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Impact of magnet hospital characteristics on nurses' perceptions of trust, burnout, quality of care, and work satisfaction
Abstract
The amount and frequency of change affecting the health care industry makes management of a work environment particularly challenging for nursing leaders Numerous studies are discussed that explore the influence of organization behavior and issues of staff perception on measurable outcomes such as nurse retention and patient satisfaction. The authors surveyed staff nurses using instruments that assess their perceptions of (a) autonomy, control, and physician relationships; (b) faith and confidence in peers and managers; (c) emotional exhaustion; (d) job satisfaction; and (e) the quality of patient care. The findings suggest that perceived autonomy, control, and physician relationships influence the trust, job satisfaction and perceived quality of patient care. Professional practice models may provide a means to achieve positive staff perceptions of autonomy and control while managing the realities of flattening organizational structures.
... Meyer and Allen (1991)'s multidimensional model of commitment stated that employee organizational commitment is a mediating variable between individual job related antecedents such as employee satisfaction and organizational outcomes such as organizational performance (Mayer and Allen, 1991;Clugston, 2000). Employee satisfaction is a positive psychological state resulting from one's job (Locke, 1976) and its relationship with employee commitment can be a determinant link for Organizational performance (Angle, 1981;Riketta, 2002) and effectiveness (Laschinger, 2001). Some studies have reported a positive correlation between employee satisfaction and commitment (Benkhoff, 1997;Shore and Martin, 1989;Knoop, 1995;Bateman and Stressor, 1984;Locke and Latham, 1990;Koh and Boo, 2004;Forese and Xiao 2012). ...
... According to Harter et al. (2002, p.276) "Employee satisfaction has a positive relationship with a business performance at a magnitude that is crucial to many organizations". Employee satisfaction and employee commitment together can be a determinant of Organizational performance (Angle, 1981;Riketta, 2002) and effectiveness (Laschinger, 2001). According to Ostroff (1992, p.963) "Organization with more satisfied employee tends to be more effective than organizations having the less satisfied employee". ...
... Understanding the multivariate concept shall enhance the organization's efficiency as a whole and employee as an individual. Employee satisfaction, employee performance, employee commitment, Human Capital, SRHRM all have been considered to be turning points in the development of positive organizational performance (Lu et al. 2009;Rettab et al. 2008;Sedikoglu and Zehir, 2010;Laschinger, 2001;Ostroff, 1992;Harter et al. 2002), that is why a study on employees and organizations is All the variables in the above framework are inter-related, as has been seen from the literature studied. None of the variable acts as an independent variable as the commitment of one depends on the other. ...
... Meyer and Allen (1991)'s multidimensional model of commitment stated that employee organizational commitment is a mediating variable between individual job related antecedents such as employee satisfaction and organizational outcomes such as organizational performance (Mayer and Allen, 1991;Clugston, 2000). Employee satisfaction is a positive psychological state resulting from one's job (Locke, 1976) and its relationship with employee commitment can be a determinant link for Organizational performance (Angle, 1981;Riketta, 2002) and effectiveness (Laschinger, 2001). Some studies have reported a positive correlation between employee satisfaction and commitment (Benkhoff, 1997;Shore and Martin, 1989;Knoop, 1995;Bateman and Stressor, 1984;Locke and Latham, 1990;Koh and Boo, 2004;Forese and Xiao 2012). ...
... According to Harter et al. (2002, p.276) "Employee satisfaction has a positive relationship with a business performance at a magnitude that is crucial to many organizations". Employee satisfaction and employee commitment together can be a determinant of Organizational performance (Angle, 1981;Riketta, 2002) and effectiveness (Laschinger, 2001). According to Ostroff (1992, p.963) "Organization with more satisfied employee tends to be more effective than organizations having the less satisfied employee". ...
... Understanding the multivariate concept shall enhance the organization's efficiency as a whole and employee as an individual. Employee satisfaction, employee performance, employee commitment, Human Capital, SRHRM all have been considered to be turning points in the development of positive organizational performance (Lu et al. 2009;Rettab et al. 2008;Sedikoglu and Zehir, 2010;Laschinger, 2001;Ostroff, 1992;Harter et al. 2002), that is why a study on employees and organizations is All the variables in the above framework are inter-related, as has been seen from the literature studied. None of the variable acts as an independent variable as the commitment of one depends on the other. ...
... Autonomy related to Emotional Exhaustion and Depersonalisation [60], and in another study, it only related to Depersonalisation [43]. Low autonomy impacted Emotional Exhaustion via organisational trust [82]. Autonomy correlated with burnout [67]. ...
... Negative work environments affected burnout (measured with a composite score) via job dissatisfaction [96]. One study looked at organisational characteristics on a single scale and found that a higher rating of organisational characteristics predicted lower Emotional Exhaustion [82]. Environmental uncertainty was related to all MBI dimensions [86]. ...
... Hospital management and organisational support had a direct effect on Emotional Exhaustion and Personal Accomplishment [84]. Trust in the organisation predicted lower levels of Emotional Exhaustion [82] and of burnout measured with a composite MBI score [87]. ...
Background:
Workforce studies often identify burnout as a nursing 'outcome'. Yet, burnout itself-what constitutes it, what factors contribute to its development, and what the wider consequences are for individuals, organisations, or their patients-is rarely made explicit. We aimed to provide a comprehensive summary of research that examines theorised relationships between burnout and other variables, in order to determine what is known (and not known) about the causes and consequences of burnout in nursing, and how this relates to theories of burnout.
Methods:
We searched MEDLINE, CINAHL, and PsycINFO. We included quantitative primary empirical studies (published in English) which examined associations between burnout and work-related factors in the nursing workforce.
Results:
Ninety-one papers were identified. The majority (n = 87) were cross-sectional studies; 39 studies used all three subscales of the Maslach Burnout Inventory (MBI) Scale to measure burnout. As hypothesised by Maslach, we identified high workload, value incongruence, low control over the job, low decision latitude, poor social climate/social support, and low rewards as predictors of burnout. Maslach suggested that turnover, sickness absence, and general health were effects of burnout; however, we identified relationships only with general health and sickness absence. Other factors that were classified as predictors of burnout in the nursing literature were low/inadequate nurse staffing levels, ≥ 12-h shifts, low schedule flexibility, time pressure, high job and psychological demands, low task variety, role conflict, low autonomy, negative nurse-physician relationship, poor supervisor/leader support, poor leadership, negative team relationship, and job insecurity. Among the outcomes of burnout, we found reduced job performance, poor quality of care, poor patient safety, adverse events, patient negative experience, medication errors, infections, patient falls, and intention to leave.
Conclusions:
The patterns identified by these studies consistently show that adverse job characteristics-high workload, low staffing levels, long shifts, and low control-are associated with burnout in nursing. The potential consequences for staff and patients are severe. The literature on burnout in nursing partly supports Maslach's theory, but some areas are insufficiently tested, in particular, the association between burnout and turnover, and relationships were found for some MBI dimensions only.
... Hospital nurse burnout has been found to be linked to negative patient outcomes such as decreased patient satisfaction (Leiter, Harvie, & Frizzell, 1998;McHugh, Kutney-Lee, Cimiotti, Sloane, & Aiken, 2011;Vahey, Aiken, Sloane, Clarke, & Vargas, 2004) reports of poor quality of care (Laschinger, Shamian, & Thomson, 2001;Parker & Kulik, 1995;Poghosyan, Clarke, Finlayson, & Aiken, 2010;Van Bogaert, Clarke, Roelant, Meulemans, & Van de Heyning, 2010), safety and overall adverse events Liu et al., 2018). ...
... To the author's knowledge, there are currently ten studies that link hospital nurse burnout to negative patient outcomes, and all found statistically significant associations between nurse burnout and poor patient outcomes. These negative outcomes include reports of poor quality of patient care (Laschinger et al., 2001;Parker & Kulik, 1995;Poghosyan et al., 2010;Van Bogaert et al., 2010) and safety (Liu et al., 2018), overall adverse events Liu et al., 2018), decreased patient satisfaction (Leiter et al., 1998;McHugh et al., 2011;Vahey et al., 2004), and increased hospital-associated urinary tract and surgical site infections (Cimiotti et al., 2012). One study included 53,846 nurses from six countries and found that, independent of other nurse characteristics and the quality of nurse work environments, higher levels of nurse burnout were associated with lower nurse-reported quality of patient care (Poghosyan et al., 2010). ...
... Burnout was also found to fully mediate the relationship between work environment stressors and social support and the outcome of nurse job performance (Parker & Kulik, 1995). Furthermore, nurse burnout was found to be a partial mediator between the work environment and the outcomes of overall adverse events (Liu et al., 2018) and nurse-reported quality of care (Laschinger et al., 2001;Van Bogaert, Meulemans, Clarke, Vermeyen, & P, 2009). Taken together, these studies provide evidence of the significant impact that hospital nurse burnout has on job performance and patient outcomes, and warrants further inquiry into the process of care by which it may have this impact. ...
Background & Significance: Nurse burnout is a healthcare crisis affecting nearly half of U.S. hospital nurses and has been tied to negative patient outcomes such as preventable adverse events – the third leading cause of death in the U.S. Despite the pervasiveness of burnout, much remains to be understood about exactly how, and to what extent, hospital nurse burnout impacts the delivery of care and patient outcomes. This study advances our understanding of the complex phenomenon of burnout by examining its impact on specific nurse-reported preventable adverse events, and positing that missed care is a pathway by which hospital nurse burnout undermines quality of care and patient safety. Methods: This cross-sectional, secondary data analysis of three linked datasets from 2005-2008 assessed a sample of 23,784 registered nurses working in 587 hospitals across four states. Employing a series of multilevel multivariable robust logistic regressions, a mediation analysis was conducted to examine the associations between hospital-level nurse burnout, hospital-level missed care, and five nurse-reported frequent adverse events (medication errors, pressure ulcers, falls with injury, hospital-associated urinary tract infections and central line bloodstream infections), after controlling for patient severity, nurse and hospital characteristics. Results: Hospital nurse burnout was found to be significantly associated with all five nurse-reported adverse events and missed care partially mediated this relationship in four out of the five outcomes. The odds of nurses reporting frequent adverse events increase by 12-20% with every 10% increase in the proportion of burned out nurses, after accounting for patient severity, nurse and hospital characteristics. Missed care was found to explain 15-33% of the relationship between hospital nurse burnout and hospital nurse-reported adverse events. Conclusion & Implications: This study provides new evidence that hospitals with higher proportions of burned out nurses have higher odds of nurse-reported preventable adverse events—partially due to missed care. To the author’s knowledge, this is the first large-scale study in the U.S. to document these associations and empirically demonstrate that missed care partially explains how nurse burnout leads to preventable harm to patients. Given the current policy climate increasingly demanding safe, high quality, value-based patient care, this study suggests that organizational-level interventions aimed at reducing nurse burnout may be a critical strategy to mitigate costly, occasionally life-threatening adverse events.
... Similarly, Moreau and Mageau (2012) found that individuals who receive autonomy support from their superiors and colleagues tend to report higher levels of work satisfaction and psychological wellbeing. In fact, nurses' perception of autonomy and control were found to directly influence workplace trust and work satisfaction (Laschinger et al., 2001) and turnover intentions (Boudrias et al., 2020;Hayes et al., 2006). ...
... Turnover intentions have also been previously found to decrease in response to a more autonomous work environment (Boudrias et al., 2020). These results are consistent with findings previously reported by Laschinger et al. (2001), suggesting that perceptions of autonomy and control tended to predict workplace satisfaction and trust, two important determinants of employees' wellbeing. Therefore, fostering a need satisfying work environment, while also putting more emphasis on the autonomy satisfaction, might help to reduce workplace turnover and to increase work satisfaction. ...
Using data from 708 French-Canadian nurses, the present study relies on self-determination theory (SDT) and its proposed motivation mediation model to examine the associations between need satisfaction, work motivation, and various manifestations of psychological wellbeing (work satisfaction, emotional exhaustion, and turnover intentions). To increase the precision and accuracy of these analyses, we relied on
analytic approaches that explicitly account for the dual global/specific nature of both work motivation and need satisfaction. Results revealed that nurses’ global psychological need satisfaction, and their specific autonomy and competence satisfaction, were positively associated with their global self-determined work motivation and specific intrinsic motivation. In turn, global self-determined work motivation and specific intrinsic motivation were associated with more desirable outcome levels. Nurses’ global need satisfaction and specific autonomy satisfaction were also directly associated with more desirable outcome levels. Our results provided support for a partially mediated version of SDT’s motivation mediation model.
... Would they describe the quality of nursing care during the last shift as excellent, good, fair, or poor? These two questions were used by many researchers in USA, Canada, U.K, and Germany (Laschinger H et al , 2001;Aiken LH et al ,2002) . Therefore, the quality of care questions had not been tested for reliability and validity. ...
For many decades, the attitude of nurses has been an area of interest for researchers. The major reason for this interest is the profound impact of nurse's attitude like organizational cynicism on many organizational outcomes. The present study is aimed to describe organizational cynicism, level of perceived organizational support, and the sequences of organizational cynicism on nurses and quality of care. Correlation descriptive cross-sectional study was carried out amongst 368 nurses working in critical care and toxicology units. The independent variable was organizational cynicism, while the dependent variables were nurse work outcomes and quality of care. The study shows high level of organizational cynicism among nurses in critical care units and low level of perceived organizational support. It also shows a negative relation between organizational cynicism and perceived organizational support, organizational commitment, job satisfaction, and quality of care. As their cynicism level increased, their perceived level of organizational support, nurses' commitment, job satisfaction, and quality of care decreased. In addition, it was obvious that nurses' perception for organizational cynicism has a positive and significant effect on deviant workplace behavior, and their leaving of employing organization and burnout.
... In the literature on burnout syndrome, there is unanimous agreement that Freudenberger was the precursor of the term "burnout" in 1974 Serrano et al., 2002;Maslach et al., 2001). Burnout negatively impacts the physical and psychological health of those affected (Gil-Monte, 2003;Laschinger, 2001), and while it has primarily been associated with the professional sphere, many scholars argue it can develop in non-work domains, affecting individuals' work and personal life (Peeters et al., 2005;Lacovides et al., 2003;Demerouti et al., 2000;Hellesøy et al., 2000). ...
The COVID-19 pandemic has deeply impacted higher education, increasing stress and emotional exhaustion among university faculty. The sudden transition to online teaching and the need to adapt to a changing academic environment have heightened tensions. High levels of burnout are evident in 71% of faculty, with 24% experiencing moderate levels, and 5% low levels. It is recommended that universities implement prevention programs and support policies to improve the mental health and well-being of the faculty.
... These prompt actions demonstrate the commitment of management to supporting the welfare of its employees, prioritizing their well-being over dealing with psychosocial stress issues. Laschinger, Shamian and Thomson debates management commitment as employees' perception of the organization they work for [13]. It underscores three aspects of organizational commitment: trust and acceptance of the organization's goals and values, employees' willingness to strive toward achieving the organization's goals, and the desire to remain a member of the organization. ...
Background
The purpose of this study is to uncover the effect of psychological safety climate (PSC) on employees’ job satisfaction and organisational climate mediating processes explaining that association. It is posited that the four PSC aspects (management commitment, management priority, organisational participation, and organisational communication) are important for employees’ job satisfaction and organisational climate act as resources to facilitate the enactment of managerial quality.
Methods
This study uses a quantitative approach through a questionnaire survey method involving 340 Kota Kinabalu City Hall employees who were selected through simple random sampling.
Results
The results of linear regression analysis found that organisation participation has a positive significant relationship with job satisfaction. Organisational communication also showed a negative and significant relationship with job satisfaction. Meanwhile, both management commitment and management priority are statistically insignificant. When the organisational climate is included in the relationship as a mediator through Structural Equation Modelling (SEM) to reinforce the role of psychological safety climate in increasing job satisfaction, such mediating role can only strengthen the relationship between management commitment and organisational participation with job satisfaction.
Conclusion
Despite the study being cross-sectional, it contributes to knowledge on the resources facilitating PSC, which is important for employees’ psychological health. From a practical viewpoint, this study contributes to the literature showing that organizations with good PSC should have policies and practices directed towards employee well-being. The implications of the study for DBKK management are to providing knowledge on the types of psychosocial safety climate domains that plays a crucial role in improving the job satisfaction of DBKK employees.
... Burnout negatively impacts the physical and psychological health of those affected (Gil-Monte, 2003;Laschinger, 2001). While it has been primarily associated with the professional sphere, numerous authors argue that it can develop in areas beyond work. ...
The COVID-19 pandemic has had an unprecedented impact on higher education and, therefore, on university teachers. The abrupt transition to online teaching, health-related concerns, as well as adaptation to an incessantly changing academic environment, have significantly increased tensions and pressure on teachers, with immediate adaptation to the new conditions being a very important challenge. teaching technologies and methodologies in response to the pandemic, triggering the level of stress and emotional exhaustion in university teachers. In order to contribute to the gap in the empirical literature in this regard, the objective of this study is to determine the state of manifestation and prevalence of burnout syndrome in university teachers in the post-COVID-19 pandemic period. The study was carried out under a quantitative methodology, with a non-experimental design, and a cross-sectional descriptive approach, applying intentional non-probabilistic sampling. The results obtained show a high prevalence of burnout syndrome in 71% of teachers, a medium level in 24%, and a low level in 5%. Universities must implement prevention programs, training in coping skills, as well as supportive institutional policies that ensure the mental health and well-being of university teachers.
... The past research's sample size has varied significantly. Most job satisfaction studies have taken a range of 200-500 observations (Laschinger, Shamian, & Thomson, 2001); (Barlett, 2007) and (Bae, Early, Mahrer, Klaristenfeld, & Gold, 2014). However, this study will take into account 240 as the sample size. ...
Aim: To measure impact of nurses’ practice environment, organizational commitment on job satisfaction and intent to leave in hospitals of Pakistan. Study Design: Cross sectional survey; Convenience sampling. Methods: Sample of 240 nurses were drawn from private and public sector hospitals. Nurses’ practice environment (Aiken, Clarke, & Sloane, Hospital Staffing, Organisation and Quality Care: Crossnational Findings, 2002), organizational commitment (Mowday, Steers, & Porter, 1979) , job satisfaction (Carbonell & Escudero, 2013) and intent to leave (Zopaitis, Constanti, & Theocharous, 2014) were used as instruments of measurement. Results: Nurse Practice environment with estimate of 0.176 has no significant effect on job satisfaction as the p value was 0.43 which was statistically insignificant ant 0.05. Hospital nurses’ organizational commitment with estimate of 0.043 has no significant effect on job satisfaction as was 0.526 which was statistically insignificant at 0.05. Job satisfaction with estimate of 0.254 has a significant effect on intent to leave as the p value was 0.007 which was statistically significant at 0.05. Hence, it is claimed that job satisfaction has significant impact on intent to leave. Conclusion: The study is integral to have in the field of occupational health psychology and to make sure that nurses are satisfied in their work whether employed in private or public hospitals. Keywords: nurse practice environment, organizational commitment, job satisfaction, intent to leave, nursing, Pakistan
... The past research's sample size has varied significantly. Most job satisfaction studies have taken a range of 200-500 observations (Laschinger, Shamian, & Thomson, 2001); (Barlett, 2007) and (Bae, Early, Mahrer, Klaristenfeld, & Gold, 2014). However, this study will take into account 240 as the sample size. ...
Aim: To measure impact of nurses’ practice environment, organizational commitment on job satisfaction and intent to leave in hospitals of Pakistan. Study Design: Cross sectional survey; Convenience sampling. Methods: Sample of 240 nurses were drawn from private and public sector hospitals. Nurses’ practice environment (Aiken, Clarke, & Sloane, Hospital Staffing, Organisation and Quality Care: Crossnational Findings, 2002), organizational commitment (Mowday, Steers, & Porter, 1979) , job satisfaction (Carbonell & Escudero, 2013) and intent to leave (Zopaitis, Constanti, & Theocharous, 2014) were used as instruments of measurement. Results: Nurse Practice environment with estimate of 0.176 has no significant effect on job satisfaction as the p value was 0.43 which was statistically insignificant ant 0.05. Hospital nurses’ organizational commitment with estimate of 0.043 has no significant effect on job satisfaction as was 0.526 which was statistically insignificant at 0.05. Job satisfaction with estimate of 0.254 has a significant effect on intent to leave as the p value was 0.007 which was statistically significant at 0.05. Hence, it is claimed that job satisfaction has significant impact on intent to leave. Conclusion: The study is integral to have in the field of occupational health psychology and to make sure that nurses are satisfied in their work whether employed in private or public hospitals. Keywords: nurse practice environment, organizational commitment, job satisfaction, intent to leave, nursing, Pakistan
... The past research's sample size has varied significantly. Most job satisfaction studies have taken a range of 200-500 observations (Laschinger, Shamian, & Thomson, 2001); (Barlett, 2007) and (Bae, Early, Mahrer, Klaristenfeld, & Gold, 2014). However, this study will take into account 240 as the sample size. ...
https://pjsr.com.pk/2023/04/12/impact-of-nurse-practice-environment-organizational-commitment-on-job-satisfaction-and-intent-to-leave-in-hospitals-of-pakistan/
... Magnet certification has an emphasis on attracting (and retaining) nurses to the organization and has been associated with the organization upholding excellent standards in quality care, continuing professional development of staff, fair hierarchal employment structures, effective staff deployment, and high job satisfaction [32]. Magnet certification has been found to be associated with several outcomes such as reduced nurse burnout, reduced intention to leave, and lower staff turnover [4,33,34], while also increasing nurse engagement in hospital affairs [4,35]. These outcomes at the nurse level are also associated with the quality of patient care. ...
Nurse shortages pose a challenge in many countries and retaining existing nursing staff is crucial to addressing these shortages. To inform possible interventions aimed at retaining nurses, managers need a comprehensive understanding of the nature of the nurse practice environment. The scales from two of the main instruments used to assess nurses’ practice environments are tested. A survey of an online panel obtained responses from 459 Australian nurses. Analyses determined a combination of items with good construct validity and improved predictive utility for outcomes of interest for individual nurses. By essentially combining the best items from each instrument, a more comprehensive representation of the nurse work environment is obtained with improved predictive utility. The resulting combined set of scales is recommended for analyses of the nurse working environment and uses a combined set of scales from each of the two source instruments, namely: nurse participation in hospital affairs, recognition, nursing process, peer work standards, nursing competence, orientation, managers, resources, nurse–physician collaboration, and positive scheduling climate. Future research can then build on that strong set of items with a validated structure and predictive utility to inform management and interventions.
... Components of outward organisational learning, such as the encounter with new information and dialog with stakeholders, were found to encourage professional development thanks to the opportunity to acquire new skills, the access to new knowledge and new information sources, and the need to cope with new challenges and new discoveries (Laschinger et al., 2001). The claim presented in this study is that outward organisational learning brings the individual in contact with new information, new languages of thinking, and other ways of action that challenge the individual and thereby lead to professional development. ...
... Components of outward organisational learning, such as the encounter with new information and dialog with stakeholders, were found to encourage professional development thanks to the opportunity to acquire new skills, the access to new knowledge and new information sources, and the need to cope with new challenges and new discoveries (Laschinger et al., 2001). The claim presented in this study is that outward organisational learning brings the individual in contact with new information, new languages of thinking, and other ways of action that challenge the individual and thereby lead to professional development. ...
... El burnout tiene consecuencias negativas sobre la salud física y psicológica de las personas que lo padecen (Gil-Monte, 2003;Laschinger, 2001) y, aunque principalmente se ha asociado su desarrollo a la esfera profesional, también son numerosos los autores que sostienen que puede desarrollarse en esferas diferentes a la laboral, y los efectos del síndrome de quemarse por el trabajo se extrapolan afectando de la vida laboral a la extralaboral de los individuos, y viceversa (Peeters et al., 2005;Lacovides et al., 2003;Demerouti et al., 2000;Hellesøy et al., 2000). ...
La pandemia mundial COVID-19 implica, entre otras, una importante amenaza para la salud física y mental de la humanidad. Con el fin de contribuir al vacío existente en la literatura al respecto, el objetivo de este estudio es determinar el estado de manifestación y prevalencia del síndrome de burnout de docentes de universidades públicas andaluzas en tiempos de la pandemia, aún en curso. El estudio se llevó a cabo bajo una metodología cuantitativa, con un diseño no experimental, y enfoque descriptivo de corte transversal, aplicándose un muestreo no probabilístico intencional a docentes de universidades públicas andaluzas. Los resultados obtenidos evidencian una prevalencia en grado alto del síndrome de burnout en un 62% de los docentes, en grado medio un 33%, y en grado bajo un 5%. Las universidades deben desarrollar estrategias de afrontamiento y medidas preventivas del síndrome de desgaste profesional.
... Inherent in first-line management is a great deal of cooperation (Nilsson, 2003) due to the manager's position of acting as a link between the operational level and the strategic management in the organization (Öberg and Dahlenborg, 2003;Skagert, et al., 2008). Leading, motivating and empowering subordinates are further important tasks for frontline managers (Laschinger, Shamian and Thomson, 2001;Öberg and Dahlenborg, 2003;MacPhee, Skelton-Green, Bouthillette and Suryaprakash, 2011). The decentralization of health care and human service management over the past years in Sweden has influenced lower-level managers' work by increasing their responsibilities and at the same time the demands put on them (Richard, 1997;Nilsson, 2003). ...
The aim of this thesis was to deepen the knowledge concerning health care managers’ everyday work experiences and their handling of stress and balance. Background. Health care managers’ work is characterized by daily hassles, conflicting perspectives, and unclear boundary setting. They could therefore use support in boundary and stress management. Methods. A qualitatively driven mixed methods approach was used. Qualitative interviews, focus groups and workplace observations were used for data collection in Study I. Physiological stress indicators, stress self-assessments, workplace observations and interviewing were used in Study II. Analyses were mainly carried out on the interview data, using grounded theory methodology (Study I) and conventional content analysis (Study II). Results. Paper I shows that a first step in managers’ boundary setting is to recognize areas at work with conflicting expectations and inexhaustible needs. Strategies can then be formed through proactive, continuous negotiating of their time commitments. These strategies, termed ‘boundary approaches’, are more or less strict regarding the boundary setting at work. Paper II shows that nonnormative, interactive feedback sessions could encourage understanding and meaningfulness of previous stress experiences through a two-step appraisal process. In the first appraisal in the study, feedback was spontaneously reacted on, while in phase two it was made sensible and given meaning. However, during the sessions, some obstacles appeared to managers’ learning about their stress, preventing a second appraisal of the feedback. Conclusions. Awareness and continuous negotiation regarding boundary dilemmas can be effective as a proactive stress management tool among managers. Further, non-normative feedback on stress indicators may initiate key 3 processes of sensemaking which can aid managers’ stress management by increasing awareness and supporting learning about their stress. Proactive boundary awareness is a concept leading to better understanding of lower-level managers’ management of their time commitments and stress, which can be supported by continuous reflection, feedback situations and a supportive context.
... The clear majority of this literature has examined perceived control among health care professionals, including nurses, doctors, and staff. The primary focus of this body of literature is to examine how it impacts their burnout and stress (Glass McKnight, & Valdimarsdottir, 1993;Laschinger, Shamian, & Thomson, 2001;Schmitz, Neumann, & Oppermann, 2000;van Servelen, Topf & Leake, 1994), health (Bosma et al, 1997;Steptoe, 2001), job attitudes (Szilagyi, Sims, & Keller, 1976). Medical or hospital related contexts are typically more hierarchical as compared to other environments, such that doctors are situated at the top of the hierarchy with the most power and control, with nurses below, and patients at the lowest rung (Coombs & Eresser, 2004;. ...
Perceived control—a psychological mechanism— is conceptualized as an individual-level perception, in which events in one’s life are within one’s control. Across multiple domains, perceived control is regarded as a protective psychological mechanism and is generally associated with positive outcomes. Despite the importance of this research, there are several significant gaps in the perceived control literature that I address in my dissertation, in the context of health. In Chapter 2, I examine the impact of perceived control within a sample of women undergoing surgery. These women were given clinical suspicion of having gynecological cancer. There is little work examining the link between perceived control and psychological health, especially for women undergoing cancer surgery. I consider the importance of the medical context, specifically the diagnosis, route of procedure, and the fact that patients have no behavioral control in the context of surgery. I find that increased perceived control was related to better preoperative psychological health, through a reduction in negative affect. I conclude the chapter by discussing the implications of these findings in the context of improving women’s health. Our findings indicate that increased perceptions of health locus of control were related to a significant increase in preoperative psychological health through a reduction in negative affe In Chapter 3, I challenge the explicit and implicit notion in the extant literature that all women’s perceptions of control are homogenous. To address this, I use data from The Study of Women’s Health Across the Nation (SWAN) and conduct an exploratory longitudinal analysis of perceptions of control over approximately 10 years. Results in this study suggest that important differences by race/ ethnicity of women exist. Hispanic women fared the worst, because on average their perceived control significantly decreased over time. Hispanic women may be at a health disadvantage as they age. I conclude this chapter by discussing the implications of my found patterns in the context of health care disparities. In Chapter 4, I examine if control can be influenced by the nature of the interpersonal environment. I use a qualitative study to examine how experiences of incivility in a hospital context impact individuals’ perception of control. In a survey, participants were told to write about an experience of incivility they experienced in a hospital and then mention if this event impacted their sense of control. I use interpretative phenomenological analysis to analyze participants’ text responses. Results suggest that interpersonal mistreatment shapes one’s sense of control in various ways, and these may have long-term implications. In Chapter 5, I discuss the overarching findings across all three studies, including the ways in which perceived control influences a number of health outcomes, functions across time, and how perceived control can be interpersonally constructed. I also provide important critiques to the general perceived control literature. First, it is necessary to integrate an intersectionality perspective in the study of perceived control. Women of color are systematically ignored in the literature, and this harms our understanding of perceived control. Second, researchers need to seriously consider how conditions of respect can influence perceived control. Perceived control is not simply a stable individual-level variable, rather it is much more dynamic and interpersonally constructed than originally theorized. Together it is necessary that future researchers critically engage with the construct of perceived control to help deepen our understanding of the construct.
... A total of 96 papers were found from the searches, from which 12 papers and an additional 14 papers (from reference lists) were deemed potentially relevant from the titles and abstracts. After screening, 22 papers were excluded with reasons: 7 evaluated the impact of Magnet status in hospitals but not specific to EDs [17,[31][32][33][34][35][36], 13 were not specific on the impact of Magnet status in EDs [37][38][39][40][41][42][43][44][45][46][47], and full texts were not available for two studies [25,48]. Thus, three papers were included in the review (see Fig. 1 and Tables 2a and 2b); these papers [49][50][51] focused on the impact of Magnet status on staff, while the fourth paper was used to inform the discussion of data as it explored the association of Magnet designation and patient mortality [52]. ...
... Tool II: Conditions of Work Effectiveness Questionnaire The Conditions of Work Effectiveness Questionnaire was used to assess nurses' structural empowerment. It was developed by Laschinger et el., [17]. I t consists of 19 questions which answered in a 5 Likert-type fashion with a scale ranging from 1-5, 1 and 2= None, 3 and 4 = Some and 5 = A Lot. ...
... Selain itu, memaksakan beban kerja secara overload kepada perawat juga sering berdampak pada emosi. Menurut Laschinger et al (2001), salah satu cara yang efektif guna meningkatkan keselamatan pasien dengan menggunakan upaya alternatif dengan cara menstabilkan emosi perawat. Untuk mengupayakan hal tersebut manajer keperawatan harus menghindari memaksakan beban kerja secara over load kepada perawat. ...
A sudden stroke is a traumatic condition causing emotional response to their family identified as the psychological response of post-traumatic incident. The Kubler-Ross approach describes the stages of phsychological response of loss on family toward the sudden stroke incident of the client i.e. denial, anger, bargaining, depression, and acceptance. Identification of the stages after losing incident increase the understanding of how people process to the loss emotionally and cognitively. This research aimed to identify the percentage of respondents on each stage of psychological response of loss on family based on Kubler-Ross approach when the first time client of stroke was attacked in Tugurejo Hospital Semarang. This study involved 30 respondents by using purposive sampling technique. This research was descriptive quantitative by using univariat analysis to analyze each variable study. The data were collected by using a questionnaire. The result of this study showed that denial was suffered by 16,7% (5 respondents), there was no respondent suffered from anger; bargaining was suffered by 96,7% (29 respondents), depression was suffered by 30% (9 respondents), and acceptance was suffered by 96,7% (29 respondents). The study concluded that the most widely experienced responses of family were bargaining and acceptance since 100% (30 respondents) were Javanese who embraced the teaching “silent is gold” and “acceptance”. They did not speak orally but they retained an unpleasant feeling and even traumatic in their mind. Acceptance of Javanese respondents made them considered that everything coming to their life were a matter that must be accepted as it was.
... However, the distinction between relationships of trust within an organisation according to hierarchy is important because this research has paid special attention to it. Because organisational trust is primarily expressed at the level of trust between employees, the foundations that provide the conditions for building trust, according to Laschinger et al. (2001), are teamwork, the right leadership style, and the possibility of reaching objectives, employee satisfaction and commitment. Trust has a positive impact on the harmonious cooperation between employees, and helps coming up with new ideas. ...
... The natural system perspective emphasizes on human resource development and value for maintaining the interconnections and morale of employees to achieve the satisfaction of stakeholders (MacGregor, 1960). The policies with regard to human resource management (HRM) practices influence the quality of patient care by impacting both technical and interpersonal aspects of quality care (Laschinger et al., 2001). According to Preuss (2003), human resource practices such as training, performance, participation, decentralized decision-making and team involvement are important for productive emergence, which are Quality in public and private hospitals the means to high-quality health care. ...
Purpose
Health-care delivery organizations (hospitals) constitute a complex adaptive system; hence, a contingency perspective is imperative to guide the design of customized approaches to quality management in different health-care settings. Accordingly, this paper aims to propose a contingency framework to advance the understanding of the relationship between situational factors and effectiveness of quality approaches in health-care organizations (HCOs), such as hospitals in India.
Design/methodology/approach
Related literature was reviewed to identify existing research and theories related to quality and quality approaches, situational factors of the HCOs (hospitals) and some existing logical evidence on public and private hospitals in India. Then a contingencies framework for quality and quality approaches was conceptualized.
Findings
This paper proposes contingent determinants arise out of conceptualization of the HCOs (hospitals) from different system perspective such as rational system, natural system, open system and integrative system; uncertainty because of physicians’ behaviour, nurses’ approach and a dual line of authority; and the task environment such as patients, competition and economic pressure. These determinants represent situational constructs to the quality enhancement of any attempt at quality approaches. While these determinants have an influence on the quality and quality approaches of the HCOs (hospital), it is imperative to build any quality improvement strategy to work effectively, i.e., quality approach is dependent on determinants of the contingencies of the hospital’s environment, be it external or internal. Propositions for future research are also incorporated.
Research limitations/implications
This paper proposes a conceptual model as well as research propositions that need to be validated and confirmed empirically. It advances the research and theory related to quality and quality approaches in a health-care setting. It can enable policymakers, hospital managers to analyze and gauge the appropriateness of quality approaches in a given context before implementing them and could help to improve the introverted quality approaches and quality dimensions currently followed in HCOs (hospitals).
Originality/value
Contingency framework is a new approach for research on the effectiveness of quality approaches in hospitals. The fundamental idea behind this framework is that effectiveness of quality approaches can be understood best by examining its contingent determinants. Thus, it has the capacity to contribute to the efforts of government and policymakers to make the quality of care affordable to all in India. Essentially, we examine the contexts and variables that determine the effectiveness of quality approaches.
... Some researchers claim that job satisfaction decreases with working years whereas other emphasise increase. The most important reason for this variance could be that job satisfaction is considerably affected by professional differences (Laschinger et al., 2001). It is stated that seniority, which is generally called service term as well, has positive impact on the job satisfaction of employees and people who work in the same working environment for a long time develop increased commitment to the institution and higher job satisfaction. ...
Background: This study, which is done using 606 nurses working in state hospitals under the Department Of Institutions For In-Patient Treatment Affiliated To Turkish Republic Of Northern Cyprus Ministry Of Health, aims to investigate the effect of manager-employee relationship on job satisfaction and contextual performance of perceived leadership style.
Methods: To determine the effect of leadership and job satisfaction on the contextual performance of the research, a screening model was used from descriptive research methods and a questionnaire consisting of four parts was prepared as data collection tool.
Results: Results show that age, gender, duration of work and working position were found to affect job satisfaction and contextual performance in general (p <0,05).
Conclusions: This study concludes that personal profiles of nurses are essential determinants of how leadership, job satisfaction, and contextual performance is perceived.
... A center-wide focus on suicide assessment and management allowed the CMHC PI team to hear from all quarters resulting in broad stakeholder contributions to the PI goal. Experiencing efficacy at work, higher levels of control, and a sense of collaboration can lead to improvements in job satisfaction and less burnout (Havens et al., 2018;Spence Laschinger et al., 2001), thus offering the opportunity for the center's community to participate in this effort was important. Not all providers at CMHC reported confidence with regard to handling suicide risk and there is reason to think that training mental health providers in this area can increase their confidence in assessing and treating suicide (Mirick et al., 2016;Oordt et al., 2009). ...
Purpose
This paper aims to describe a performance improvement process related to suicide assessment in a community mental health center. As suicide rates rise in the USA, it is crucial that community mental health providers are capable and comfortable to assess for suicide risk among individuals with mental illness. Support for healthcare providers is emphasized in the quadruple aim model of enhancing healthcare delivery and patient experience. The quadruple aim model is applied in the present performance improvement project in a community mental health center.
Design/methodology/approach
An interprofessional team used provider survey responses, critical incident data and other stakeholder input to implement a new assessment mechanism and education plan to support direct care staff to address suicide risk.
Findings
Although the rate of patient death by suicide at the community mental health center is low, managing risk is a frequent provider concern. Providers’ comfort assessing and managing suicide risk varied widely based on survey responses. A structured suicide assessment process was implemented to offer clarity and direction for providers. Education to address assessment and management was designed and implemented.
Research limitations/implications
Suicide data were retrospective and limited to known deaths, thus there may have been higher numbers of deaths by suicide historically. Providers’ comfort with suicide risk management was based on self-report and future work should also integrate skills-based assessment.
Originality/value
Improving the provider experience in mental health care must be explored. Focusing on provider input and voice in suicide-related efforts in community settings is a step toward integrating the quadruple aim ideals into mental health care.
... The equity theory has been used in numerous human resources studies to substantiate this reasoning (Kotabe, Dubinsky & Chae, 1992;Shelley, 2001). On top of this, prior empirical studies have supported a positive linkage between EPE and OC (Laschinger, Shamian & Thomson, 2001;Lemons & Jones, 2001;N'Goala, 2007). Likewise, when SME employees perceive their rewards to be fair or equitable when compared to their effort they are likely to be committed to that organisation. ...
Most research conducted on the influence of employee perception of equity (EPE), organisational citizenship behaviour (OCB), organisational commitment (OC) and turnover intention (ITS) has been on large organisations and little attention has been paid to SMEs. Studies on EPE and OCB have not filtered down to SMEs in developing countries. The primary objective of the study is to investigate the influence of OCB, EPE and OC on ITS in Zimbabwe’s SME sector. It also sought to ascertain the kind of relationships between OCB and OC, EPE with OC, OCB with ITS, EPE with ITS and finally OC with ITS. Structured questionnaires were distributed to SMEs in five major cities. A quantitative method using Smart PLS was employed to test the relationships among the three hypotheses. The results showed that there is a positive relationship between the three proposed hypotheses. Based on the findings, recommendations will be made to both the government policy makers and SME owners. The proposed study is expected to have practical and theoretical implications to both the policy makers in the government and the owners of small businesses in Zimbabwe. In addition, it will provide added insights and new knowledge to the existing body of literature on human resource management, hitherto not studied extensively in developing countries of Southern Africa and Zimbabwe in particular.
... The findings concerning perceived control are particularly important as perceived control at work is associated with high levels of job satisfaction, commitment, involvement, performance and motivation (Spector, 1986), increased sense of personal accomplishment (Park, Jacob, Wagner, & Baiden, 2014), and perceived quality of patient care (Laschinger, Heather, Shamian, & Thomson, 2001). ...
The aim of this pilot study was to design, implement and evaluate an intervention aiming at increasing professional recognition among health-care professionals working in primary care. Professional recognition was operationalized at three levels: self, co-workers and patients/recipients of care. Thirty-six (n = 36) residents and consultants working in primary health-care settings in Greece participated in the study. Emotional states of participants were measured before and after the intervention with the Self-Assessment Manikin, Positive and Negative Affect Schedule, and an open-ended question. Results showed significantly higher levels of dominance after the intervention (t(35) = −3.014, p= .005), higher levels of excitement (t(37) = −2.158, p= .038), feelings of being proud (t(37) = −2.485, p= .018) and being inspired (t(37) = −2.490, p= .017). Furthermore, the analysis of open-ended responses using the Pleasure-Arousal-Dominance model showed that participants reported higher levels of positive emotions and lower levels of arousal emotions after receiving the intervention (χ²(4, N = 36) = 35.526, p < .001). To our knowledge, this is the first intervention targeting professional recognition implemented in health-care settings. Results indicate significant changes on the emotional states of participants after receiving the intervention. Future research is needed to examine the feasibility of positive psychology interventions in primary health-care settings.
... Three studies pointed out that good coworker relationships can enhance job satisfaction (Gulick et al., 2007;Masum et al., 2016;Sharp, 2008). Four studies indicated that collaboration with others in the healthcare team increased job satisfaction (Adams & Bond, 2000;Chaboyer, Williams, Corkill, & Creamer, 1999;Havens, Gittell, & Vasey, 2018;Laschinger, Shamian, & Thomson, 2001c). ...
Aims:
This review aimed to systematically assess the findings of primary studies to identify the factors associated with nurse job satisfaction in rural and urban contexts while analyzing the findings according to Herzberg's theory.
Background:
While there is evidence linking several factors to nurses' job satisfaction, gaps still exist in understanding the differences between factors affecting job satisfaction for nurses working in rural and urban settings.
Design:
Systematic review with narrative summary.
Data sources:
Six databases were used to identify original studies that discuss the factors associated with the nurse's job satisfaction between 1998 - 2018.
Review methods:
Two authors independently reviewed each study using the Joanna Briggs Institute's critical appraisal checklists. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to report and examine study biases systematically.
Results:
A total of 38 studies were selected for this review. Physical working environment and authority and freedom were the most frequently reported factors associated with nurses' job satisfaction. Several extrinsic, intrinsic, personal and community factors were also found to be associated with nurses' job satisfaction. Urban studies tended to focus on extrinsic factors, whereas there was more balance between the two sets of factors in rural studies.
Conclusion:
Both intrinsic and extrinsic factors play an essential role in nurses' job satisfaction. Future research should use more robust research methods and pay more attention to contrasting rural and urban contexts. Herzberg's theory can provide conceptual clarity when investigating the factors associated with nurses' job satisfaction.
Impact:
This review discussed the factors associated with nurses' job satisfaction in rural and urban settings. The findings linked several extrinsic and intrinsic factors to nurses' job satisfaction. Nursing management should search for the perfect blend of intrinsic and extrinsic factors, based on nurses' needs and organizational commitment to improve nurses' job satisfaction.
... Since nurses typically provide direct patient care, they should have accurate perceptions of quality of care (Laschinger, Shamian, & Thomson, 2001). ...
Although there are studies that highlight how healthcare professionals use smartphones for work purposes, there is a scarcity of knowledge of this phenomenon among nurses – the largest group of healthcare professionals in a hospital. Existing studies are also theoretically and methodologically limited. To address these research gaps, this research aims to determine the factors and issues associated with nurses’ use of smartphones for work purposes in the Philippines based on a theoretical framework constructed using the Theory of Planned Behaviour, Organisational Support Theory, and IT Consumerisation Theory. First, an Exploratory Study based on in-depth interviews with 30 nurses in the Philippines was conducted. Results showed that nurses used their smartphones for communication, information seeking, and documentation purposes to facilitate clinical work. It also showed that several behavioural (i.e., instrumental and affective attitudes, injunctive and descriptive norms, perceived behavioural control, and intention) and organisational antecedents (i.e., perceived organisational support) could influence nurses’ use of smartphones for work purposes. Moreover, a relevant outcome of its use is enhanced quality of patient care. The study also uncovered some organisational issues that might affect how nurses used smartphones for work purposes. In general, results of the Exploratory Study were used to further develop Study I and Study II. Study I identified the predictors and outcome of nurses’ use of smartphones for work purposes. Hypothesis testing used structural equation modelling (SEM) of survey data from 517 staff nurses employed in 19 tertiary-level general hospitals in Metro Manila, Philippines. Exploratory and confirmatory factor analysis results showed that nurses’ use of smartphones for work purposes is operationally defined by its use for communication and information seeking purposes. Next, SEM results showed that injunctive norm and perceived behavioural control were positively associated with intention to use smartphones for work purposes. Moreover, intention was positively associated with nurses’ use of smartphones for work purposes. On the other hand, nurses’ use of smartphones for work purposes was positively associated with perceived quality of care. Results of the indirect effect analysis showed that perceived organisational support had an indirect effect on nurses’ intention to use smartphones for work purposes through injunctive norm and perceived behavioural control. Study II identified organisational issues that influence support to nurses’ use of smartphones for work purposes from the perspective of nurse administrators – one of the organisational agents where nurses derive organisational support. Nine focus groups were conducted with 43 nurse-administrators from nine randomly selected tertiary-level general hospitals that were part of Study I. The findings showed that the issues were divided on those that encouraged (i.e., problems with existing workplace technologies, absent or insufficient unit phones, insufficient unit phone credits, and unrealistic policies) or inhibited (i.e., smartphone use for non-work purposes and misinterpretation by patients) nurse administrators to support nurses’ use of smartphones for work purposes. Overall, the research findings were used to generate key recommendations on nurses’ use of smartphones in hospital settings. These recommendations can be used by hospitals to develop policies on nurses’ or healthcare professionals’ use of smartphones in hospitals.
... Aside from job satisfaction, some researchers have examined the relationship of stress to perceived quality of care. Examining nurses' self-reported quality of care is valid since it serves as a proxy to actual quality of care (Laschinger, Shamian, & Thomson, 2001). Previous works demonstrate how certain stressors negatively affect perceived quality of care. ...
Aims: To determine which stressor has the highest occurrence and which among them are related to nurse-outcomes, such as job satisfaction, perceived quality of care, and turnover intention.
Background: There are several stressors in nursing practice. However, it is unclear if specific stressors are related to nurse-outcomes.
Design: The study used a cross sectional and descriptive-correlational research design.
Methods: In July-August 2017, survey data were collected from 427 staff nurses employed in a large tertiary level private hospital in Metro Manila, Philippines. The Nursing Stress Scale (NSS) was used to measure stress frequency. Structural equation modelling (SEM) was used to determine the relationship of stressors and nurse outcomes.
Results: Exploratory and confirmatory factor analyses indicate nine NSS factors. Workload is the most frequent stressor. Moreover, workload was negatively related to job satisfaction and perceived quality of care. Workload and conflict with nurses were positively related to turnover intention.
Conclusions: NSS has a different factor structure based on a survey of nurses in the Philippines. Only workload and conflict with nurses were related to specific nurse-outcomes. Nurse managers should identify and mitigate stressors experienced by nurses since these can lead to turnover and poor quality of care.
... The nurses may be also more satisfied due to the status quo than young nurses, who often pursue for better working condition. This is also supported by (Aziz & Al-Doski 2010, Drafke & Kossen 2002, Laschinger et al 2001, Abu.Ajamieh et al. 1996, Yaktin et al. 2003, Ronen 1978, Shader et al. 2001, Al-Enezi et al 2009. ...
Objective: This study investigates the level of satisfaction of nurses working in
Ministry of health hospitals (MOH) and the influence of their personal demographics
on their job satisfaction.
Background: Given the current difficulties experienced by Emirati hospitals in
recruiting and retaining a sufficient number of nurses, the need to determine the
reasons of nurses’ dissatisfaction are urgent. Retention has been directly related both
to job satisfaction and particular demographics. Satisfaction at work is essentially a
personal experience that is also affected by cultural factors. This study examines the
links between personal demographics and nurses’ dissatisfaction.
Methods: The study included 726 registered nurses (RN) from six MOH hospitals
using Muller/McCloskey (1990) satisfaction scale, and demographic instrument
developed for this reason (2011).Descriptive correlational design was used to assess
the influence of these demographics on their level of job satisfaction.
Results: Four factors were derived from the factor analysis: “Approval”, “Scheduling”,
“Professional” and “Maintenance” needs accounting for 85.2% of the total variance.
Nurses were found to be dissatisfied with two factors: the Maintenance (M=2.05) and
professional ones (M=2.70). MOH nurses were neither satisfied nor dissatisfied with
their job (M=3), but hovering toward dissatisfaction with the Approval (M=3.36) and
Scheduling dimensions (M=3.18). Demographics such as gender, place of work,
tenure as RN, Length of experience in the present hospital, work Unit, Shift, traveling
distance, financing family, place of growth and employment change significantly
contributed to job satisfaction. However, age, education level, degree besides nursing,
marital status, number of children, nursing position, working hours, residency, and
Emirate Nursing Association membership did not influence nurses’ satisfaction.
Conclusion/implications: This study adds to the existing body of knowledge of the
factors impacting nurses’ satisfaction. Nurse administrators may use the findings of
this study as a baseline to improve job satisfaction. Enhancement of extrinsic elements, professional nursing practice, professional growth, career advancement,
recognition and encouragement are all recommended to enhance nurses’ satisfaction
and retention.
Key Words: Registered nurses, Job satisfaction; Nurse Shortage; Nurse Retention;
Nurse Turnover; Intention to quit, demographics, Muller/Mucclosky Satisfaction Scale,
Healthcare organization, Professional environment.
Importance
Occupational burnout syndrome is characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment and is prevalent among nurses. Although previous meta-analyses have explored the correlates of nurse burnout, none have estimated their association with health care quality and safety and patient morbidity and mortality.
Objective
To evaluate the magnitude and moderators of the association between nurse burnout and patient safety, patient satisfaction, and quality of care.
Data Source
The Web of Science, Scopus, MEDLINE, Embase, PsycINFO, CINAHL, and ProQuest databases were searched from January 1, 1994, to February 29, 2024.
Study Selection
Two reviewers independently identified studies that reported a quantifiable association between nurse burnout and any of the outcomes of patient safety, patient satisfaction, or quality of health care.
Data Extraction and Synthesis
The PRISMA 2020 guideline was followed. Two reviewers independently extracted the standardized mean difference (SMD) (Cohen d ) estimates for a random-effects meta-analysis. Subgroup analyses and meta-regressions were conducted using prespecified variables.
Main Outcomes and Measures
Any measure of patient safety, patient satisfaction, or quality of health care previously associated with nurse burnout.
Results
A total of 85 studies (81 cross-sectional and 4 longitudinal) involving 288 581 nurses from 32 countries (mean [SD] age, 33.9 (2.1) years; 82.7% female; mean [SD] burnout prevalence rate with study-specific ascertainments, 30.7% [9.7%]) were included. Nurse burnout was associated with a lower safety climate or culture (SMD, −0.68; 95% CI, −0.83 to −0.54), lower safety grade (SMD, −0.53; 95% CI, −0.72 to −0.34), and more frequent nosocomial infections (SMD, −0.20; 95% CI, −0.36 to −0.04), patient falls (SMD, −0.12; 95% CI, −0.22 to −0.03), medication errors (SMD, −0.30; 95% CI, −0.48 to −0.11), adverse events or patient safety incidents (SMD, −0.42; 95% CI, −0.76 to −0.07), and missed care or care left undone (SMD, −0.58; 95% CI, −0.91 to −0.26) but not with the frequency of pressure ulcers. Nurse burnout was also associated with lower patient satisfaction ratings (SMD, −0.51; 95% CI, −0.86 to −0.17) but not with the frequencies of patient complaints or patient abuse. Finally, nurse burnout was associated with lower nurse-assessed quality of care (SMD, −0.44; 95% CI, −0.57 to −0.30) but not with standardized mortality rate. The associations were consistent across nurses’ age, sex, work experience, and geography and persistent over time. For patient safety outcomes, the association was smaller for the low personal accomplishment subcomponent of burnout than for emotional exhaustion or depersonalization, as well as for nurses with a college education.
Conclusions and Relevance
In this systematic review and meta-analysis, nurse burnout was found to be associated with lower health care quality and safety and lower patient satisfaction. This association was consistent across nurse and study characteristics.
Introduction
The present study analysed the mediating role of interactional justice and horizontal trust between transformational leadership and organisational outcomes (i.e., job performance and service quality) at the work team level and the cross-level relationship of team horizontal trust with job performance at the individual level, controlling for work engagement based on the HERO Model.
Methods
Through structural equations and hierarchical linear models, the proposed hypotheses were addressed. The sample corresponds to 1,638 workers grouped into 109 work teams belonging to 28 hospitals in Spain.
Results
First, Structural Equation Modelling analysis revealed that, as expected, at the team level, interactional justice and horizontal trust mediate positive and significantly the relationship between transformational leadership and organisational outcomes (i.e., job performance and service quality). Secondly, the results of the Linear Hierarchical Models showed a positive relationship between work engagement and individual level performance. Finally, the multilevel analysis revealed that horizontal trust at the team level is positively related to work engagement at individual level; however, there is no cross-level relationship between horizontal trust at the team level and individual performance controlled by work engagement.
Discussion
Horizontal trust, at the team level, is positioned as a mediating variable between resources and organisational outcomes. Furthermore, it proves to be a key cross-level element for generating work engagement and job performance. The theoretical and practical implications of the study based on the HERO Model are discussed.
Teknoloji, bilgiye ulaşma ve saklama alanlarında yaşanan hızlı dönüşümle birlikte baş döndürücü bir hızla yaşanan küreselleşme, iş dünyasındaki değişimleri de beraberinde getirmektedir. İşletmeler açısından yeni pazarlar, fırsatlar yaratan
bu süreç aynı zamanda değişimlere adaptasyonlarını zorunlu kılmaktadır.
Örgütler küreselleşmenin getirdiği artan rekabet ortamında varlıklarını sürdürebilmek ve buna ilave olarak belirsizliklerden olumsuz etkilenmemek için değişmek dönüşmek
durumundadırlar.
Dinamik bir organizma olan örgütler yönetim ve diğer fonksiyonlar açısından bu sürece kayıtsız kalamamaktadırlar. Ekonomik, sosyal, kültürel ve teknolojik hareketliliği takip ederek kendi iç ve dış süreçlerini yaşanan gelişmelerle uyumlu hale getirmektedirler. Örgütlerde en önemli değişim, iş, iş yapış şekli,
liderlik tarzı ve örgütsel yapı anlamında ortaya çıkmıştır.
Şebeke türü örgüt yapıları ve sanal organizasyonların sayısında hızlı bir artış görülmektedir. Özellikle, küresel anlamda içinden geçilen pandemi bu süreci bir anlamda tetiklemiştir. Birçok örgüt bir anda işlevlerinin bir kısmını elektronik platforma taşımak durumunda kalmıştır.
In the context of the current global health crisis caused by COVID-19, a series of significant challenges affecting both physical and psychological health of populations have been identified. This study aims to investigate the prevalence and manifestation of burnout syndrome among the teaching staff of public universities in Andalusia during this pandemic period. Using a quantitative research methodology, with a non-experimental and descriptive cross-sectional design, teachers were selected through non-probabilistic intentional sampling. The results revealed urgent need for educational institutions to develop effective strategies for managing and preventing this professional weariness syndrome is highlighted.
Frontline mental health care professionals (FMHPs) in a variety of roles such as nursing, social work, psychology, psychiatry, case managers and mental health workers are often required to provide a high degree of care to clients over time which can result in physical and psychological complaints often referred to as compassion fatigue (CF). The aim of this nonexperimental, cross sectional study was to determine the relationships among compassion satisfaction (CS), compassion fatigue (CF), work life conditions and burnout among FMHPs. The Professional Quality of Life Revision IV (ProQOL), the Areas of Work Life Survey, Maslach Burnout Inventory-General Survey and a Demographic Data sheet were completed by 169 FMHPs. Consistent with our hypothesis, higher levels of compassion satisfaction, lower levels of compassion fatigue, and higher overall degree of fit in the six areas of work life were predictive of lower burnout in FMHPs.
Sağlık hizmet sunumunda önemli yere sahip olan hemşirelerin, kaliteli bakım sunmaları ve nitelikli hemşirelerin hastaneye çekilmesi ve hastanede kalmaları ile ilgili olan “mıknatıs hastane” 1983 yılında Amerikan Hemşireler Akademisi tarafında geliştirilen bir kavramdır. Özellikle hemşirelere yönelik olarak algılanan bir kavram olmasının yanında, hizmet sunucuları ve hizmet alıcıları olmak üzere iki tarafın da beklentilerini karşılayarak en iyi sonuçlara ulaşmaya hedeflemektedir. Derleme yöntemiyle gerçekleştirilen bu çalışmanın amacı mıknatıs hastane kavramını kavramsal açıdan ele alarak sağladığı faydaları incelemektir. Ayrıca mıknatıs hastane olma niyetinde olan kurumlar için rehber niteliğindedir. Sonuç olarak, mıknatıs hastaneler yönetimsel açıdan da başarılı süreçlerin yürütüldüğü hizmet veren hizmet alanların memnuniyetinin sağlandığı özellikli kurumlardan sayılmaktadır. Bu hastanelerin sayısının arttırılmasıyla çalışan hemşirelerin memnuniyetinin yanı sıra hastaların memnuniyetinin de artacağı açıkça görülmektedir.
Aim:
To explore if human resource practices are the key to manage job burnout in nurses.
Objective:
To determine if human resource practices provide more meaningful work to nurses, subsequently leading to enhanced work-life balance and lower job burnout (emotional exhaustion and cynicism).
Background:
Job burnout is a global phenomenon, particularly relevant in the nursing profession due to pressures within the health sector. Job burnout is also a result of nurses not balancing work with their life roles and maintaining meaning in one's work. High-performance systems are tools that hospital human resource departments can use to increase core employee factors that ultimately reduce the risk of job burnout.
Methods:
Using cross-sectional data from 114 New Zealand nurses, we tested a path model to distinguish whether human resource practices can influence job burnout, with meaningful work and work-life balance mediating. The data were analysed using structural equation modelling and indirect effects for mediating. This research adhered to the STROBE Statement.
Results:
Human resource practices are positively related to meaningful work and work-life balance, and meaningful work was positively related to work-life balance and negatively related to cynicism. Finally, work-life balance is negatively related to emotional exhaustion and cynicism.
Conclusions:
Given the influence of human resource practices on job burnout is fully mediated by meaningful work and work-life balance, indicating that managing job burnout is best understood via human resource practices enhancing nurses meaning from work and role balance, which subsequently reduces job burnout.
Relevance to clinical practice:
Human resource practices can enhance work factors, such as meaningful work and work-life balance, that can enable nurses to have reduced job burnout. This will help prevent cynicism, exhaustion and will therefore prevent absenteeism, enhance performance and overall aid long-term employment benefitting not only patients but hospitals.
Research in the field of the nursing profession has attained its heights, especially in the developed countries. Most of the research in this field has addressed nursing empowerment, work attitude, and organizational outcomes. This study aims to extend understanding of whether structural and psychological empowerment drive work outcomes. Thus, this study has attempted to develop and customize a scale for primary data collection. Researchers highlighted various steps of questionnaire development, data collection procedure, and establishing reliability and validity at the pilot level. These steps help researchers to ground data collection tools in extant literature. Initial findings from pilot study data are reported. Data for this study was collected through a closed-ended questionnaire by employing a convenience sampling technique from registered nurses from public-private sector hospitals in Hyderabad, Sindh. Cronbach’s alpha, mean, and corrected total-item correlation for all items are well above the threshold values. Findings of EFA shown that there are seven factors in the model. The CFA identified that every factor arises as a single factor and loads onto its construct with significant levels of indices.
Günümüzde özellikle küreselleşme ile beraber özel sektörde yüksek derecede bir rekabet bulunmaktadır. Kamu kuruluşları bu rekabetten muaf gibi görünseler de günümüzde vatandaşlar kamu kuruluşlarından yüksek kalitede hizmet beklemektedirler. Kamu kuruluşlarının vatandaşların talebini karşılamaları için insan kaynaklarını etkin bir şekilde kullanmaları gerekmektedir. Örgütsel güven kavramı çalışanların yöneticilerine, işyerlerine ve çalışma arkadaşlarına karşı sahip olduğu güven bağını tanımlamaktadır. Tükenmişlik kavramı ise duygusal tükenme, duyarsızlık ve başarısızlık hissi olmak üzere üç farklı olumsuz durumu işaret eden bir psikolojik durumdur. Alan yazınında olumlu çıktıları tespit edilmiş olan örgütsel güven ile olumsuz çıktıları tespit edilmiş olan tükenmişlik algısı arasındaki ilişki incelenmiştir. Bu araştırmanın amacı örgütsel güvenin tükenmişlik algısı üzerine olan etkisini saptamaktır. Araştırmanın amacı doğrultusunda Ankara Sosyal Güvenlik Kurumu evren olarak belirlenmiştir. Bu evrende bulunan 350 kişiye anket formu ulaştırılmış ve 306 çalışandan elde edilen sağlıklı veriler ile araştırma gerçekleştirilmiştir. Anket formu örgütsel güven ölçeği, tükenmişlik algısı ölçeği ve demografik bilgileri belirlemeye yönelik sorulardan oluşmaktadır. Araştırmanın en önemli sınırlılığı Ankara SGK çalışanlarını kapsayan küçük bir evren bazında gerçekleştirilmiş olmasıdır. SPSS analiz programı aracılığıyla yapılan regresyon analizi sonucunda örgütsel güvenin tükenmişlik algısını negatif ve anlamlı bir şekilde etkilediği sonucuna ulaşılmıştır.
Researchers, please take due care of the formal caregivers in nursing homes - Volume 32 Issue 3 - Terence W. H. Chong, Edmond Chiu
Bu çalışma; hemşirelerin iş yaşamı yalnızlıklarının çalışma ortamını değerlendirmeleri üzerinde bir etkisinin olup olmadığını ölçmek amacıyla yapılmıştır. Çalışmanın evreni; Çorum İlinde bulunan bir kamu hastanesinde hemşire olarak görev yapan çalışanlardan oluşmaktadır. Hastanede görev yapan ve anket uygulamasına katılmayı kabul eden 234 hemşire ile gerçekleştirilen çalışma sonucunda; hemşirelerin iş yaşamı yalnızlıklarının çalışma ortamını değerlendirmeleri üzerinde anlamlı bir etkisinin olduğu bulunmuştur. Bununla birlikte iş yaşamı yalnızlığı boyutları ile çalışma ortamını değerlendirme boyutları arasında anlamlı ilişkiler tespit edilmiştir. Son olarak hemşirelerin “orta düzeyde” iş yaşamı yalnızlığı yaşadıkları ve çalışma ortamlarını da “orta düzey”olarak değerlendirdikleri tespit edilmiştir.
Introduction:
The contribution of the health workforce for better health care service provision is undoubtedly of great merit to any health system. However, the public district hospitals in Rwanda have been faced with the challenges of retaining the health personnel. This study looks into the management approach to address this challenge by investigating into the effect of employee involvement in the hospital decision-making processes on the retention of professional health workers.
Methods:
A cross-sectional design with quantitative approach was used. With a population of 469 health workers from 3 hospitals, a sample of 252 respondents was considered. Data collection was done by use of survey questionnaire. For data analysis, we used descriptive statistics to report perceived levels of involvement of health workers and intents to stay, and multiple logistic regression at 95% of confidence intervals to assess the effect of health workers? involvement in the hospital decision-making processes on the retention.
Results:
The findings revealed that health workers who perceived a high level of involvement in the hospital decision-making processes through the determination of teams for quality improvement in the health care service delivery were more likely to stay in the hospital (OR=100.111; P=0.001; CI=5.984-16.747) than those who perceived this function as low. It was also found that while an average level of involvement of health workers in the establishment of systems for suggestion in the hospital was associated with 6 odds of staying (OR=6.005; P=0.010; CI=1.529-23.571), health workers who perceived a high level of involvement were nearly 11 times more likely to stay (OR=10.952; P=0.001; CI=7.730-15.519) than their counterparts with low levels of perceptions.
Conclusion:
Although there are positive associations between involvement of health workers in the hospitals decision-making processes and the intentions to stay, the existing level of staff involvement may have a negative effect on retention capacity in the public district hospitals.
Aim of this study was measuring whether the working life loneliness of nurses had a significant impact on their working environment assessment or not. Target population of the study consists of nurses working in a Public Hospital in Çorum City. As a result of the study which was carried out with 234 nurses who work in the hospital and agreed to particpate in the survey application; it was found that working life loneliness of the nurses had a significant impact on their working environment assessment. In addition to this, it was determined that there were significant correlations between the dimensions of the working life loneliness and the dimensions of the working environment assessment. Finally, it was found that the working life loneliness levels and the working environment assessment levels of the nurses were “moderate”.
Background:
Whether health care provider burnout contributes to lower quality of patient care is unclear.
Purpose:
To estimate the overall relationship between burnout and quality of care and to evaluate whether published studies provide exaggerated estimates of this relationship.
Data sources:
MEDLINE, PsycINFO, Health and Psychosocial Instruments (EBSCO), Mental Measurements Yearbook (EBSCO), EMBASE (Elsevier), and Web of Science (Clarivate Analytics), with no language restrictions, from inception through 28 May 2019.
Study selection:
Peer-reviewed publications, in any language, quantifying health care provider burnout in relation to quality of patient care.
Data extraction:
2 reviewers independently selected studies, extracted measures of association of burnout and quality of care, and assessed potential bias by using the Ioannidis (excess significance) and Egger (small-study effect) tests.
Data synthesis:
A total of 11 703 citations were identified, from which 123 publications with 142 study populations encompassing 241 553 health care providers were selected. Quality-of-care outcomes were grouped into 5 categories: best practices (n = 14), communication (n = 5), medical errors (n = 32), patient outcomes (n = 17), and quality and safety (n = 74). Relations between burnout and quality of care were highly heterogeneous (I2 = 93.4% to 98.8%). Of 114 unique burnout-quality combinations, 58 indicated burnout related to poor-quality care, 6 indicated burnout related to high-quality care, and 50 showed no significant effect. Excess significance was apparent (73% of studies observed vs. 62% predicted to have statistically significant results; P = 0.011). This indicator of potential bias was most prominent for the least-rigorous quality measures of best practices and quality and safety.
Limitation:
Studies were primarily observational; neither causality nor directionality could be determined.
Conclusion:
Burnout in health care professionals frequently is associated with poor-quality care in the published literature. The true effect size may be smaller than reported. Future studies should prespecify outcomes to reduce the risk for exaggerated effect size estimates.
Primary funding source:
Stanford Maternal and Child Health Research Institute.
The goal of this study was to examine the effects of transformational leadership behaviors, within the context of Kerr and Jermier’s (1978) substitutes for leadership. Data were collected from 1539 employees across a wide variety of different industries, organizational settings, and job levels. Hierarchical moderated regression analysis procedures generally showed that few of the substitutes variables moderated the effects of the transformational leader behaviors on followers’ attitudes, role perceptions, and “in-role” and “citizenship” behaviors in a manner consistent with the predictions of Howell, Dorfman and Kerr (1986). However, the results did show that: (a) the transformational leader behaviors and substitutes for leadership each had unique effects on follower criterion variables; (b) the total amount of variance accounted for by the substitutes for leadership and the transformational leader behaviors was substantially greater than that reported in prior leadership research; and (c) several of the transformational behaviors were significantly related to several of the substitutes for leadership variables. Implications of these findings for our understanding of the effects of transformational leader behaviors and substitutes for leadership are then discussed.
Presents a conceptual model of burnout as a function of the organizational environments of human service environments. The conflict of professional role expectations with administrative policies accelerates the development of the syndrome. This perspective places secondary importance on client demands as a determinant of burnout. It also challenges individual-oriented approaches to the management of organizational stress. It is suggested that interventions which enhance workgroup autonomy and provide opportunities for professionals to utilize their skills while developing their competence would reduce burnout. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Developed scales to assess one individual's trust in another in meaningful interpersonal relationships. For males, the scale included factors of reliableness, emotional trust, and general trust. For females, similar but not identical reliableness and emotional trust factors emerged. The scales demonstrated adequate reliability and were discriminable from the related constructs of liking and love. In Exp I, 435 undergraduates' responses on the Reliableness subscale varied appropriately as a function of the reliable or nonreliable behavior of the target person. In Exp II, 84 undergraduates' responses on the Emotional Trust subscale varied appropriately when the target person either betrayed or did not betray a confidence. In both experiments, the appropriate subscale was more sensitive to experimental manipulations than were the other trust subscales, attesting to the discriminant validity of the trust factors. (27 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A scale designed to assess various aspects of the burnout syndrome was administered to a wide range of human services professionals. Three subscales emerged from the data analysis: emotional exhaustion, depersonalization, and personal accomplishment. Various psychometric analyses showed that the scale has both high reliability and validity as a measure of burnout. Since the publication of this article in 1981, more extensive research was done on the MBI, which resulted in some modifications of the original measure. The present article has been re-edited to reflect those modifications. However, it does not include other new additions (which are contained in the MBI Manual distributed by the publisher, Mind Garden).
In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators.
Structural equation modeling is a comprehensive, flexible approach to research design and data analysis. Although in recent years there has been phenomenal growth in the literature on technical aspects of structural equation modeling, relatively little attention has been devoted to conceiving research hypotheses as structural equation models. The aim of this article is to provide a conceptual overview of clinical research hypotheses that invite evaluation as structural equation models. Particular attention is devoted to hypotheses that are not adequately evaluated using traditional statistical models.
The organizational context in which nurses practice is important in explaining variation in patient outcomes, but research has been hampered by the absence of instruments to measure organizational attributes empirically.
To report on the development and utility of the Revised Nursing Work Index (NWI-R) in measuring characteristics of professional nursing practice environments.
The NWI-R was used in a national acquired immunodeficiency syndrome (AIDS) care study. The sample consisted of 40 units in 20 hospitals. Of these 20 hospitals, 10 provided AIDS care in both dedicated AIDS units and general medical units, thus introducing to the design an element of internal control. The remaining 10 hospitals were selected through a matching procedure. Three of the matched control hospitals were magnet hospitals. Nurses were recruited into the study if they worked at least 16 hours per week on the study unit. The nurses completed the NWI-R in addition to other measures.
A response rate of 86% was attained. Response rates per unit ranged from 73% to 100%. Cronbach's alpha was 0.96 for the entire NWI-R, with aggregated subscale alphas of 0.84 to 0.91. Validity of the NWI-R was demonstrated by the origin of the instrument, its ability to differentiate nurses who worked within a professional practice environment from those who did not, and its ability to explain differences in nurse burnout.
The NWI-R has been found to capture organizational attributes that characterize professional nursing practice environments.
The current nursing shortage, high hospital nurse job dissatisfaction, and reports of uneven quality of hospital care are not uniquely American phenomena. This paper presents reports from 43,000 nurses from more than 700 hospitals in the United States, Canada, England, Scotland, and Germany in 1998-1999. Nurses in countries with distinctly different health care systems report similar shortcomings in their work environments and the quality of hospital care. While the competence of and relation between nurses and physicians appear satisfactory, core problems in work design and workforce management threaten the provision of care. Resolving these issues, which are amenable to managerial intervention, is essential to preserving patient safety and care of consistently high quality.
Competitive advantage is largely generated by the resources and capabilities of a firm's internal strategic assets. It should not be surprising, then, that continuity of employment is a critical ingredient in long-term quality improvement. Many American companies, including those seemingly dedicated to quality improvement, fail to consider the implications of employment and job continuity. Consequently, these companies pursue contradictory policies that severely reduce the probability of achieving their goal of continuous quality improvement. This article examines alternative courses of action for firms seeking quality improvement when faced with the reality of high employee turnover.
In a random sample of 20 hospitals, the availability and consistency of five patient outcome indicators were examined, including medication administration errors, patient falls, occurrence of new decubitus ulcers, nosocomial infections, and unplanned readmission to the hospital. The results indicate that information about only two outcome indicators--medication errors and patient falls--were collected consistently by the sampled hospitals. The findings are discussed in the context of implications for the study of patient outcomes research. Language: en
In studies of the effectiveness of health care organizations, the job satisfaction level of professional staff is often viewed as an "outcome," since providing a climate that satisfies participants' needs is one aspect of organizational effectiveness. Staff satisfaction, however, has not been linked with outcomes associated with clients. In this article, the authors examine the relationship between the aggregate job satisfaction level of nursing staff in 77 family planning clinics and two client outcomes: 1) the aggregate satisfaction level of teenage clients with contraceptive services obtained in the clinic, and 2) the subsequent rate of client compliance with contraceptive prescriptions. Among the variables studied in testing an organizational-level model, it is found that the job satisfaction level of nursing staff is the strongest determinant of the aggregate satisfaction level of clients; client satisfaction level, in turn, predicts the rate of clients' subsequent contraceptive compliance. Staff satisfaction has a noteworthy indirect effect on compliance through client satisfaction. Compliance, however, appears to be more susceptible to variations in clinic structure than to variations in staff satisfaction levels. Implications of these findings for studies of effectiveness of health services and for management of health care organizations are discussed.
Data from a survey of more than 800 nurses who care for AIDS patients revealed that the organizational form of the unit and hospital in which care was provided significantly affected the likelihood of nurses reporting that they were emotionally exhausted. Nurses who worked in dedicated or specialized AIDS units, or in “magnet” hospitals known to possess organizational characteristics attractive to nurses, exhibited lower levels of emotional exhaustion than did nurses who cared for AIDS patients in general, scattered-bed medical units. These differences persisted after nurse characteristics were statistically controlled, but they were accounted for in part by controlling for the amount of organizational support that nurses perceived was present in their workplaces.
Downsizing has become a popular organization-wide intervention for improving effectiveness. However, much of the existing literature is based on prescriptions and anecdotes. This article presents a longitudinal, quasi-experimental field study of a downsizing intervention in a healthcare organization. Measures of work attitudes (job satisfaction, organizational commitment, supervisor support, and workgroup trust) were taken at annual intervals over a 3-year period. Results partially supported the hypotheses that managers and front-line employees would report different reactions to downsizing programs. Explanations and implications for future research and practice are discussed.
Objective. To compare differences in AIDS patients' 30-day mortality and satisfaction with care in dedicated AIDS units, scattered-bed units in hospitals with and without dedicated AIDS units, and in magnet hospitals known to provide good nursing care.
Methods. Data were obtained on 1,205 consecutively admitted patients in 40 units in 20 hospitals and on 820 of their nurses.
Results. Mortality was lower and satisfaction was higher for AIDS patients in dedicated AIDS units and in nursing magnet hospitals. Primary nursing, end-of-life care counseling, and discharge planning were also more common. Higher nurse to patient ratios and AIDS physician specialty services were strongly associated with lower mortality. Patient satisfaction was strongly associated with organizational control of care by bedside nurses. Homosexuals were more likely to be admitted to dedicated AIDS units, which largely explains the under-representation of minorities and women.
Conclusions. Dedicated AIDS units and magnet hospitals offer important benefits to AIDS patients, including lower odds on dying within 30 days of admission, higher patient satisfaction, and care meeting professional standards. Better nurse staffing, AIDS physician specialty services, and more organizational control by bedside nurses improve patient outcomes.
Researchers have demonstrated repeatedly the importance of the relationship linking job satisfaction to employee retention. In rural areas of the country, where a persistent maldistribution of nurses continues to hamper health care delivery, the potential benefits of bolstering retention via enhancements in job satisfaction are of utmost utility to administrators and providers alike. Data were gathered from a multistate survey of registered nurses (RNs) practicing in rural hospitals, skilled nursing facilities, and community/public health settings (N = 1,647; response rate = 40.3%). The investigators found that the use of tuition reimbursement corresponded significantly with increased levels of job satisfaction among nurses in all three practice environments, as did day care services for nurses in acute care settings. Also, among hospital-based RNs, level of nursing education was found to be a significant factor in the relationship between tuition reimbursement and job satisfaction, with the highest level occurring among diploma-prepared nurses.
Factor analysis, path analysis, structural equation modeling, and related multivariate statistical methods are based on maximum likelihood or generalized least squares estimation developed for covariance structure models. Large-sample theory provides a chi-square goodness-of-fit test for comparing a model against a general alternative model based on correlated variables. This model comparison is insufficient for model evaluation: In large samples virtually any model tends to be rejected as inadequate, and in small samples various competing models, if evaluated, might be equally acceptable. A general null model based on modified independence among variables is proposed to provide an additional reference point for the statistical and scientific evaluation of covariance structure models. Use of the null model in the context of a procedure that sequentially evaluates the statistical necessity of various sets of parameters places statistical methods in covariance structure analysis into a more complete framework. The concepts of ideal models and pseudo chi-square tests are introduced, and their roles in hypothesis testing are developed. The importance of supplementing statistical evaluation with incremental fit indices associated with the comparison of hierarchical models is also emphasized. Normed and nonnormed fit indices are developed and illustrated.
Job satisfaction remains an important consideration for both employer and employee and, despite numerous investigations, many questions about it remain unanswered. Many research methodologies have been used with varying degrees of success. However, the trend is now away from simple correlational studies towards modelling techniques. Data from 221 female nurses working full-time in hospitals were collected using questionnaires delivered with monthly salary cheques. The model presented had many statistically significant path coefficients including (in order of size): benefits, participation in decision making, education, routine, promotion, and opportunity for advancement outside their institution. The level of salary was not found to be a statistically significant factor in determining job satisfaction.
This article examines the importance of outcomes as indicators of quality of care. The appropriateness of selected traditional and emerging outcomes in measuring the effectiveness of nursing interventions is addressed.
This study was an examination of the combined ability of perceived work environment, demographic, and work-related variables to predict burnout among 314 nurses at a large metropolitan hospital. The three dimensions of burnout measured were emotional exhaustion, depersonalization, and personal accomplishment. High work pressure and low work involvement and supervisor support predicted emotional exhaustion. Task orientation, work pressure, work involvement, and age predicted both depersonalization and personal accomplishment. Burnout among nurses on each of the three work shifts also was examined. Results are discussed from the perspective of how to decrease or to prevent burnout among nurses.
The health care environment of the 1980s is one of increasing concern for cost containment. In such an environment caution must be exercised in order to ensure that the quality of health care does not suffer. Cost containment and high quality can coexist if proper risk management and quality assurance programs are effectively instituted. The study presented here found that the occurrence of patient incidents is influenced by very few factors from the hospital's context and organization. Patient acuity is not a significant factor in explaining variations in incident rates (except patient injury), and neither is the number of registered nurses on staff. The lack of relationship between patient incidents and nursing resource consumptions may be explained by variations in the competence of registered nurses. This suggests that quality assurance and risk management programs would benefit from developing the capability to account for the competence of individual employees.
In a random sample of 20 hospitals, the availability and consistency of five patient outcome indicators were examined, including medication administration errors, patient falls, occurrence of new decubitus ulcers, nosocomial infections, and unplanned readmission to the hospital. The results indicate that information about only two outcome indicators--medication errors and patient falls--were collected consistently by the sampled hospitals. The findings are discussed in the context of implications for the study of patient outcomes research.
The restructuring of health care delivery systems and the redesign of nursing roles is creating dramatic changes in the work environment for nurses. Empirical evidence supports the relationship between work environment and job satisfaction of nurses. However, in order for research to be applicable to practice settings, more information is needed on the specific components of the work environment most salient to nurses. Therefore, the purpose of this study was to determine the effect of the organizational and unit work environment on nurses' job satisfaction. The results of this study indicate the importance of relationships in the work setting. A cohesive peer group may compensate for other frustrations from the work environment, and a supportive manager may buffer nurses from effects of less desirable environments.
The objective of this study is to investigate whether hospitals known to be good places to practice nursing have lower Medicare mortality than hospitals that are otherwise similar with respect to a variety of non-nursing organizational characteristics. Research to date on determinants of hospital mortality has not focused on the organization of nursing. We capitalize on the existence of a set of studies of 39 hospitals that, for reasons other than patient outcomes, have been singled out as hospitals known for good nursing care. We match these "magnet" hospitals with 195 control hospitals, selected from all nonmagnet U.S. hospitals with over 100 Medicare discharges, using a multivariate matched sampling procedure that controls for hospital characteristics. Medicare mortality rates of magnet versus control hospitals are compared using variance components models, which pool information on the five matches per magnet hospital, and adjust for differences in patient composition as measured by predicted mortality. The magnet hospitals' observed mortality rates are 7.7% lower (9 fewer deaths per 1,000 Medicare discharges) than the matched control hospitals (P = .011). After adjusting for differences in predicted mortality, the magnet hospitals have a 4.6% lower mortality rate (P = .026 [95% confidence interval 0.9 to 9.4 fewer deaths per 1,000]). The same factors that lead hospitals to be identified as effective from the standpoint of the organization of nursing care are associated with lower mortality among Medicare patients.
The effects of key factors in the nursing practice environment--management style, group cohesion, job stress, organizational job satisfaction, and professional job satisfaction--on staff nurse retention and process aspects of quality of care were examined. Hinshaw and Atwood's (1985) anticipated turnover model was modified and expanded to include relevant antecedent and outcome variables. The four-stage theoretical model was tested using data from 50 nursing units at four acute care hospitals in the southeast. The model explained 49% of the variance in staff nurse retention and 39% of the variance in process aspects of quality of nursing care. Study findings warrant careful consideration in light of recent practice environment changes: experience on the unit and professional job satisfaction were predictors of staff nurse retention; job stress and clinical service were predictors of quality of care. The variable contributing the most to indirect, and in turn, total model effects, was that of management style. These results substantiate the belief that aspects of the practice environment affect staff nurse retention, and most importantly, the quality of care delivered on hospital nursing units.
Nurse administrators are seeking ways to create organizational work environments that empower nurses to exercise more control over the content and context of their practice. This study used Rosabeth Kanter's Structural Theory of Organizational Behavior to examine relationships between staff nurses' perceptions of work empowerment, and control over nursing practice, and subsequently, job satisfaction and perceived work effectiveness. Implications for nurse administrators are discussed.
A study was undertaken to examine the relationships between patient's perceptions of care received, nurses' perceptions of care delivered, and traditional measures of nursing care quality. Findings suggest that traditional quality indicators used in hospitals across the country have little in common with either patients' or nurses' perceptions of quality of care.
This study examined the relationships of nurse burnout, intention to quit, and meaningfulness of work as assessed on a staff survey with patient satisfaction with nursing care, physician care, information provided and coordination of care, and outcomes of the hospital stay assessed post-discharge. Sixteen inpatient units from two hospital sites formed the data base and included 605 patients and 711 nurses. Patients' perceptions of the quality of each of the four care dimensions corresponded to the relationships nurses had with their work. Patients on units where nurses found their work meaningful were more satisfied with all aspects of their hospital stay. Patients who stayed on units where nursing staff felt more exhausted or more frequently expressed the intention to quit were less satisfied with the various components of their care. Although nurse cynicism was reflected in lower patient satisfaction with interactions with nursing staff, the correlations between cynicism and other aspects of care fell below statistical significance. No significant correlations were found between nurse professional efficacy and any of the patient satisfaction components measured. The implications of the relationship between patient satisfaction and nurses' perception of their work is discussed.