Factors predicting quality of nursing care among nurses in tertiary care hospitals in Mongolia.

BACKGROUND: An increasing nursing shortage, high workloads and poor working environments are affecting the quality of nursing care in many countries including Mongolia. AIM: To explore the level of quality of nursing care, nursing competency and nursing practice environment, as well as the predictability of nurses' personal factors, nursing competency and nursing practice environment on quality of nursing care as perceived by nurses in Mongolia. METHODS: We collected data from 346 registered nurses, randomly selected and working in seven general public tertiary care hospitals in the capital city of Ulaanbaatar, and four regions of Mongolia. Instruments used were the Good Nursing Care Scale, the Competency Inventory for Registered Nurses and the Practice Environment Scale of Nursing Work Index. Data were analysed using descriptive statistics and multiple regression analysis. RESULTS: The overall quality of nursing care and nursing competency was perceived to be at a high level, whereas nursing practice environment was at a favourable level. Nursing competency and nursing practice environment were found as significant predictors of nursing care quality, while personal factors were found as non-significant predictors. DISCUSSION: Improving nursing competency and practice environment enhances the quality of nursing care. However, a study limitation is that self-reporting may not have reflected the accuracy of variables. CONCLUSION: Findings provide important evidence for the use of measures and strategies to enhance the quality of nursing care by improving nursing competency and the nursing practice environment. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Policymakers, administrators and nurses need to work together to develop and implement policies to enhance and support the competency and practice environments of the Mongolian nurses.

Analysis of a government policy to address nursing shortage and nursing education quality.

BACKGROUND: A well-educated, sufficient nursing workforce improves population health and standards of nursing care. Analysing workforce policies assists nurses to learn from the past and develop better future policies. AIM: Describe policy-making processes in the first Thai government plan to increase nursing capacity and improve nursing education quality. DESIGN: A qualitative study employing Longest's model to examine policy-making processes. METHODS: Data were obtained from 28 in-depth interviews with key informants, who had been committee members and former deans of nursing involved with the policy processes in the 1990s. Both qualitative and quantitative data were extracted from relevant documents, and content analysis employed with all data. FINDINGS: Three policy phases were identified. Policy formulation, where three streams of problems, politics and policy resulted in identification of nursing shortage, changes of government incumbents and needing to increase nurse production; Policy implementation included creating methods of implementation, appointing responsible people and committees, creating operational plans, producing more nurses and faculty development projects and Policy modification which incorporated implementing the first Thai international doctoral degree in English, a collaborative programme between universities. STUDY LIMITATIONS: Not all key informants could be accessed due to the passage of time. Findings are unique to Thailand but inform internationally of nurses' abilities and need to be involved in policy. CONCLUSION: Nurses were involved in all policy phases. While the policy produced positive developments in growing nursing capacity and education in the past, nursing shortages remained and are now acute in Thailand. IMPLICATIONS FOR NURSING/HEALTH POLICY: Lessons learned from this policy analysis help explain why the nursing education and nursing shortage policy was legislated through the government agenda, and the active involvement of Thai nurses in this process. Nurses globally need to be at the policy-making table to try to reduce nursing shortages, and enhance practice and education environments.

Effects of nurse work environment on job dissatisfaction, burnout, intention to leave.

BACKGROUND: The nursing shortage is a critical issue in many countries. High turnover rates among nurses is contributing to the shortage, and job dissatisfaction, intention to leave, and burnout have been identified as some of the predictors of nurse turnover. A well-established body of evidence demonstrates that the work environment for nurses influences nurse job dissatisfaction, intention to leave, and burnout, but there never has been a study undertaken in Thailand to investigate this relationship. OBJECTIVES: To investigate how work environment affects job dissatisfaction, burnout, and intention to leave among nurses in Thailand. METHODS: The study used a cross-sectional survey to collect data from 1351 nurses working in 43 inpatient units in five university hospitals across Thailand. The participants completed the Practice Environment Scale of the Nursing Work Index, the Maslach Burnout Inventory, and measures of job dissatisfaction and intention to leave. Logistical regression models assessed the association between work environment and nurse-reported job dissatisfaction, burnout, and intent to leave. RESULTS: Nurses working in university hospitals with better work environments had significantly less job dissatisfaction, intention to leave, and burnout. CONCLUSION: The nurse work environment is a significant feature contributing to nurse retention in Thai university hospitals. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Improving the work environment for nurses may lead to lower levels of job dissatisfaction, intention to leave, and burnout. Focusing on these nurse outcomes can be used as a strategy to retain nurses in the healthcare system. Addressing the challenges of poor work environments requires coordinated action from policymakers and health managers.