work suggested that a hospital's investment in a nurse-friendly workplace can enhance its acquisition, retention and devotion of the nursing staff. This, in turn, can have profound impacts on its overall healthcare quality. Existing empirical evidence on the relation between nurse-friendly workplace and healthcare quality is limited and inconclusive. We documented evidence that the quality of healthcare services provided by hospitals varies with their treatment of nursing staff. Our results provided insights into key policies that have the potential to improve healthcare quality.

Relationship between transformational leadership, adverse patient events, and nurse-assessed quality of care in emergency units: The mediating role of work satisfaction

BackgroundEffective leadership plays a pivotal role in healthcare settings, particularly in the fast-paced and high-pressure environment of the emergency room, as it is closely linked to patient safety and the overall quality of care. This study assessed the mediating role of work satisfaction in the relationship between nurses' perceptions of their nurse managers' transformational leadership, reported adverse patient events, and the nurse-assessed quality of care in the emergency units. MethodsA cross-sectional survey design was carried out involving 283 emergency room nurses from the Philippines, utilizing standardized scales. Mediation testing was performed using Hayes' PROCESS macro in SPSS (Model 4). ResultsEmergency room nurses perceived their nurse managers as highly transformational. Nurses' perceptions of transformational leadership in their nurse managers were associated with a reduction in reported adverse patient events and an increase in nurse-assessed nursing care quality. Work satisfaction partially mediated the relationship between transformational leadership and nurse-assessed nursing care quality, but it did not serve as a mediator between transformational leadership and reported adverse patient events. ConclusionThe results suggested that enhancing transformational leadership behaviors among nurse leaders can foster work satisfaction in ER nurses, which, in effect, contributes to enhanced nursing quality of care provision in emergency settings.

Factors associated with missed nursing care and nurse-assessed quality of care during the COVID-19 pandemic.

BackgroundThe coronavirus outbreak has brought unprecedented pressures to many health care systems worldwide, potentially compromising nursing care delivery and overall health care services.AimsThis study identified factors that contributed to missed nursing care and nurse‐assessed quality of care during the coronavirus pandemic.MethodsThis study employed a cross‐sectional research design using an online survey. Survey respondents were 295 frontline nurses from the Central Region of the Philippines.ResultsMissed care occurred at a low level, with “adequate patient surveillance” as the most often missed nursing care activity. Hospital facility size, nurse staffing levels, and patient safety culture predicted missed nursing care. Personal protective equipment adequacy, nurse staffing levels, and patient safety culture were identified as predictors of quality of care.ConclusionFrontline nurses tended to miss clinical aspects of nursing care during the pandemic. Modifying elements of the work environment, including nurse staffing levels, safety culture, and adequacy of protective equipment, may reduce care compromise and improve the quality of nursing care.Implications for Nursing ManagementBy addressing the identified predictors, nurse managers could effectively develop appropriate interventions to support the professional role of nurses and ensure the delivery of complete, safe, and quality nursing care during the pandemic.

Interprofessional collaboration as a mediator in the relationship between nurse work environment, patient safety outcomes and job satisfaction among nurses.

As an important organisational feature, the nurse work environment has been associated with increased work effectiveness, reduced patient safety issues and improved care quality. However, the mechanism underlying this association remains unexplored. This study aims to assess the mediating role of interprofessional collaboration in the relationships between nurse work environment, select patient safety outcomes and job satisfaction. This cross-sectional, descriptive study used five standardized scales and included 881 clinical nurses employed in select teaching hospitals in Oman. Nurses who worked in teaching hospitals in Oman perceived their work environment as highly favourable. Nurse work environment was directly and indirectly associated with nurse-assessed quality of care, adverse patient events and job satisfaction, through interprofessional collaborations. Findings of the study suggest that enhancing nurse work environments can be a potential strategy to foster interprofessional collaboration and improve job satisfaction and patient safety outcomes. Organisational strategies to improve patient safety outcomes and job satisfaction in nurses can be facilitated by improving nurses' work conditions and enhancing interprofessional collaboration through supportive leadership, theory-driven approaches, obtaining hospital accreditation/certification and relevant workplace policies.

Relationship between nurse practice environment and work outcomes: A survey study in the Philippines.

Challenges in the nurse practice environment greatly affect nurse work outcomes. This study investigated the relationship between nurse practice environment and work outcomes in the Philippines. This cross-sectional survey involved 549 hospital nurses in the Philippines in 2018. The nurse practice environment was measured using the Practice Environment Scale of the Nursing Work Index (PES-NWI). Four self-report scales were used to measure work outcomes: job satisfaction, job burnout, job stress and nurse-assessed quality of care. Multiple linear regression analysis was used to analyse the data. Significant relationships were found between nurse and organizational characteristics and nurse practice environment. Further, multivariate regression analysis revealed that the nurse practice environment had a significant and positive relationship with perceived quality of care and a significant and negative relationship with job burnout and job stress. A favourable work environment significantly reduced job burnout and job stress and improved the quality of patient care. With considerable migration abroad, a favourable nurse practice environment may engage a better nurse workforce in the country and subsequently reduce migration. Managers must focus on developing good nurse practice environments that will improve professional work outcomes and quality patient care.

The Impact of Nursing Work and Engagement on Patient Falls.

This study explored the relationships between nurse-sensitive structures, processes (work engagement [WE], frequency of fall risk discussion during report, and frequency of purposeful rounds), and patient falls. Strong WE is associated with better nurse-assessed quality of care, but previous research is limited by self-reported outcome measures. We used a descriptive, cross-sectional, survey design with 41 nursing units from 7 hospitals. Nurses completed a survey including the Utrecht Work Engagement Scale. National Database of Nursing Quality Indicators reports provided falls data. WE was not related to patient falls, even after controlling for RN staffing and skill mix. The nursing units that had more nurses performing frequent purposeful rounds experienced greater falls with injury. Highly engaged nurses participated more in purposeful rounding and discussion of fall risk during bedside report than less engaged nurses. Further research is needed to understand the impact of WE on patient outcomes.

Mediating role of psychological well-being in the relationship between organizational support and nurses' outcomes: A cross-sectional study.

To examine the relationship between organizational support for nursing practice and nurse-assessed quality of care and nurses' job satisfaction in hospital settings and to investigate the mediating role of psychological well-being in the aforementioned relationships. There has been growing concern about quality of care in healthcare organizations. The past research has documented the effect of nurse practice environment on nurses' quality of care and job satisfaction. However, little is known about the underlying mechanism behind these associations. A cross-sectional survey was undertaken. Data were collected from two large public hospitals in Iran between February - March 2017. A sample of 345 nurses participated in the study. Data were analysed using descriptive statistics and partial least squared-structural equationmodelling. The results showed that nurses' perception of organizational support was related to their quality of care, job satisfaction and psychological well-being. Also, there was a positive relationship between nurses' psychological well-being and their quality of care and job satisfaction. Moreover, psychological well-being partially mediated the relationship between organizational support with nurse-assessed quality of care and nurses' job satisfaction. The findings suggest that organizational support for nursing practice and psychological well-being are two factors that contribute to caring behaviour of nurses and their job satisfaction. Also, positively perceived organizational support generates favourable psychological well-being which in turn enhances nurses' quality of care and job satisfaction. The findings highlight the importance of establishing a supportive nurse practice environment and paying attention to the nurses' psychological well-being in healthcare sectors.

Promoting Work Engagement: One Medical Center’s Journey

The ability to effectively engage employees is now recognized as an important business differentiator. 1 Bersin J It's time to rethink the employee engagement issue. http://www.forbes.com/sites/joshbersin/2014/04/10/its-time-to-rethink-the-employee-engagement-issue/Date: April 10, 2014 Google Scholar In health care, it has been shown to impact quality of care, patient satisfaction, and safety. 2 Laschinger H Wilk P Cho J Greco P Empowerment, engagement, and perceived effectiveness in nursing work environments: does experience matter?. J Nurs Manag. 2009; 17: 636-646 Crossref PubMed Scopus (108) Google Scholar , 3 Bacon C Mark B Organizational effects on patient satisfaction in hospital medical-surgical units. J Nurs Adm. 2009; 39: 220-227 Crossref PubMed Scopus (58) Google Scholar , 4 Gobenbach V Drenkard K The outcomes of magnet environments and nursing staff engagement: a case study. Nurs Clin N Am. 2011; 46: 89-105 Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar , 5 Bogaert PV van Heusden D Timmermans O Frank E Nurse work engagement impacts job outcome and nurse-assessed quality of care: model testing with nurse practice environment and nurse work characteristics as predictors. Front Psychol. 2014; 5: 1261-1271 PubMed Google Scholar Yet, employee engagement and loyalty can be challenging in our current turbulent health care environment when the focus for most organizations has been on reducing costs, improving quality, and implementing innovative change. Recent nationwide research conducted by the Advisory Board Company indicates that only 32.8% of registered nurses (RNs) are engaged in their work, and 7.4% are actively disengaged. 6 Virkstis N The national prescription for nurse engagement: best practices for enfranchising frontline staff in organizational transformation. April 10, 2014. Advisory Board Company website. http://www.advisory.com/research/nursing-executive-center/studies/2014/national-prescription-for-nurse-engagement Google Scholar Statistically, professional nurses have lower work engagement and higher disengagement rates than other frontline staff in health care agencies. This is troubling because nurses contribute substantially to the patient care experience and are also crucial in efforts to transform health care. The 2010 Institute of Medicine Report on The Future of Nursing recommended that nurses should be prepared to lead change to address the gaps in health. 7 Institute of Medicine The Future of Nursing: Leading Change, Advancing Health. National Academies Press, Washington DC2010 Google Scholar This will not happen if nurses are disengaged in their jobs. The ability to effectively engage employees is now recognized as an important business differentiator. 1 Bersin J It's time to rethink the employee engagement issue. http://www.forbes.com/sites/joshbersin/2014/04/10/its-time-to-rethink-the-employee-engagement-issue/Date: April 10, 2014 Google Scholar In health care, it has been shown to impact quality of care, patient satisfaction, and safety. 2 Laschinger H Wilk P Cho J Greco P Empowerment, engagement, and perceived effectiveness in nursing work environments: does experience matter?. J Nurs Manag. 2009; 17: 636-646 Crossref PubMed Scopus (108) Google Scholar , 3 Bacon C Mark B Organizational effects on patient satisfaction in hospital medical-surgical units. J Nurs Adm. 2009; 39: 220-227 Crossref PubMed Scopus (58) Google Scholar , 4 Gobenbach V Drenkard K The outcomes of magnet environments and nursing staff engagement: a case study. Nurs Clin N Am. 2011; 46: 89-105 Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar , 5 Bogaert PV van Heusden D Timmermans O Frank E Nurse work engagement impacts job outcome and nurse-assessed quality of care: model testing with nurse practice environment and nurse work characteristics as predictors. Front Psychol. 2014; 5: 1261-1271 PubMed Google Scholar Yet, employee engagement and loyalty can be challenging in our current turbulent health care environment when the focus for most organizations has been on reducing costs, improving quality, and implementing innovative change. Recent nationwide research conducted by the Advisory Board Company indicates that only 32.8% of registered nurses (RNs) are engaged in their work, and 7.4% are actively disengaged. 6 Virkstis N The national prescription for nurse engagement: best practices for enfranchising frontline staff in organizational transformation. April 10, 2014. Advisory Board Company website. http://www.advisory.com/research/nursing-executive-center/studies/2014/national-prescription-for-nurse-engagement Google Scholar Statistically, professional nurses have lower work engagement and higher disengagement rates than other frontline staff in health care agencies. This is troubling because nurses contribute substantially to the patient care experience and are also crucial in efforts to transform health care. The 2010 Institute of Medicine Report on The Future of Nursing recommended that nurses should be prepared to lead change to address the gaps in health. 7 Institute of Medicine The Future of Nursing: Leading Change, Advancing Health. National Academies Press, Washington DC2010 Google Scholar This will not happen if nurses are disengaged in their jobs.

Nurse work engagement impacts job outcome and nurse-assessed quality of care: model testing with nurse practice environment and nurse work characteristics as predictors.

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.

Occupational burnout, caring behavior and nurse-assessed quality of care among Taiwanese nurses

Occupational burnout, caring behavior and nurse-assessed quality of care among Taiwanese nurses

Validation of the Essentials of Magnetism II in Chinese critical care settings

To translate and evaluate the psychometric properties of the Essentials of Magnetism II tool (EOM II) for Chinese nurses in critical care settings. The EOM II is a reliable and valid scale for measuring the healthy work environment (HWE) for nurses in Western countries, however, it has not been validated among Chinese nurses. The translation of the EOM II followed internationally recognized guidelines. The Chinese version of the Essentials of Magnetism II tool (C-EOM II) was reviewed by an expert panel for culturally semantic equivalence and content validity. Then, 706 nurses from 28 intensive care units (ICUs) affiliated with 14 tertiary hospitals participated in this study. The reliability of the C-EOM II was assessed using the Cronbach's alpha coefficient; the content validity of this scale was assessed using the content validity index (CVI); and the construct validity was assessed using the confirmatory factor analysis (CFA). The C-EOM II showed excellent content validity with a CVI of 0·92. All the subscales of the C-EOM II were significantly correlated with overall nurse job satisfaction and nurse-assessed quality of care. The CFA showed that the C-EOM II was composed of 45 items with nine factors, accounting for 46·51% of the total variance. Cronbach's alpha coefficients for these factors ranged from 0·56 to 0·89. The C-EOM II is a promising scale to assess the HWE for Chinese ICU nurses. Nursing administrators and health care policy-makers can use the C-EOM II to evaluate clinical work environment so that a healthier work environment can be created and sustained for staff nurses.

The relationship between nurse practice environment, nurse work characteristics, burnout and job outcome and quality of nursing care: A cross-sectional survey

AimTo 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. BackgroundAcute 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. DesignCross-sectional survey. MethodGrounded 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. ResultsNurse 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. ConclusionThe 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.

Transforming the hospital structure and organization from hierarchical and departmental to flat and interdisciplinary: effect on nurse job outcomes and nurse-assessed quality of care

Transforming the hospital structure and organization from hierarchical and departmental to flat and interdisciplinary: effect on nurse job outcomes and nurse-assessed quality of care

Impacts of unit-level nurse practice environment, workload and burnout on nurse-reported outcomes in psychiatric hospitals: A multilevel modelling approach

AimTo investigate impacts of practice environment factors, nurse perceptions of workload and self-reported burnout at the unit-level on job outcomes and nurse-assessed quality of care in psychiatric hospitals. BackgroundAssociations between practice environments and nurse and patient outcomes have been widely described in acute care hospitals in nursing research examining variables primarily at the respondent level. Research on this topic in psychiatric hospitals is sparse. DesignA cross-sectional design with a survey. MethodSamples of registered nurses, licenced practical nurses and non-registered caregivers from 32 clinical units in two psychiatric hospitals were surveyed. Validated instruments were used to measure work environment, workload, burnout, job outcomes and nurse-perceived quality of care. Unit-level associations were examined using multilevel modelling techniques. ResultsMultiple multilevel models identified depersonalization and nurse–physician relations as predictors of turnover intentions and quality of care of the interdisciplinary team. Ratings of nursing management at the unit level were predictors of all of the quality of care variables. Emotional exhaustion was predictive of quality of care at the unit level. While workload was correlated with burnout, it was not predictive of any of the outcomes examined in multiple multilevel models. ConclusionWhile relatively low levels of burnout and fairly favourable job and quality of care outcomes were reported by the mental health personnel surveyed, differences across units in ratings of practice environment factors such as nurse–physician relations and nurse management as well as levels of depersonalization were predictive of outcomes. While most findings are consistent with those from other studies of acute care settings, some (slight) differences were also identified.

The Effect of Hospital Electronic Health Record Adoption on Nurse-Assessed Quality of Care and Patient Safety

The aim of this study was to examine the effect of having a basic electronic health record (EHR) on nurse-assessed quality of care, including patient safety. Few large-scale studies have examined how adoption of EHRs may be associated with quality of care. A cross-sectional, secondary analysis of nurse and hospital survey data was conducted. The final sample included 16,352 nurses working in 316 hospitals in 4 states. Logistic regression models were used to evaluate the relationship between basic EHR adoption and nurse-assessed quality of care outcomes. Nurses working in hospitals with basic EHRs consistently reported that poor patient safety and other quality outcomes occurred less frequently than reported by nurses working in hospitals without an EHR. Our findings suggest that the implementation of a basic EHR may result in improved and more efficient nursing care, better care coordination, and patient safety.

The professional nursing practice environment and nurse‐reported job outcomes in two European countries: a survey of nurses in Finland and the Netherlands

The working environment of nurses is receiving international interest, because there is a growing consensus that identifying opportunities for improving working conditions in hospitals is essential to maintain adequate staffing, high-quality care, nurses' job satisfaction and hence their retention. Thus, the aim of this study was to investigate the relationship between nurse work environment characteristics and nurse-reported job outcomes in hospital settings in Finland and the Netherlands and to compare these results. A comparative cross-sectional nurse survey was conducted. Data were collected from the two countries randomly sampling the countries' National Nurses Association' membership databases. In this paper, the results from Registered Nurses working in hospital settings are used. In total, 869 hospital nurses participated: 535 from Finland and 334 from the Netherlands with the response rate of 44.9 and 33.4%, respectively. Fifty-five items from the Nursing Work Index-Revised were used as a main tool for the practice environment. Exploratory factor analysis was used to identify a set of internally consistent subscales. Further, logistic regression analysis and T-tests were used. Three practice environment characteristics were identified: adequacy of resources, supportiveness of management and assurance of care quality via collaborative relationships. Favourable evaluations of the adequacy of resources and supportiveness of management were positively correlated with nurse-assessed quality of care and job-related positive feelings and negatively correlated with intentions to leave a unit, organization or the entire profession. In neither of the participating countries were adverse incidents affecting nurses related to nurses' evaluations of their current professional practice environment. Compared with Finland, in the Netherlands, RN appears to evaluate the majority of work environment characteristics more positively; nevertheless, to some extent, the results were uniform as adequacy of resources and supportiveness of management were main predictors for nurse-reported job outcomes considered.

Hospital nurses' work environment, quality of care provided and career plans

In several European countries, the availability of qualified nurses is insufficient to meet current healthcare requirements. Nurses are highly dissatisfied with the rising demands of the healthcare environment and increasingly considering leaving their jobs. The study aims to investigate the relationships between the characteristics of hospital nurses' work environment and the quality of care provided, and furthermore to examine Dutch nurses' career plans. A cross-sectional, questionnaire survey of registered nurses (n = 334) working in the academic and district hospitals was conducted in 2005/2006. Previously validated questionnaires translated into the participants' language were used. Factor and regression analysis were used for data analysis. Overall, nurses rated their work environment rather favourably. Five work environment characteristics were identified: support for professional development, adequate staffing, nursing competence, supportive management and teamwork. Significant relationships were found between nurses' perceptions of their work environment characteristics and quality of care provided and nurses' career plans. When work environment characteristics were evaluated to be better, nurse-assessed quality of care also increased and intentions to leave current job decreased linearly. Study findings suggest that nurses' perceptions of their work environment are important for nurse outcomes in hospital settings. Further research is needed to explore the predictive ability of the work environment for nurse, patient and organizational outcomes in hospitals.

Work-Related Burnout, Job Satisfaction, Intent to Leave, and Nurse-Assessed Quality of Care Among Travel Nurses

This research study examines work-related burnout, job satisfaction, nurse-assessed quality of care, and intent to leave in travel nurses, a population that has not been studied previously. Travel nurses are frequently used to supplement nursing staff in acute care hospitals, especially in times of shortage--understanding their satisfaction with the job may further illuminate the problem of nurse job dissatisfaction in general. Ordinary least-squares regression analyses were used to examine the influence of nurse and workplace characteristics on work-related burnout, job satisfaction, intent to leave, and perceived quality of care. Quality of care and job satisfaction were significantly influenced by whether a hospital held Magnet designation. As the number of patients cared for increases, there was a significant increase in work-related burnout. Work-related burnout was also significantly lower for nurses working in California. The results of this study suggest that different workplace characteristics influence the perceptions of quality of care provided at a hospital facility and the degree to which a nurse is either burned out or satisfied with his/her job.

Effects of work environments on nurse and patient outcomes

To determine the relationship between nurses' perceptions of their work environment and quality/risk outcomes for patients and nurses in acute care settings. 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. 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. Using multilevel structural equation modelling, the hypothesized model fitted well with the data [χ(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)]. Empowering workplaces had positive effects on nurse-assessed quality of care and predicted fewer falls and nurse-assessed risks as mediated through group processes. These conditions positively impacted individual psychological empowerment which, in turn, had significant direct effects on empowered behaviour, job satisfaction and care quality. Empowered workplaces support positive outcomes for both nurses and patients. Managers employing strategies to create more empowered workplaces have the potential to improve nursing teamwork that supports higher quality care, less patient risk and more satisfied nurses.

Hospital nurse practice environment, burnout, job outcomes and quality of care: test of a structural equation model

The aim of the study was to investigate relationships between nurse practice environment, burnout, job outcomes and nurse-assessed quality of care. A growing line of work confirms that, in countries with distinctly different healthcare systems, nurses report similar shortcomings in their work environments and the quality of care in hospitals. Neither the specific work environment factors most involved in dissatisfaction, burnout and other negative job outcomes, and patient outcomes, nor the mechanisms tying nurse job outcomes to quality of care are well understood. A Nurse Practice Environment and Outcome causal structure involving pathways between practice environment dimensions and outcome variables with components of burnout in a mediating position was developed. Survey data from 401 staff nurses across 31 units in two hospitals (including the Revised Nursing Work Index, the Maslach Burnout Inventory, and job outcome and nurse-assessed quality of care variables) were used to test this model using structural equation modelling techniques. The data were collected from December 2006 to January 2007. Goodness of fit statistics confirmed an improved model with burnout dimensions in mediating positions between nurse practice environment dimensions and both job outcomes and nurse-assessed quality of care, explaining 20% and 46% of variation in these two indicators, respectively. These findings suggest that hospital organizational properties, including nurse-physician relations, are related to quality of care assessments, and to the outcomes of job satisfaction and turnover intentions, with burnout dimensions appearing to play mediating roles. Additionally, a direct relationship between assessments of care quality and management at the unit level was observed.