Impact of Nursing Practice Environment on Job Outcomes and Safety Climate: Testing a Model

Purpose: To test the theoretical model of the effect of nursing practice environment on safety climate, job satisfaction, intention to remain at job and in the nursing profession, and burnout.

Methods: Cross-sectional study of explanatory scope, with a probabilistic sample of 465 nurses from the state of São Paulo, Brazil. The inclusion criteria were nurses who exercised direct assistance activities for patients and with experience of six or more months in the institution. The instruments used for the study were the subscales job satisfaction and safety climate of the Brazilian version of the Safety Attitudes Questionnaire - Short Form 2006, the Brazilian version of the Nursing Work Index Revised and the Maslach Burnout Inventory. Data collection was carried out electronically via the SurveyMonkey® software. For the multivariate analysis, we used Structural Equation Modeling, by applying the Partial Least Squares Path Modeling (PLS-PM) approach, using the SmartPLS® software version 3.0.

Results:  Initially, we performed the measurement model, considering the measures related to convergent and discriminant validity. Five items were excluded five items from the proposed model, which showed adequate levels of composite reliability (ρ = 0.81 to 0.93) for all latent variables in the model. Subsequently, in the structural model, the path coefficients between included variables of nursing practice environment and outcome variables were significant (p <0.001). The included constructs contributed to the model adjustment (Q² > 0), with size of effect moderate to high (f² = 0.207 a 0.596). The adjusted model explained 35.7% of burnout, 42.3% of the safety climate, 42.6% of job satisfaction, 22.3% of the intention to remain in job and 16.7% of the intention to stay in the profession.

Conclusion: The improved model required minor adjustments and makes it possible to conclude that the nursing practice environment influences job satisfaction, intention to remain in employment and in nursing, the safety climate, and burnout. Implications for practice: The evaluation of the characteristics of nursing practice environment and the safety climate from the perspective of nurses can provide essential information for planning strategic actions in health care services, and the development of public policies for managing human resources in the health care field.