Purpose: To determine the effect of hospital work environments on hospital outcomes across multiple countries. Design: Primary survey data using a common instrument were collected from separate cross sections of 98 116 bedside care nurses practising in 1406 hospitals in 9 countries between 1999 and 2009. Main Outcome Measures: Nurse burnout and job dissatisfaction, patient readiness for hospital discharge and quality of patient care. Results: High nurse burnout was found in hospitals in all countries except Germany, and ranged from roughly a third of nurses to about 60% of nurses in South Korea and Japan. Job dissatisfaction among nurses was close to 20% in most countries and as high as 60% in Japan. Close to half or more of nurses in every country lacked confidence that patients could care for themselves following discharge. Quality-of-care rated as fair or poor varied from 11% in Canada to 68% in South Korea. Between one-quarter and one-third of hospitals in each country were judged to have poor work environments. Working in a hospital with a better work environment was associated with significantly lower odds of nurse burnout and job dissatisfaction and with better quality-of-care outcomes. Conclusions: Poor hospital work environments are common and are associated with negative outcomes for nurses and quality of care. Improving work environments holds promise for nurse retention and better quality of patient care.
Bibliographical noteFunding Information:
This research was supported in part by the National Institute of Nursing Research, National Institutes of Health [grant numbers R01NR04513, P30NR05043] the University of Pennsylvania School of Nursing Office of Global Affairs; the China Medical Board; the National Research Foundation of Korea (NRF) grant funded by the Korea government (MEST) [grant number 2009-0068921]; the University of Auckland’s staff fund; Rho Pi Chapter, Thailand, Sigma Theta Tau International; Nurses’ Association of Thailand; the International Research Grant (principal investigator Masako Kanai-Pak) by Pfizer Health Research Foundation.
All Science Journal Classification (ASJC) codes
- Health Policy
- Public Health, Environmental and Occupational Health