Paper
Thursday, July 22, 2004
The Effect of Work Environment and Nurse Characteristics on Nurse Outcomes
Sping Wang, PhD1, Linda O'Brien-Pallas, RN, PhD2, Donna Thomson, BScN, MScN3, Linda McGillis Hall, RN, PhD2, Xiaoqiang Li, PhD4, and Raquel M Meyer, RN, PhD, Student5. (1) Nursing Effectiveness, Utilization and Outcomes Research Unit, University of Toronto, Toronto, ON, Canada, (2) Faculty of Nursing, University of Toronto, Toronto, ON, Canada, (3) St. Peter's Hospital, University of Toronto, Hamilton, ON, Canada, (4) Nursing Effectiveness, Utilization & Outcomes Research Unit, University of Toronto, Toronto, ON, Canada, (5) NRU, University of Toronto, Toronto, ON, Canada
Objective: This paper describes how inputs and throughputs in the PCDM influence nurse autonomy, relationships with physicians, satisfaction, burnout, SF-12 health status, and intent to leave. Design: Cross sectional and longitudinal. Population, Sample, Setting: In total, 727 nurses out of a possible 1107 completed the nurse survey. Concepts and variables measured: As described in Abstract 1 Results: Improved nurse-physician relationships were associated with higher proportions of physically healthy nurses and increases in RN worked hours on the unit. Deterioration in nurse-physician relationships was associated with P/U levels beyond 85%. Higher nurse autonomy was associated with P/U greater than 85% and nurse satisfaction. Job satisfaction was 57% less likely when P/U levels exceeded 80%. Nurses who rated the quality of nursing care as good or better, were 301% more likely to be satisfied. Improved job satisfaction was also 56% more likely for degree nurses and 24% more likely for every one point increase in their ratings of nurse autonomy. Emotional exhaustion was 66% less likely when nurses were satisfied and 32% less likely for every 10% increase in satisfied nurses on the unit. Emotional exhaustion was 242% more likely were at risk of an effort and reward imbalance and 179% more likely when nurses worked full-time. Intent to leave was 197% more likely amongst nurses who were concerned about job security and 101% more likely amongst degree nurses. Conclusion: Maintaining nurses’ physical health, promoting job security and designing jobs where degree prepared nurses can exercise full scope of practice will improve retention. Implication: The work environment is under the control of managers who can influence both patient and nurse outcomes.
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