Pediatric Nursing Practice Environment, Job Outcomes and Safety Climate: Structural Equation Modeling Approach

Purpose: The nursing practice environment is critical to the wellbeing of professionals and patient safety, as highlighted by national and international studies. However, there is a lack of evidence regarding this issue in pediatric units. The aim of this study was to assess correlations between the characteristics of nursing practice environment, emotional exhaustion, job satisfaction, intention to leave the job, and safety climate.

Methods: A cross-sectional study in fifteen inpatient units and three intensive care units of two pediatric hospitals in Brazil. The study was conducted from December 2013 to February 2014. For data collection, we used the Nursing Work Index - Revised, the Safety Attitudes Questionnaire - Short Form 2006, and the Maslach Burnout Inventory. The analysis was performed using Spearman’s correlation coefficient and Structural Equation Modeling.

Results: The sample consisted of two hundred and sixty-seven nursing professionals. The results showed that professionals with greater autonomy, good working relationships with the medical staff, control over the work environment, and organizational support have lower levels of emotional exhaustion, higher job satisfaction, less intention of leaving the job, and a positive safety climate. The structural equation modelling showed satisfactory levels of adjustment and indicated that the variables of the nurse work environment are predictors of job outcomes and safety climate. The values obtained in the Pearson’s coefficient determination indicated that emotional exhaustion was the variable that was best explained by the predictors, while the safety climate and job satisfaction were presented as the mean effect.

Conclusion: Autonomy, control over the work environment and relationship between nursing and medical staff are factors associated with emotional exhaustion, job satisfaction, safety climate, and intention to leave the job. Organizational investments - such as initiatives for reduction or relief of burnout, professional involvement in decision-making related to patient care, professional recognition, support of the nursing manager, and a learning through failures approach - contribute positively to the development of a favorable work environment and have significant impact on job satisfaction and safety climate.