Changes in hospital nurse work environments and nurse job outcomes: An analysis of panel data

Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, United States.
International journal of nursing studies (Impact Factor: 2.25). 08/2012; 50(2). DOI: 10.1016/j.ijnurstu.2012.07.014
Source: PubMed

ABSTRACT BACKGROUND: One strategy proposed to alleviate nursing shortages is the promotion of organizational efforts that will improve nurse recruitment and retention. Cross-sectional studies have shown that the quality of the nurse work environment is associated with nurse outcomes related to retention, but there have been very few longitudinal studies undertaken to examine this relationship. OBJECTIVES: To demonstrate how rates of burnout, intention to leave, and job dissatisfaction changed in a panel of hospitals over time, and to explore whether these outcomes were associated with changes in nurse work environments. METHODS: A retrospective, two-stage panel design was chosen for this study. Survey data collected from large random samples of registered nurses employed in Pennsylvania hospitals in 1999 and 2006 were used to derive hospital-level rates of burnout, intention to leave current position, and job dissatisfaction, and to classify the quality of nurses' work environments at both points in time. A two-period difference model was used to estimate the dependence of changes in rates of nurse burnout, intention to leave, and job dissatisfaction on changes in nurse work environments between 1999 and 2006 in 137 hospitals, accounting for concurrent changes in nurse staffing levels. RESULTS: In general, nurse outcomes improved between 1999 and 2006, with fewer nurses reporting burnout, intention to leave, and job dissatisfaction in 2006 as compared to 1999. Our difference models showed that improvements in work environment had a strong negative association with changes in rates of burnout (β=-6.42%, p<0.01) intention to leave (β=-4.10%, p<0.01), and job dissatisfaction (β=-8.00%, p<0.01). CONCLUSIONS: Improvements in nurse work environments over time are associated with lower rates of nurse burnout, intention to leave current position, and job dissatisfaction.

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    ABSTRACT: Research has documented an association between Magnet hospitals and better outcomes for nurses and patients. However, little longitudinal evidence exists to support a causal link between Magnet recognition and outcomes. To compare changes over time in surgical patient outcomes, nurse-reported quality, and nurse outcomes in a sample of hospitals that attained Magnet recognition between 1999 and 2007 with hospitals that remained non-Magnet. Retrospective, 2-stage panel design using 4 secondary data sources. One hundred thirty-six Pennsylvania hospitals (11 emerging Magnets and 125 non-Magnets). American Nurses Credentialing Center Magnet recognition; risk-adjusted rates of surgical 30-day mortality and failure-to-rescue, nurse-reported quality measures, and nurse outcomes; the Practice Environment Scale of the Nursing Work Index. Fixed-effects difference models were used to compare changes in outcomes between emerging Magnet hospitals and hospitals that remained non-Magnet. Emerging Magnet hospitals demonstrated markedly greater improvements in their work environments than other hospitals. On average, the changes in 30-day surgical mortality and failure-to-rescue rates over the study period were more pronounced in emerging Magnet hospitals than in non-Magnet hospitals, by 2.4 fewer deaths per 1000 patients (P<0.01) and 6.1 fewer deaths per 1000 patients (P=0.02), respectively. Similar differences in the changes for emerging Magnet hospitals and non-Magnet hospitals were observed in nurse-reported quality of care and nurse outcomes. In general, Magnet recognition is associated with significant improvements over time in the quality of the work environment, and in patient and nurse outcomes that exceed those of non-Magnet hospitals.
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    ABSTRACT: Research has shown that hospitals with better nurse staffing and work environments have better nurse outcomes-less burnout, job dissatisfaction, and intention to leave the job. Many studies, however, have not accounted for wage effects, which may confound findings. By using a secondary analysis with cross-sectional administrative data and a four-state survey of nurses, we investigated how wage, work environment, and staffing were associated with nurse outcomes. Logistic regression models, with and without wage, were used to estimate the effects of work environment and staffing on burnout, job dissatisfaction, and intent to leave. We discovered that wage was associated with job dissatisfaction and intent to leave but had little influence on burnout, while work environment and average patient-to-nurse ratio still have considerable effects on nurse outcomes. Wage is important for good nurse outcomes, but it does not diminish the significant influence of work environment and staffing on nurse outcomes.
    Policy Politics &amp Nursing Practice 08/2014; 15(3-4). DOI:10.1177/1527154414546868
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    ABSTRACT: The recent global economic recession has affected nursing working conditions in terms of salary reductions, increased workload and staff shortages. Poor nursing working conditions are associated with higher levels of burnout. However in Greece this association has not yet been studied. The aim of this study was to explore financial crisis related changes in nurses' working conditions and their associations with burnout. A cross-sectional quantitative survey was conducted and data were collected through self-reported questionnaires from 299 Greek nurses from two Public Hospitals in 2012. Multiple linear regression analyses were used in order to find independent factors associated with burnout. The results showed that Greek nurses had high levels of burnout. Satisfaction from the job, quality of care and feeling equivalent with other professionals were independent predictors of lower emotional exhaustion. Workload increase and willingness to change career and work department were independent predictors of higher emotional exhaustion. Job satisfaction and satisfaction from care quality were independent predictors of lower depersonali-zation. Changes in working relationships and willingness to change career were independent pre-dictors of higher depersonalization. Higher personal accomplishments were independently associated with more years in nursing, satisfaction from the salary prior to reductions, better quality of care, feeling suitable for the job and being anxious about future career. Influence on nurse efficiency by income reduction was an independent predictor of lower personal accomplishments. In conclusion, Greek nurses were suffering from high levels of burnout which was independently associated with crisis related working conditions. Interventions are needed in order to reduce the A. Skefales et al. 549 burden of burnout among Greek nurses.
    Open Journal of Nursing 07/2014; 4(4):548-563. DOI:10.4236/ojn.2014.47058