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Physician and nurse well-being, patient safety and recommendations for interventions: cross-sectional survey in hospitals in six European countries

Por: Aiken · L. H. · Sermeus · W. · McKee · M. · Lasater · K. B. · Sloane · D. · Pogue · C. A. · Kohnen · D. · Dello · S. · Maier · C. B. B. · Drennan · J. · McHugh · M. D. · For the Magnet4Europe Consortium · Sermeus · Bruyneel · Witte · Schaufeli · Dello · Kohnen · Aiken · McHugh · Smith
Objectives

To determine the well-being of physicians and nurses in hospital practice in Europe, and to identify interventions that hold promise for reducing adverse clinician outcomes and improving patient safety.

Design

Baseline cross-sectional survey of 2187 physicians and 6643 nurses practicing in 64 hospitals in six European countries participating in the EU-funded Magnet4Europe intervention to improve clinicians’ well-being.

Setting

Acute general hospitals with 150 or more beds in six European countries: Belgium, England, Germany, Ireland, Sweden and Norway.

Participants

Physicians and nurses with direct patient contact working in adult medical and surgical inpatient units, including intensive care and emergency departments.

Main outcome measures

Burnout, job dissatisfaction, physical and mental health, intent to leave job, quality of care and patient safety and interventions clinicians believe would improve their well-being.

Results

Poor work/life balance (57% physicians, 40% nurses), intent to leave (29% physicians, 33% nurses) and high burnout (25% physicians, 26% nurses) were prevalent. Rates varied by hospitals within countries and between countries. Better work environments and staffing were associated with lower percentages of clinicians reporting unfavourable health indicators, quality of care and patient safety. The effect of a 1 IQR improvement in work environments was associated with 7.2% fewer physicians and 5.3% fewer nurses reporting high burnout, and 14.2% fewer physicians and 8.6% fewer nurses giving their hospital an unfavourable rating of quality of care. Improving nurse staffing levels (79% nurses) and reducing bureaucracy and red tape (44% physicians) were interventions clinicians reported would be most effective in improving their own well-being, whereas individual mental health interventions were less frequently prioritised.

Conclusions

Burnout, mental health morbidities, job dissatisfaction and concerns about patient safety and care quality are prevalent among European hospital physicians and nurses. Interventions to improve hospital work environments and staffing are more important to clinicians than mental health interventions to improve personal resilience.

Newly graduated nurses' commitment to the nursing profession and their workplace during their first year of employment: A focused ethnography

Abstract

Background

The commitment of nurses to their profession and workplace is closely linked to the delivery of high-quality patient care. Existing literature highlights the positive impact of commitment on care quality and patient outcomes. Conversely, a lack of commitment can lead to nurse burnout and disengagement. However, it remains unclear whether and how cultural beliefs and practices influence newly graduated nurses' commitment to the nursing profession and their workplace.

Aim

To explore the cultural beliefs and practices influencing newly graduated nurses' commitment to the profession and commitment to their workplace during their first year of employment.

Design

A focused ethnographic study.

Methods

Data consisted of field notes from 94 h of participant observations and 10 semi-structured interviews with newly graduated nurses working in acute care settings in Denmark. Data were analysed using ethnographic content analysis. Data were collected between March and June 2022.

Results

The findings reveal a major theme, termed ‘A State of Transience among Newly Graduated Nurses’, consisting of two themes: ‘Newly Graduated Nurses’ Pursuit of Professional Development and Supportive Work Environments' and ‘A Lack of Formal Agreements or Conditions to Meet Expectations for Professional Development.’

Conclusion

Hospitals and nurse managers need to support newly graduated nurses in their first employment after registration by providing a range of clinical experiences through job rotation opportunities within the same organization, deliver on promises for onboarding support and foster a culture of trust. These strategies will help maintain the motivation, commitment and ability of newly graduated nurses to deliver high-quality patient care, thereby reducing the likelihood of turnover.

Relevance for Clinical Practice

A trusting and supportive work environment is fostered by providing diverse clinical experiences and consistent support for newly graduated nurses. To address potential high turnover associated with job rotation, hospitals need to rethink how retention is defined and measured, moving beyond hospital unit-level models and measures.

Reporting Method

This study reports to the SRQR guidelines.

Patient or Public Contribution

No patient or public contribution.

Association between the nurse work environment and patient experience in Chilean hospitals: A multi‐hospital cross‐sectional study

Abstract

Introduction

International evidence shows that nurses' work environments affect patient outcomes, including their care experiences. In Chile, several factors negatively affect the work environment, but they have not been addressed in prior research. The aim of this study was to measure the quality of the nurse work environment in Chilean hospitals and its association with patient experience.

Design

A cross-sectional study of 40 adult general high-complexity hospitals across Chile.

Methods

Participants included bedside nurses (n = 1632) and patients (n = 2017) in medical or surgical wards, who responded to a survey. The work environment was measured through the Practice Environment Scale of the Nursing Work Index. Hospitals were categorized as having a good or poor work environment. A set of patient experience outcomes were measured through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Adjusted logistic regression models were used to test associations between the environment and patient experiences.

Results

For all outcomes, the percentage of patients satisfied was higher in hospitals with good as compared to poor work environments. In good environment hospitals patients had significantly higher odds of being satisfied with communication with nurses (OR 1.46, 95% CI: 1.10–1.94, p = 0.010), with pain control (OR 1.52, 95% CI: 1.14–2.02, p = 0.004), and with nurses' timely responses in helping them to go to the bathroom (OR 2.17, 95% CI: 1.49–3.16, p < 0.0001).

Conclusions

Hospitals with good environments outperform hospitals with poor environments in most patient care experience indicators. Efforts to improve nurses' work environment hold promise for improving patient experiences in Chilean hospitals.

Clinical Relevance

Hospital administrators and nurse managers should value, especially in the context of financial constraints and understaffing, the implementation of strategies to improve the quality of nurses´ work environments so that they can provide patients with a better care experience.

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