The role of the nursing work environment, head nurse leadership and presenteeism in job embeddedness among new nurses: a cross-sectional multicentre study.

BACKGROUND: The retention of new nurses has become a major challenge for medical institutions. Job embeddedness has been seen as a valuable lens for examining nurse turnover, but greater details about job embeddedness are rarely disclosed, especially among new nurses. This study aimed to reveal how the nursing work environment, head nurse leadership and presenteeism shape job embeddedness in this population from the perspective of conservation of resources (COR) theory. METHOD: A cross-sectional multicentre study involving 436 participants from 10 cities and 33 hospitals was conducted over 4 months. Samples were selected using a two-stage convenience sampling method. A sequential multiple mediation model performed with SPSS-PROCESS was used to analyse the relationships among the nursing work environment, head nurse leadership, presenteeism and job embeddedness. RESULTS: The nursing work environment not only directly affects the job embeddedness of new nurses (ß = 0.480, p < 0.001) but also indirectly affects it through the sequential multiple mediating effects of head nurse leadership and presenteeism (R2 = 0.535, F = 82.160, p < 0.001). CONCLUSIONS: New nurses' job embeddedness needs to be improved. These results suggest that preserving adequate resources for new nurses, such as work environment resources, head nurse leadership resources, and individual productivity resources, is an effective way to shape their job embeddedness. In addition, when a certain resource is insufficient, fully considering the principles of investment and buffering between resources and providing reciprocal, alternative, or buffer resources in a timely manner are necessary to improve new nurses' job embeddedness. LARGE LANGUAGE MODELS: Large language models (LLMs), such as ChatGPT, were not used during the writing of this article. An expert native English speaker performed language revision.

Using item response theory to develop a shortened practice environment scale of the nursing work index.

The 31-item Practice Environment Scale of the Nursing Work Index (PES-NWI) has been frequently used globally to measure the nurse work environment. However, due to its length and subsequent respondent burden, a more parsimonious version of the PES-NWI may be desirable. Item response theory (IRT) is a statistical technique that assists in decreasing the number of items in an instrument without sacrificing reliability and validity. Two separate samples of nurses in the United States (one called the "internal data source" and the other called "external data source"; sample sizes = 843 and 722, respectively) were analyzed. The internal data source was randomly split into training (n = 531) and validating data sets (n = 312), while a separate whole external data source was used as the final validating data set. Using IRT with training data, we removed nine items; two additional items were removed based on recommendations from a previous study. Confirmatory factor analyses supported the validity of the measurement model with the 20-item of PES-NWI in both internal and external validation data sources. The correlations among subscales between 31- and 20-item versions were high magnitude for five subscales in both validation data sets (τ = 0.84-0.89). Ultimately, we identified a 20-item version of the PES-NWI which demonstrated adequate validity and reliability properties while decreasing data collection burden yet maintaining a similar factor structure to the original instrument. Additional research may be necessary to update the items themselves on the PES-NWI.

Factors associated with the extent of nurses' involvement in promotion of the nursing profession: a cross-sectional study among nurses working in diverse healthcare settings.

AIMS AND OBJECTIVES: To examine factors associated with promotion of the nursing profession, to the nursing community, other healthcare professionals and the general public, by nurses employed in diverse healthcare settings. BACKGROUND: Little is known about the factors that contribute to nurses' involvement in the promotion of the nursing profession. METHODS: This cross-sectional study comprises a convenience sample of registered nurses (n = 526) with ≥ 3 months' experience in nursing, who are employed in internal and surgical units, pediatric wards, psychiatric wards or in the community across Israel. Participants completed a self-administered questionnaire addressing socio-demographic, occupational and organizational factors relating to the nursing work environment and to the extent of nurses' involvement in promotion of the nursing profession. Descriptive statistics, one-way analysis of variance, Pearson's correlation analysis, and multivariate linear regression were performed. RESULTS: Nurses in all the surveyed healthcare settings reported relatively low levels of involvement in promotion of the profession, either to the nursing community or to other healthcare professionals and the public. Being a female-nurse was significantly negatively associated with nurses' involvement in promotion of the nursing profession. In contrast, holding a master's degree in nursing, having a managerial role, and working in a supportive organizational nursing work environment were the principal factors associated with positive promotion of the nursing profession. CONCLUSION: The extent of nurses' involvement in promotion of the nursing profession mainly depends on occupational factors and a supportive organizational nursing work environment. CLINICAL RELEVANCE: Healthcare managers may advance nurses' involvement in promotion of the profession by modifying the organizational nursing work environment. Specifically, we recommend nurse leaders to dedicate efforts to make professional promotion an integral part of a nurse's role.

The newly-licensed registered nurse workforce: Looking back to move forward.

BACKGROUND: Newly licensed registered nurses (NLRNs) are a vital health human resource necessary for the sustainability of the nursing workforce. There are challenges associated with the transition of NLRNs into practice; yet, new nurses continue to leave their positions within the first year. To compound the situation, a global pandemic hit in 2020. To leverage a sustainable future for our nursing workforce we must examine workforce data of NLRNs. PURPOSE: The purpose of this descriptive study was to review the most recent national source of workforce data to determine if the data reveals insight to help renew the focus on the NLRN workforce. METHODS: This descriptive study was a secondary analysis of demographic, education, employment, and work environment variables from the 2018 National Sample Survey of Registered Nurses. FINDINGS: The NLRN workforce is slightly more diverse, seeking a BSN as the first degree, and funding their initial education with federal loans. NLRNs cite inadequate staffing, stressful work environments, burnout, and salary as the reasons for leaving the first job. NLRNs cite a balanced schedule, experience in the job, and a sense of community with peers as reasons why they stay. DISCUSSION: This study joins the decades of literature that points to a small group of problems that account for the overwhelming majority or nursing turnover and attrition. After analyzing the data, the authors pose several questions to readers for consideration about the NLRN workforce. The authors' hope is to garner renewed attention to the issues facing NLRNs.

Decent work in nursing: Relationship between nursing work environment, job satisfaction, and physical and mental health.

AIM: To examine the relationship between nursing work environment, nurses' perception of decent work, job satisfaction, and physical and mental health. BACKGROUND: According to the psychology of working theory, work-related and overall well-being levels of employees with decent work increase as their basic needs are met. METHODS: This study was conducted as a cross-sectional, correlational study. The study sample consisted of 311 nurses working in two hospitals in a province of Turkey. The participants were selected using convenience sampling method. The model of the research was analyzed using structural equation modeling. This study was reported using the STROBE checklist for cross-sectional studies. RESULTS: The four dimensions of the nursing work environment were found to have a significant relationship with decent work. Decent work was found to have a direct relationship with physical and mental health. It had an indirect relationship between three subscales of work environment and physical and mental health, however, decent work had no significant relationship with job satisfaction. CONCLUSIONS: The findings of this study indicated the role of decent work environment and its relationship with nurses' physical and mental health. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nurse managers, policy makers, and decision-makers at all levels should improve nursing work environment and working conditions.

Effects of nurses' individual, professional and work environment characteristics on job performance.

AIMS AND OBJECTIVES: This study aimed to examine the effects of nurses' individual, professional and work environment characteristics on their job performance levels. BACKGROUND: Nurses' job performance is important in the effective and efficient provision of health care. DESIGN: A descriptive, cross-sectional study. The STROBE guidelines were used in this study. METHODS: The sample of this descriptive, correlational and cross-sectional study comprised 370 nurses working at one private and two university hospitals in Turkey. A demographic information form, the Practice Work Environment Scale of the Nursing Work Index (PES-NWI) and the Nursing Job Performance Scale (JPS) were used to collect the data. Data were analysed using descriptive statistics, Spearman's correlation and multiple linear (stepwise) regression. RESULTS: There was a significant and positive correlation between the scores on the PES-NWI and the JPS (r: 0.65, p < .05). Regression analysis showed that nurses' job performance was affected by five variables (R2 : 59%, p < .05, Durbin-Watson: 2.06). CONCLUSION: The results of the study show that three sub-dimensions of the PES-NWI (nursing foundations for quality of care; staffing and resource adequacy; nurse manager abilities, leadership and support for nurses), colleague solidarity and education level were important factors affecting job performance. RELEVANCE TO CLINICAL PRACTICE: The job performance of nurses is a priority issue in delivering quality healthcare services. Further efforts need to be pursued to nurse managers ensure a positive work environment to increase their nurses' job performance.

Same place but different experience: A qualitative study on gender and the nursing work environment.

AIM: This study aimed to reveal the opinions and experiences of male and female nurses concerning the nursing work environment in hospitals. BACKGROUND: The quality of the nursing work environment greatly impacts the improvement of the patient, nurse and organizational outcomes. Therefore, a better understanding of the experiences of male and female nurses can contribute to the creation of a more positive work environment. METHODS: In this descriptive qualitative study, data were collected with semi-structured interviews conducted in 2020 with 18 nurses who were recruited via purposive and maximum variation sampling. Data was analysed with content analysis. RESULTS: The content analysis revealed two major themes (the effects of gender on workplace practices and the image of nursing and gendered communication in the nursing work environment) and eight subthemes. CONCLUSION: This study concluded that male and female nurses experience advantages/disadvantages and similarities/differences in the nursing work environment and that both male and female nurses experience challenges regarding workplace relations and the work environment. IMPLICATIONS FOR NURSING MANAGEMENT: A better understanding of the problems associated with the different experiences of male and female nurses in the workplace may help nurse managers to create a more positive work environment.

Appraisal and evaluation of the instruments measuring the nursing work environment: A systematic review.

AIMS: To appraise the current instruments available for measuring the nursing work environment and re-examine the definition and construct of the nursing work environment. BACKGROUND: A psychometrically sound instrument is fundamental to understanding and improving the nursing work environment. The nursing work environment is a complex construct, and its definition remains inconclusive. None of the instruments available is considered as the gold standard. EVALUATION: A comprehensive searching was undertaken in August 2021 in six databases according to PRISMA. The COSMIN and modified GRADE were applied to assess the methodological quality and measurement properties of the instruments. Instruments were categorized into three levels. The definition and construct of nursing work environment were revisited. KEY ISSUES: Forty-one studies (19 instruments) were included. One, fourteen, and four instruments are respectively appraised as A-, B- and C-level recommendation. Definition and eight labels of nursing work environment are identified. CONCLUSION: This paper provides recommendations for selecting a proper instrument for the nursing work environment. IMPLICATIONS FOR NURSING MANAGEMENT: This study helps nurse managers to select instruments and understand the construct of the nursing work environment. The eight labels can be used as a reference for tailoring policy aimed at creating a favourable nursing work environment.

Association of work environment and resilience with transition shock in newly licensed nurses: A cross-sectional study.

AIMS AND OBJECTIVES: To examine transition shock in newly licensed nurses and the association of work environment and resilience with nurses' transition shock. BACKGROUND: Although work environment is related to transition shock in newly licensed nurses, little is known about the factors of nursing work environment associated with transition shock. Furthermore, resilience is known to help nurses positively face workplace challenges; however, there is little evidence on the associations between resilience and transition shock in new nurses. DESIGN: A cross-sectional, descriptive study. METHODS: Data from 163 new nurses with <12 months of work experience in the current hospital since graduation were analysed. Participants' characteristics, work environment, nurse resilience and transition shock were self-reported. Multivariable linear regressions were performed in three steps (following the STROBE checklist). RESULTS: The highest mean score of transition shock was obtained for the item 'I perceive the limitations of my professional knowledge in nursing care'. In the regression analysis adjusted for all variables, two factors of work environment-'nurse staffing and resource adequacy' and 'collegial nurse-physician relationships'-were associated with transition shock. Meanwhile, resilience was not related to transition shock. CONCLUSIONS: The gap between newly licensed nurses' theoretical and practical knowledge continues to exist. Adequate nurse staffing and a positive relationship with physicians, rather than nurse resilience, were more likely to associate with new nurses' transition shock. RELEVANCE TO CLINICAL PRACTICE: Hospitals need to provide ward-based simulations and case-based learning methods to enhance nurses' transition to professional practice. For nurses' transition, hospitals should make efforts to provide adequate nurse staffing and resources. Furthermore, hospitals should provide communication opportunities to build a positive collaborative culture between nurses and physicians. Unit nurse managers need to assess newly licensed nurses' perception of nurse-physician professional relationship and create an atmosphere of respect and understanding for each other.

The relationship of nursing work environment and innovation support with nurses' innovative behaviours and outputs.

AIM: To determine the relationship of nursing work environment and innovation support with nurses' innovative behaviours and innovation outputs. BACKGROUND: According to the social exchange theory, nursing work environment must be regulated to support innovation for nurses' innovative behaviours, which results in useful innovation outputs. METHODS: The sample of the research determined using the convenience sampling method consisted of 618 nurses working in four hospitals in Istanbul. In statistical analysis of the data, descriptive analyses, correlation and linear regression analysis were used. RESULTS: It was found a significant correlation between nursing work environment and innovation support with innovative behaviour and innovation outputs. It was found that innovative behaviour was the variable that had a significant impact on nurses' innovation outputs and that the model explained 40.1% of the variance of innovation outputs. The model created for innovative behaviour was determined to have an explanatory variance of 19.4%. CONCLUSIONS: This study reveals the necessity for developing nurses' innovative behaviours to increase innovation outputs and examines the relationship of nurses' innovative behaviours with nursing work environment and innovation support. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should create a nursing work environment that supports and develops nurses' innovative behaviours.

Generational preferences in the nursing work environment: A dimensional concept analysis.

AIM: The purpose of this dimensional concept analysis was to identify preferences for favourable nursing work environments by Baby Boomer, Generation X and Millennial nurses. BACKGROUND: Favourable nursing work environments have been associated with better nurse and patient outcomes. Researchers have reported differences among generations related to the work environment, but the extent to which there are differences in preferences, not just perceptions, is less certain. METHOD: A dimensional concept analysis was performed, in which one concept was analysed from multiple points of view. Articles were obtained from PubMed, CINAHL and PsycINFO. Articles published in the last ten years were included if they reported preferences, desires or ideals for the nursing work environment and were categorized by generational cohort. Eight articles qualified for review. RESULTS: Four major themes were identified: nursing practice/unit characteristics, managers/leadership, team/professional interactions and pay/benefits. An additional theme of personal/self emerged among Millennials. CONCLUSIONS: All generations reported preferences related to benefits/pay, manager/leadership, nursing practice/unit characteristics and team/interactions. Only Millennials reported aspects related to self. IMPLICATIONS FOR NURSING MANAGEMENT: All generations desired the first four themes. To address each, nursing leaders should consider the following: (a) ensure adequate staffing and resources are in place for nursing staff; (b) obtain input from all generations about their level of satisfaction with benefits/pay and examine ways to provide better benefits or pay when possible; (c) encourage leadership self-development, such as educational opportunities and mentorship; and (d) determine opportunities to improve interactions among staff members. For Millennials, the only group who had expectations in the area of 'self', provide individualized attention and opportunities that allow them to create a better work-life balance, such as self-scheduling.

Association between nursing work environment and compassion satisfaction among clinical nurses.

AIM: This study investigated the association between nursing work environment and compassion satisfaction among clinical nurses. BACKGROUND: Nursing work environment and compassion satisfaction are important factors for preventing burnout and decreasing clinical nurse turnover. METHOD: This study used a secondary analysis and obtained data from a previous cross-sectional study. RESULTS: The mean scores (mean ± SD) for the nursing work environment and compassion satisfaction were 2.54 ± 0.34 and 33.40 ± 6.69, respectively. As the results of hierarchical regression, staffing and resources (ß = 0.175, p = .002) and collegial nurse-physician relationships (ß = 0.103, p = .038) were significantly associated with compassion satisfaction. CONCLUSION: Improving the nursing work environment could be an effective way to boost compassion satisfaction among nurses. Therefore, organizational support for adequate human resources and materials and mutual relations among nurses and physicians are needed. IMPLICATIONS FOR NURSING MANAGEMENT: Improvements to the work environment and the management of human resource may increase compassion satisfaction in clinical nurses.

[Reflections on the Nursing Work Environment in Light of the Experience With COVID-19].

Labor issues related to the nursing profession have been gaining prominence in Taiwan as well as overseas. In 2016, the United Nations highlighted the importance of societies investing sufficient funds in their professional nurses to support and promote public health, gender equality, and economic growth. Good-quality care requires that nurses have good physical and mental health, while creating and maintaining a friendly nursing work environment rely on cooperation among the government, labor unions, and hospitals. Over the past decade, the Taiwan government has increasingly promoted relevant regulations and established a friendly platform to allow nursing staffs to identify problems and report labor rights violations. In addition, nurses have formed unions to defend and advocate for their professional rights. After the outbreak of COVID-19 in late 2019, the Department of Nursing and Health Care of the Ministry of Health and Welfare actively proposed policies related to creating and maintaining good nursing work environments. The Taiwan Nursing and Medical Industries Union took a supervisory role in this process, providing feedback on policies from the perspective of Taiwan's professional nurses and arguing for the reasonable and fair subsidization of epidemic prevention facilities, implementation of mask and protective equipment, nursing labor rights, and social respect for the nursing profession. Much work still needs to be done to improve the domestic working environment for nursing staffs, including improving and expanding education, normalizing and effectively utilizing nursing staff feedback and whistleblowing information, promoting information transparency, and implementing better policies. We hope that a friendlier nursing work environment will attract many more outstanding young persons to pursue a career in nursing.

Associations Among Nursing Work Environment and Health-Promoting Behaviors of Nurses and Nursing Performance Quality: A Multilevel Modeling Approach.

PURPOSE: This study aimed to determine the relationships among the unit-level nursing work environment and individual-level health-promoting behaviors of hospital nurses in South Korea and their perceived nursing performance quality. METHODS: This study used a cross-sectional design. Data were collected using self-reported questionnaires from 432 nurses in 57 units at five hospitals in South Korea. Nursing performance quality, nursing work environment, and health-promoting behaviors were measured using the Six Dimension Scale of Nursing Performance, Practice Environment Scale of the Nursing Work Index, and Health Promoting Lifestyle Profile-II, respectively. RESULTS: Nurses working in units with nurse managers who were characterized by better ability and by quality leadership, and who provided more support to nurses exhibited significantly greater health responsibility and physical activity. Nurses working with sufficient staffing and resources reported better stress management. Positive collegial nurse-physician relationships in units were significantly associated with more healthy eating among nurses. Nurses working in units with sufficient staffing and resources, and who had a higher level of spiritual growth and health responsibility, were more likely to perceive their nursing performance quality as being higher. CONCLUSIONS: To improve the quality of nursing practice, hospitals should focus on helping nurses maintain healthy lifestyles, as well as improving their working conditions in South Korea. Organizational support for adequate human resources and materials, mutual cooperation among nurses and physicians, and workplace health-promotion interventions for spiritual growth and health responsibility are needed. CLINICAL RELEVANCE: Organizational efforts to provide sufficient staffing and resources, boost the development of personal resources among nurses, and promote nurses' responsibility for their own health could be effective strategies for improving nursing performance quality and patient outcomes.

Jordanian Nursing Work Environments, Intent to Stay, and Job Satisfaction.

PURPOSE: The purpose of this study was to examine associations among the nursing work environment, nurse job satisfaction, and intent to stay for nurses who practice in hospitals in Jordan. DESIGN: A quantitative descriptive cross-sectional survey design was used. METHODS: Data were collected through survey questionnaires distributed to 650 registered nurses (RNs) who worked in three hospitals in Jordan. The self-report questionnaire consisted of three instruments and demographic questions. The instruments were the Practice Environment Scale of the Nursing Work Index (PES-NWI), the McCain Intent to Stay scale, and Quinn and Shepard's (1974) Global Job Satisfaction survey. Descriptive statistics were calculated for discrete measures of demographic characteristics of the study participants. Multivariate linear regression models were used to explore relationships among the nursing work environment, job satisfaction, and intent to stay, adjusting for unit type. FINDINGS: There was a positive association between nurses' job satisfaction and the nursing work environment (t = 6.42, p < .001). For each one-unit increase in the total score of the PES-NWI, nurses' average job satisfaction increased by 1.3 points, controlling for other factors. Overall, nurses employed in public hospitals were more satisfied than those working in teaching hospitals. The nursing work environment was positively associated with nurses' intent to stay (t = 4.83, p < .001). The Intent to Stay score increased by 3.6 points for every one-unit increase in the total PES-NWI score on average. The highest Intent to Stay scores were reported by nurses from public hospitals. CONCLUSIONS: The work environment was positively associated with nurses' intent to stay and job satisfaction. More attention should be paid to create positive work environments to increase job satisfaction for nurses and increase their intent to stay. CLINICAL RELEVANCE: Hospital and nurse managers and healthcare policymakers urgently need to create satisfactory work environments supporting nursing practice in order to increase nurses' job satisfaction and intent to stay.

The culture contributing to interruptions in the nursing work environment: An ethnography.

AIMS AND OBJECTIVES: To understand the occurrence of interruptions within the culture of the medical nursing unit work environment. BACKGROUND: Interruptions may lead to errors in nursing work. Little is known about how the culture of the nursing work environment contributes to interruptions. DESIGN: A micro-focused ethnographic study was conducted. METHOD: Data collection involved extensive observation of a nursing unit, 1:1 observations of nurses and follow-up interviews with the nurses. Data were analysed from unstructured field notes and interview transcripts. The definitions of interruption and culture guided coding, categorising and identification of themes. RESULTS: A framework was developed that describes the medical nursing unit as a complex culture full of unpredictable, nonlinear changes that affect the entire interconnected system, often in the form of an interruption. The cultural elements contributing to interruptions included (i) the value placed on excellence in patient care and meeting personal needs, (ii) the beliefs that the nurses had to do everything by themselves and that every phone call was important, (iii) the patterns of changing patients, patient transport and coordination of resources and (iv) the normative practices of communicating and adapting. CONCLUSIONS: Interruptions are an integral part of the culture of a medical nursing unit. Uniformly decreasing interruptions may disrupt current practices, such as communication to coordinate care, that are central to nursing work. In future research, the nursing work environment must be looked at through the lens of a complex system. RELEVANCE TO CLINICAL PRACTICE: Interventions to minimise the negative impact of interruptions must take into account the culture of the nursing as a complex adaptive system. Nurses should be educated on their own contribution to interruptions and issues addressed at a system level, rather than isolating the interruption as the central issue.

The nursing work environment and quality of care: A cross-sectional study using the Essentials of Magnetism II Scale in England.

AIMS AND OBJECTIVES: To explore the structure of the Essentials of Magnetism II (EOMII) scale using data from nurses working in England; and to describe the impact of different aspects of the nursing work environment on nurse-assessed care quality (NACQ). BACKGROUND: The EOMII Scale was developed in the United States to measure nursing work environments. It has been widely used in the United States and in a number of other countries, but has not yet been used in the UK. DESIGN: Cross-sectional study. METHODS: Registered nurses (n = 247) providing direct patient care in two National Health Service hospitals in England completed the EOMII scale and a single-item measuring NACQ. Principal components analysis was used to assess the structure of the scale. Correlation and regression analyses were used to describe the relationships between factors and NACQ. RESULTS: A solution with explanatory variance of 45.25% was identified. Forty items loaded on five factors, with satisfactory consistency: (i) ward manager support; (ii) working as a team; (iii) concern for patients; (iv) organisational autonomy; and (v) constraints on nursing practice. While in univariate analyses, each of the factors was significantly associated with NACQ, in multivariate analyses, the relationship between organisational autonomy and NACQ no longer reached significance. However, a multiple mediation model indicated that the effect of organisational autonomy on NACQ was mediated by nurse manager support, working as a team and concern for patients but not constraints on nursing practice. CONCLUSIONS: Subscales of the EOMII identified in an English sample of nurses measured important aspects of the nursing work environment, each of which is related to NACQ. RELEVANCE TO CLINICAL PRACTICE: The EOMII could be a very useful tool for measuring aspects of the nursing work environment in the English Trusts particularly in relation to the quality of care.

Medical surgical nurses describe missed nursing care tasks-Evaluating our work environment.

PURPOSE: The purpose of the study was to explore the nurse work environment by evaluating the self-report of missed nursing care and the reasons for the missed care. METHODS: A convenience sample of medical surgical nurses from four hospitals was invited to complete the survey for this descriptive study. The sample included 168 nurses. The MISSCARE survey assessed the frequency and reason of 24 routine nursing care elements. RESULTS: The most frequently reported missed care was ambulation as ordered, medications given within a 30 minute window, and mouth care. Moderate or significant reasons reported for the missed care were: unexpected rise in volume/acuity, heavy admissions/discharges, inadequate assistants, inadequate staff, meds not available when needed, and urgent situations. CONCLUSION: Identifying missed nursing care and reasons for missed care provides an opportunity for exploring strategies to reduce interruptions, develop unit cohesiveness, improve the nurse work environment, and ultimately leading to improved patient outcomes.

Construction of a new model of job engagement, psychological empowerment and perceived work environment among Chinese registered nurses at four large university hospitals: implications for nurse managers seeking to enhance nursing retention and quality of care.

AIM: To explore the relationships among perceived work environment, psychological empowerment and job engagement of clinical nurses in Harbin, China. BACKGROUND: Previous studies have focused on organisational factors or nurses' personal characteristics contributing to job engagement. Limited studies have examined the effects of perceived work environment and psychological empowerment on job engagement among Chinese nurses. METHOD: A cross-sectional quantitative survey with 923 registered nurses at four large university hospitals in China was carried out. Research instruments included the Chinese versions of the perceived nurse work environment scale, the psychological empowerment scale and the job engagement scale. The relationships of the variables were tested using structural equation modelling. RESULTS: Structural equation modelling revealed a good fit of the model, χ(2) /df = 4.46, GFI = 0.936, CFI = 0.957. Perceived work environment was a significant positive direct predictor of psychological empowerment and job engagement. Psychological empowerment was a significant positive direct contributor to job engagement and had a mediating effect on the relationship between perceived work environment and job engagement. CONCLUSIONS: Perceived work environment may result in increased job engagement by facilitating the development of psychological empowerment. IMPLICATIONS FOR NURSING MANAGEMENT: For nurse managers wishing to increase nurse engagement and to achieve effective management, both perceived work environment and psychological empowerment are factors that need to be well controlled in the process of nurse administration.

[Correlation Between Nursing Work Environment and Nurse Burnout, Job Satisfaction, and Turnover Intention in the Western Region of Mainland China].

BACKGROUND: Nurse burnout and low job satisfaction are main reasons that cause nurses to leave their current position. Improving the nursing work environment may reduce the severity of job burnout and of job dissatisfaction and thus decrease the turnover intention of nursing staff. PURPOSE: The aim of this study was to explore the correlation between the nursing work environment and the outcome variables of burnout, job satisfaction, and turnover intention in the western region of Mainland China. METHODS: This is a cross-sectional descriptive study. Survey data were collected between February and December 2012 from 1,112 clinical nurses working at 83 medical, surgical, and intensive care units in 20 hospitals across the western region of Mainland China. Multistage sampling was conducted on some of the participants. The research instruments that were used included the Practice Environment Scale of the Nursing Work Index, Maslach Burnout Inventory, Nurse Job Satisfaction Scale, and the self-developed basic information and turnover intention questionnaire. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 19.0. The level of statistical significance was set at p<.05. RESULTS: Among the five dimensions of the nursing work environment, collegial nurse-physician relations earned the most favorable mean scores (3.57±0.68; total=4 points), whereas adequacy of staffing and resources earned the lowest (3.21±0.82). Over half of the participants (58.4%) reported experiencing a high level of emotional exhaustion (EE) burnout, 45.2% reported experiencing a high level of depersonalization (DP) burnout, and 24.6% reported experiencing a high level of personal accomplishment (PA) burnout. About 59% of the participants were satisfied with their work and 3.8% reported intention to leave. Participants in self-reported "favorable" work environments were less likely to report high burnout, less likely to report intention to leave, and more likely to report job satisfaction than their peers in self-reported "poor" work environments. The odds ratio (OR) values were 0.64 (EE), 0.66 (DP), 0.57 (PA), 0.19, and 2.26. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results of the present study support that the nursing work environment affects nurse burnout, job satisfaction, and turnover intention. Therefore, nursing managers should work to improve nursing work environments in order to reduce the turnover intent among their nursing staff.