Paper
Saturday, 22 July 2006
This presentation is part of : Initiatives in Nursing Administration
The Impact of Nursing Work Environments on Patient Safety Outcomes: The Mediating Role of Burnout/Engagement
Heather K. S. Laschinger, RN, PhD, School of Nursing, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada, Michael Leiter, PhD, Psychology, Acadia University, Wolfville, NS, Canada, and Joan M. Almost, RN, MScN, Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
Learning Objective #1: describe the relationship between nursing work environments and patient safety outcomes.
Learning Objective #2: describe the role of burnout on the relationship between the quality of nursing practice work environments and patient safety outcomes.
Interest in the impact of nursing working conditions on patient safety outcomes has grown with numerous studies linking worklife characteristics to patient outcomes.  The 2004 Institute of Medicine Report raised serious concerns about the impact of hospital restructuring on nursing work environments and patient safety outcomes.  The report noted that typical nursing work environments are characterized by many serious threats to patient safety and suggests that organizational management practices, weak nursing leadership, and work design issues cause these conditions.  Nurse burnout has also played a major role in the studies that examined the relationship between nursing work environments and patient outcomes.  Few studies, however, have used an explicit theoretical framework to study these relationships.  The purpose of this study was to test a theoretical model of professional nursing work environments linking perceived conditions for professional nursing practice in nursing work environments to burnout/engagement, and subsequently, patient safety outcomes.  Hospital based nurses in Canada (N=8,597) were surveyed by mail.  The Nursing Work Index (NWI-PES), Maslach Burnout Inventory – Human Service Scale (MBI-HSS) and the frequency of adverse patient events were used to measure the major study variables.  Structural equation modeling analysis showed that nursing leadership played a fundamental role in the quality of worklife regarding policy involvement, staffing levels, support for a nursing model of care (versus medical), and physician/nurse relationships.  Staffing adequacy directly affected emotional exhaustion and the use of a nursing model of care had a direct effect on nurses’ personal accomplishment.  Both directly affected patient safety outcomes.  The results suggest that patient safety outcomes are related to the quality of the nursing practice work environment and that burnout plays an important mediating role.

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