TY - JOUR
T1 - Association of changes in nursing work environment, non-professional tasks, and nursing care left undone with nurse job outcomes and quality of care
T2 - A panel study
AU - Liu, Xu
AU - Liu, Jiali
AU - Liu, Ke
AU - Baggs, Judith Gedney
AU - Wang, Jun
AU - Zheng, Jing
AU - Wu, Yan
AU - Li, Mengqi
AU - You, Liming
N1 - Publisher Copyright:
© 2020
PY - 2021/3
Y1 - 2021/3
N2 - Background: Strengthening quality of care without compromising nurse job outcomes by building a safer health care system is a common concern worldwide including in China. Most of the current evidence comes from cross-sectional studies conducted in western countries, which limits inferences of causality and generalization. Objective: The objectives of this longitudinal study were to compare changes in quality of care, nurse job outcomes, nursing work environment, non-professional tasks, and nursing care left undone in acute hospitals in China between 2014 and 2018. Secondly, we wanted to determine the association of changes in nursing work environment, non-professional tasks, and nursing care left undone with nurse job outcomes and quality of care. Design, settings, and participants: A prospective two-stage panel study conducted in 108 adult medical and surgical units from 23 hospitals in Guangdong province, China in 2014 and repeated in 2018. Methods: Work environment was measured by the Practice Environment Scale of the Nursing Work Index. Non-professional tasks were measured with a seven-item scale surveying the performance of and time spent on non-professional tasks. Nursing care left undone was measured by 12 items addressing necessary nursing activities. Nurse job outcomes included burnout, dissatisfaction, and retention. Quality of care was measured by four items indicating overall quality of care as assessed by nurses (three items) and patients (one item). Generalized estimating equations with linear regression were employed to analyze data. Results: In 2018, compared with 2014, the nursing work environment had improved, and non-professional workloads had decreased minimally. The average number of the 12 nursing care tasks left undone had increased to 6.5 from 5.6 in 2014. Fewer nurses reported job dissatisfaction or intention to leave. Quality of care was improved slightly as assessed by nurses and patients. As for the changes of hospital organizational factors on quality of care, a better nursing work environment was related to better nurse job outcomes and quality of care. More non-professional tasks were related to higher levels of nurse job burnout. Less nursing care left undone was associated with better nurse-assessed quality of care. Units with more nurses experiencing job burnout and dissatisfaction were likely to have poorer nurse-assessed quality of care. Conclusions: Improving nursing work environment and supporting nurses to engage in professional and direct patient care as opposed to non-professional work may be beneficial to nurse job outcomes and promote quality of care.
AB - Background: Strengthening quality of care without compromising nurse job outcomes by building a safer health care system is a common concern worldwide including in China. Most of the current evidence comes from cross-sectional studies conducted in western countries, which limits inferences of causality and generalization. Objective: The objectives of this longitudinal study were to compare changes in quality of care, nurse job outcomes, nursing work environment, non-professional tasks, and nursing care left undone in acute hospitals in China between 2014 and 2018. Secondly, we wanted to determine the association of changes in nursing work environment, non-professional tasks, and nursing care left undone with nurse job outcomes and quality of care. Design, settings, and participants: A prospective two-stage panel study conducted in 108 adult medical and surgical units from 23 hospitals in Guangdong province, China in 2014 and repeated in 2018. Methods: Work environment was measured by the Practice Environment Scale of the Nursing Work Index. Non-professional tasks were measured with a seven-item scale surveying the performance of and time spent on non-professional tasks. Nursing care left undone was measured by 12 items addressing necessary nursing activities. Nurse job outcomes included burnout, dissatisfaction, and retention. Quality of care was measured by four items indicating overall quality of care as assessed by nurses (three items) and patients (one item). Generalized estimating equations with linear regression were employed to analyze data. Results: In 2018, compared with 2014, the nursing work environment had improved, and non-professional workloads had decreased minimally. The average number of the 12 nursing care tasks left undone had increased to 6.5 from 5.6 in 2014. Fewer nurses reported job dissatisfaction or intention to leave. Quality of care was improved slightly as assessed by nurses and patients. As for the changes of hospital organizational factors on quality of care, a better nursing work environment was related to better nurse job outcomes and quality of care. More non-professional tasks were related to higher levels of nurse job burnout. Less nursing care left undone was associated with better nurse-assessed quality of care. Units with more nurses experiencing job burnout and dissatisfaction were likely to have poorer nurse-assessed quality of care. Conclusions: Improving nursing work environment and supporting nurses to engage in professional and direct patient care as opposed to non-professional work may be beneficial to nurse job outcomes and promote quality of care.
KW - Burnout, professional
KW - China
KW - Job satisfaction
KW - Organization and administration
KW - Personnel management
KW - Quality of health care
KW - Workload
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U2 - 10.1016/j.ijnurstu.2020.103860
DO - 10.1016/j.ijnurstu.2020.103860
M3 - Article
C2 - 33517080
AN - SCOPUS:85100008550
SN - 0020-7489
VL - 115
JO - International Journal of Nursing Studies
JF - International Journal of Nursing Studies
M1 - 103860
ER -