The Impact of Nursing Practice Environment on Job Dissatisfaction, Burnout, and Intention to Leave

Background: The shortage of nurses is a significant problem for healthcare systems. Nursing shortages have led to concerns following warnings and evidence of shortcomings in patient safety, quality of care, and welfare of nurses. Improving nursing practice environments has been suggested to reduce nurse turnover and improve nurse retention. To enhance strategies for solving the issues related to nursing shortages it is essential to better understand the effects of the nursing practice environment and how they relate to nurses’ job satisfaction, intent to quit their current job, and nurses’ burnout that contributes to turnover.

Purpose: To describe how the nursing practice environment affects job dissatisfaction, burnout, and intention to leave 

Methods: A cross-sectional survey was used with linked nurse data. The 1,351 registered nurses working in 45 inpatient units in five university hospitals across Thailand completed questionnaires: the Practice Environment Scale of the Nursing Work Index, job dissatisfaction, intention to leave, and Maslach Burnout Inventory. Logistic regression models were used to determine whether the nursing practice environment was predictive of nurses’ reported job outcomes, with controls for nurse and organizational characteristics. 

Results: Around 17%, 10%, and 51% of nurses reporting job dissatisfaction, intention to leave, and high emotional exhaustion, respectively. The PES-NWI subscale with the highest mean scores was Nurse Foundations for Quality of Care. The PES-NWI subscale with the lowest mean scores was the Staffing Resources and Adequacy. Our model presented that nurses working in hospital with a better work environment was associated with significantly lower odds of job dissatisfaction, intention to leave, and high emotional exhaustion, controlling for individual and unit characteristics. 

Conclusion: The nursing practice environment is a significant feature contributing to nurse retention for Thai university hospitals. Improving nursing practice environment with a causing decrease in job dissatisfaction, intention to leave, and burnout might be a financial strategy to retain nurses in health care system. Addressing this challenge would require coordinated action from policymakers and health managers.