Brazilian Nurses' Perceptions of the Work Environment (RD)

Saturday, 23 February 2019: 10:25 AM

Edinêis de Brito Guirardello, PhD, RN
School of Nursing, University of Campinas - Unicamp, Campinas, SP, Brazil
Herica Silva Dutra, PhD, RN
Basic Nursing Department of Nursing School, Federal University of Juiz de Fora, Juiz de Fora, Brazil

Background: It has been reported that work environments that do not support nurses, high levels of job-related burnout and job dissatisfaction are associated with nurses’ intent to leave their job. Although the nurse shortage and intent to leave is not a problem in Brazil, the high rates of turnover are concerning and these can result in poor care outcomes and compromise patient safety. Much of the research on nurse work environment has been conducted in North America; few studies have been conducted in South America. Brazil is a country of more than 1.5 million nursing professionals most of whom work in the Unified Health System. These numbers alone demand that we examine the work environment of nurses and the associated nurse outcomes of job-related burnout, job dissatisfaction and intent to leave.

Objective: The objective was to describe the perceptions of the nurse work environment among Brazilian nursing professionals.

Method: This study was a cross-sectional survey of hospital-based, Brazilian nursing professionals. Hospitals were selected if they were designated as a general hospital, had 100 or more beds, and delivered care only to patients of the Brazilian Unified Health System. Four hospitals meet inclusion criteria and three agreed to participate in the study (A, B and C).

All direct care nurses and nurse technicians who had been employed for 6 months or longer in a study hospital were invited to participate. The nurse survey included questions on demographic and employment characteristics and the Nursing Work Index-Revised, Brazilian version. Nursing professionals who agreed to participate received an envelope with the survey instruments. The study principal investigator and two research assistants collected onsite nurse survey data from February 15, 2015 to April 30, 2015. All study participants provided a signed, informed consent form prior to distribution and completion of the nurse survey. This study was approved by the hospitals human research ethics committee.

Nurse and hospital characteristics were described as means and standard deviations (SD) or numbers and percents. For the analysis involving a quantitative and a qualitative variable, the Mann-Whitney or Kruskal-Wallis tests were used according to the number of categories of the qualitative variable. In order to verify among which variables there were differences statistically significant, the Dunn post-test was used after the Kruskal-Wallis test. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) - version 22.0

Results: A total of 838 nursing professionals were invited to participate and 452 (54%) completed and returned a survey. The final sample included 102 nurses and 350 nursing technicians. These nursing professionals worked on 48 adult and pediatric units including medical-surgical, intensive care and outpatient service.

On average nurses were 37.4 (SD = 9.3) years of age, and the majority were female (76%) and married (42%). Approximately half (51%) of the nurses surveyed worked on a medical-surgical unit. Sixty-one percent of the nurses had four years of experience or less. Twenty-seven percent of nurses reported poor autonomy, 30% reported poor nurse physician relationships, and 38% reported poor control over the work environment.

The mean scores of each subscale in this study ranged from 2.11 to 2.32. There was no difference between nurses and nursing technicians’ perceptions on B-NWI-R subscales. Among hospitals, we found that all subscales were different with a better perception of nurse work environment among participants of Hospital B. The mean score of the items of the B-NWI-R ranged from 1.92 to 2.62. The percentage of agreement and disagreement among the participants ranged from 48.7 to 80.5 and from 19.5 to 51.3, respectively considering the results of the entire sample (Table 3).

Nurses’ and nursing technicians’ perceptions of the work environment differed only on two items: “enough time and opportunity to discuss patient care problems with other nurses” and “a supervisory staff that is supportive of nurses.” We found that most of the items differ among the three hospitals, with lower scores to hospital B, when compared with hospitals A and C.

Conclusions: In general, nurses and nursing technicians perceived their work environment as favorable as they reported having autonomy, control over the work environment, good relationships with physicians, and organizational support. Nurses and nursing technicians did not differ on the perceptions of the nurse work environment. The nurse work environment was perceived differently among the three included hospitals, with better scores to the hospital which holds accreditation certification. These scores suggest that accreditation can influence nursing professionals' perceptions of nurse work environment.