Orn-Anong Wichaikhum

Impact of Nurse Work Environment and Staffing on Hospital Nurse and Quality of Care in Thailand

PURPOSE To determine the impact of nurse work environment and staffing on nurse outcomes, including job satisfaction and burnout, and on quality of nursing care. DESIGN Secondary data analysis of the 2007 Thai Nurse Survey. METHODS The sample consisted of 5,247 nurses who provided direct care for patients across 39 public hospitals in Thailand. Multivariate logistic regression was used to estimate the impact of nurse work environment and staffing on nurse outcomes and quality of care. FINDINGS Nurses cared for an average of 10 patients each. Forty-one percent of nurses had a high burnout score as measured by the Maslach Burnout Inventory; 28% of nurses were dissatisfied with their job; and 27% rated quality of nursing care as fair or poor. At the hospital level, after controlling for nurse characteristics (age, years in unit), the addition of each patient to a nurses workload was associated with a 2% increase in the odds on nurses reporting high emotional exhaustion (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.00-1.03; p < .05). Nurses who reported favorable work environments were about 30% less likely to report fair to poor care quality (OR 0.69; 95% CI 0.48-0.98; p < .05) compared with nurses who reported unfavorable work environments. The addition of each patient to a nurses workload was associated with a 4% increase in the odds on nurses reporting quality of nursing care as fair or poor (OR 1.04; 95% CI 1.02-1.05; p < .001). CONCLUSIONS Improving nurse work environments and nurse staffing in Thai hospitals holds promise for reducing nurse burnout, thus improving nurse retention at the hospital bedside as well as potentially improving the quality of care. CLINICAL RELEVANCE Nurses should work with management and policymakers to achieve safe staffing levels and good work environments in hospitals throughout the world.

Effects of nurse work environment on job dissatisfaction, burnout, intention to leave

BACKGROUND The nursing shortage is a critical issue in many countries. High turnover rates among nurses is contributing to the shortage, and job dissatisfaction, intention to leave, and burnout have been identified as some of the predictors of nurse turnover. A well-established body of evidence demonstrates that the work environment for nurses influences nurse job dissatisfaction, intention to leave, and burnout, but there never has been a study undertaken in Thailand to investigate this relationship. OBJECTIVES To investigate how work environment affects job dissatisfaction, burnout, and intention to leave among nurses in Thailand. METHODS The study used a cross-sectional survey to collect data from 1351 nurses working in 43 inpatient units in five university hospitals across Thailand. The participants completed the Practice Environment Scale of the Nursing Work Index, the Maslach Burnout Inventory, and measures of job dissatisfaction and intention to leave. Logistical regression models assessed the association between work environment and nurse-reported job dissatisfaction, burnout, and intent to leave. RESULTS Nurses working in university hospitals with better work environments had significantly less job dissatisfaction, intention to leave, and burnout. CONCLUSION The nurse work environment is a significant feature contributing to nurse retention in Thai university hospitals. IMPLICATIONS FOR NURSING AND HEALTH POLICY Improving the work environment for nurses may lead to lower levels of job dissatisfaction, intention to leave, and burnout. Focusing on these nurse outcomes can be used as a strategy to retain nurses in the healthcare system. Addressing the challenges of poor work environments requires coordinated action from policymakers and health managers.

Work empowerment and burnout among registered nurses in two tertiary general hospitals

AIMS AND OBJECTIVES To describe and explore the relationship between work empowerment and burnout as perceived by nurses in two tertiary general hospitals in China. BACKGROUND Studies conducted in Western countries show that work empowerment can negatively influence burnout. Review of literature indicates that currently, no study on the relationship between work empowerment and burnout has been conducted in China. DESIGN A correlational, cross-sectional design was adopted using questionnaires for data collection. METHODS This study used correlational and cross-sectional designs to collect and analyse data. The demographic data were analysed using frequency and percentage distributions. Work empowerment and burnout as perceived by registered nurses were analysed using means and standard deviation. The relationship between work empowerment and burnout was analysed using Spearmans rank-order coefficient after testing the normal distribution using the Kolmogorov-Smirnov test. RESULTS The registered nurses perceive work empowerment at a moderate level. Emotional exhaustion as determined in this study is higher than in other nursing studies. A negative correlation is indicated between work empowerment and emotional exhaustion. A statistically significant positive correlation is also indicated between work empowerment and personal accomplishment. CONCLUSION When the work environment provides empowerment, registered nurses are less likely to experience burnout. Nursing supervisors should empower staff nurses by giving them opportunities to study, actualise the hospitals vision and share information with other staff nurses. RELEVANCE TO CLINICAL PRACTICE Nurse administrators can use the results of this study to develop policies, improve work empowerment programmes and decrease burnout so that staff nurses can work more effectively.

Occupancy rate and adverse patient outcomes in general hospitals in Thailand: A predictive study

Patient outcomes are important indicators of the quality of care. Occupancy rate is one factor that significantly affects adverse patient outcomes. The aim of the present study was to determine factors associated with adverse patient outcomes in Thailand. A retrospective study was conducted with 146 inpatient units from 16 general hospitals. Hospital characteristics and adverse patient outcomes were recorded, and data were analyzed by using frequency, percentage, and binomial logistic regression. The results revealed that the average number of beds per hospital was 430.5 (standard deviation [SD] = 108.6), the average number of beds per unit was 27.9 (SD = 8.9), and the average occupancy rate was 81.1% (SD = 20.6, range = 28.8-133.1%). Data were adjusted for hospital size, unit type, and number of beds in each unit; a 1% increase in occupancy rate increased the likelihood of pressure ulcers by 4.3% (P = 0.001), of hospital-acquired pneumonia by 2.4% (P = 0.032), and of hospital-acquired urinary tract infections by 2.1% (P = 0.033). The findings suggest that a higher level of occupancy rates predicted a greater likelihood of adverse patient outcomes.

Investigation of the key determinants of Asian nurses’ quality of life

The study aimed to compare nurses’ quality of life and investigate key determinants among Asian countries with different economic status. A cross-sectional survey was conducted across five Asian countries (Japan, Singapore, Malaysia, Thailand, and Bhutan). Quality of life (WHOQOL-BREF), job stress (National Institute of Occupational Safety and Health questionnaire), and demographic data were assessed. Stepwise multivariate linear regression analysis was performed to identify the key determinants of quality of life. Participants were 3,829 nurses (response rate: 82%) with a mean age of 33 ± 10 yr and majority were women (92%). Regarding quality of life, Bhutan yielded the highest scores, followed by Malaysia, Thailand, Singapore, and Japan, and these results were statistically significant. The key determinants that were significantly related to quality of life were “stress coping ability,” “life satisfaction,” “Japan,” “social support,” “job stress,” and “Singapore” (adjusted R2=0.46). In conclusion, nurses’ quality of life differs across Asian countries and is not linked to the country’s economic development. To maintain a good quality of life for nurses, an international exchange program like international nursing conferences for work environment and staff coping strategies is recommended to broaden institution’ minds and share experiences and exchange views to be able to realize their own problems and discover global solutions to them.