Front-line management, staffing and nurse–doctor relationships as predictors of nurse and patient outcomes. A survey of Icelandic hospital nurses

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Abstract

Objective

To investigate aspects of nurses’ work environments linked with job outcomes and assessments of quality of care in an Icelandic hospital.

Background

Prior research suggests that poor working environments in hospitals significantly hinder retention of nurses and high quality patient care. On the other hand, hospitals with high retention rates (such as Magnet hospitals) show supportive management, professional autonomy, good inter-professional relations and nurse job satisfaction, reduced nurse burnout and improved quality of patient care.

Methods

Cross-sectional survey of 695 nurses at Landspitali University Hospital, Reykjavík. Nurses’ work environments were measured using the nursing work index—revised (NWI—R) and examined as predictors of job satisfaction, the Maslach burnout inventory (MBI) and nurse-assessed quality of patient care using linear and logistic regression approaches.

Results

An Icelandic adaptation of the NWI—R showed a five-factor structure similar to that of Lake (2002). After controlling for nurses’ personal characteristics, job satisfaction, emotional exhaustion and nurse rated quality of care were found to be independently associated with perceptions of support from unit-level managers, staffing adequacy, and nurse–doctor relations.

Conclusions

The NWI—R measures elements of hospital nurses’ work environments that predict job outcomes and nurses’ ratings of the quality of patient care in Iceland. Efforts to improve and maintain nurses’ relations with nurse managers and doctors, as well as their perceptions of staffing adequacy, will likely improve nurse job satisfaction and employee retention, and may improve the quality of patient care.

Section snippets

What is already known about the topic?

  • Supportive work environments are important for the quality of working life for nurses, and improved patient outcomes

  • There are gaps in the literature about the link between nurse work environment and nurse and patient outcomes, notably in countries other than the United States.

What this paper adds

  • Re-emphasizes the important role of front line nurse managers and nurse–doctor relationships for successful hospital care.

  • Provides further support for the idea that perceptions of staffing adequacy are linked to perceptions of quality.

  • The NWI—R was successfully adapted into Icelandic and resulted in empirically and conceptually acceptable sub-scales that demonstrated all expected associations.

Participants

Subjects in this cross-sectional study included nurses working in direct patient care in all specialities at the Landspitali University Hospital, Reykjavik (LSH) including medicine, surgery, intensive care, emergency care, pediatrics, psychiatry, obstetrics and geriatric care. All eligible nurses were approached to participate in the study, a total of 930 nurses working in 98 clinical wards. Nurses who held more than 40% of a full-time equivalent position were eligible for the study. Nurses on

Sample characteristics

Of the final sample of 695 nurses working with direct nursing in all specialities at LSH, a majority of the study participants (64.2%) were between 31 and 50 years of age, 22.1% were older than 51 years, 13.6% were between 20 and 30 years of age, and 5.5% had a master's degree. A review of hospital records (LSH, 2003) indicated that the study cohort was representative for nurses at LSH as a whole with respect to the distribution of ages and nurse specialities. A large majority of the

Discussion

This paper indicates that an Icelandic adaptation of the NWI—R, a tool employed extensively in nursing administration research in English-speaking countries, shows a factor structure comparable to that found by researchers working with it elsewhere. The aspects of nurses’ work environments it measures appear to form stable clusters of items across the countries in which it has been tested. The five NWI—R scales identified here are similar to a factor solution for the NWI—R published by Lake

Acknowledgements

This study has been supported by the British Council Chevening Scholarship and by grants from the Icelandic Centre for Research, the Icelandic Nurse Association Scientific Fund, the Icelandic Nurse Association Continuing Education Fund, the Landspitali University Hospital Scientific Fund and the Landakot Hospital Scientific Fund.

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      The nurse work environment is commonly measured by the Practice Environment Scale of the Nursing Work Index Lake (2002). The Practice Environment Scale of the Nursing Work Index has been used extensively to demonstrate the impact of the nurse work environment on mortality, failure to rescue (i.e., deaths in patients with complications), adverse patient events and complications, patient satisfaction, nurse-rated quality of care, nurse burnout, and job satisfaction (Aiken et al., 2008, 2011; Gunnarsdóttir et al., 2009; Kutney-Lee et al., 2013; Olds et al., 2017; Spence Laschinger and Leiter, 2006). The nurse work environment is defined as the set of “organizational characteristics of a work setting that facilitate or constrain professional nursing practice” (Lake, 2002, p. 178).

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