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Journal ArticleDOI

Hospital nursing, care quality, and patient satisfaction: Cross-sectional surveys of nurses and patients in hospitals in China and Europe

TL;DR: Nursing is important in quality and safety of hospital care and in patients' perceptions of their care, and expanding the number of baccalaureate-prepared nurses hold promise for improving hospital outcomes in China.
About: This article is published in International Journal of Nursing Studies.The article was published on 2013-02-01. It has received 310 citations till now. The article focuses on the topics: Surgical nursing & Primary nursing.
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01 Jan 2011
TL;DR: In this paper, the effect of hospital work environments on hospital outcomes across multiple countries was determined to determine the effect the hospital work environment has on patient outcomes and nurse burnout and job dissatisfaction.
Abstract: 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.

350 citations

22 Feb 2016
TL;DR: Three recommendations for transforming nursing education are offered: create new nursing education systems which use existing resources in community colleges and universities and which provide for common prerequisites and a shared competency-based nursing curriculum and instructional materials, and invest in a national initiative to develop and evaluate new approaches to pre-licensing clinical education.
Abstract: Evidence is accumulating that nurses completing pre-licensure programs are not equipped with the essential knowledge and skills for today’s nursing practice, nor prepared to continue learning for tomorrow’s nursing. Citing the need to improve quality and increase capacity, this paper offers three recommendations for transforming nursing education: (1) Create new nursing education systems which use existing resources in community colleges and universities and which provide for common prerequisites and a shared competency-based nursing curriculum and instructional materials. (2) Convene one or more expert panels to develop model pre-licensure curricula which: (a) can be used as a framework by faculty in community college-university partnerships for development of their local curriculum; (b) are based on emerging health care needs and widely accepted nursing competencies as interpreted for new care delivery models; (c) incorporate best practices in teaching and learning. (3) Invest in a national initiative to develop and evaluate new approaches to pre-licensure clinical education, including a required post-graduate residency under a restricted license. The author notes that these changes will require significant investment in the reforms, as well as in nursing education research and faculty development. The return on investment would be improved educational capacity and a better prepared nursing workforce, responsive to emerging health care needs and rapidly changing health care delivery systems. TRANSFORMING PRE-LICENSURE NURSING EDUCATION: PREPARING THE NEW NURSE TO MEET EMERGING HEALTH CARE NEEDS The Carnegie Foundation for the Advancement of Teaching joins a chorus of calls for transformation of pre-licensure nursing education (Benner et al., 2009b). Citing the shift of significant responsibility to nurses for managing complex medical regimens, as well as increasing complexity of community based practices, Benner and colleagues concluded that nurses entering the field are not equipped with the essential knowledge and skills for today’s practice nor prepared to continue learning for tomorrow’s nursing (p. 31). They found (1) weak curricula in natural sciences, technology, social sciences and humanities, and in developing cultural competency; (2) weak classroom instruction and limited integration between classroom and clinical experiences; (3) limited strategies in helping The Future of Nursing: Leading Change, Advancing Health Copyright National Academy of Sciences. All rights reserved.

336 citations


Cites background from "Hospital nursing, care quality, and..."

  • ...Since the report’s publication, however, the body of evidence on this association has strengthened (Aiken et al., 2011, 2014; Blegen et al., 2013; Cho et al., 2015; Kutney-Lee et al., 2013; Naylor et al., 2015; Yakusheva et al., 2014a,b; You et al., 2013)....

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Journal ArticleDOI
TL;DR: The nurse work environment is a significant feature contributing to nurse retention in Thai university hospitals and improving the work environment for nurses may lead to lower levels of job dissatisfaction, intention to leave, and burnout.
Abstract: 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.

246 citations

Journal ArticleDOI
TL;DR: A systematic literature review and meta-analysis was conducted to provide summary estimations of the relation between provider burnout and quality of care, estimate study heterogeneity, and explore the potential of reporting bias in the field.
Abstract: Background Whether health care provider burnout contributes to lower quality of patient care is unclear. Purpose To estimate the overall relationship between burnout and quality of care and to evaluate whether published studies provide exaggerated estimates of this relationship. Data sources MEDLINE, PsycINFO, Health and Psychosocial Instruments (EBSCO), Mental Measurements Yearbook (EBSCO), EMBASE (Elsevier), and Web of Science (Clarivate Analytics), with no language restrictions, from inception through 28 May 2019. Study selection Peer-reviewed publications, in any language, quantifying health care provider burnout in relation to quality of patient care. Data extraction 2 reviewers independently selected studies, extracted measures of association of burnout and quality of care, and assessed potential bias by using the Ioannidis (excess significance) and Egger (small-study effect) tests. Data synthesis A total of 11 703 citations were identified, from which 123 publications with 142 study populations encompassing 241 553 health care providers were selected. Quality-of-care outcomes were grouped into 5 categories: best practices (n = 14), communication (n = 5), medical errors (n = 32), patient outcomes (n = 17), and quality and safety (n = 74). Relations between burnout and quality of care were highly heterogeneous (I2 = 93.4% to 98.8%). Of 114 unique burnout-quality combinations, 58 indicated burnout related to poor-quality care, 6 indicated burnout related to high-quality care, and 50 showed no significant effect. Excess significance was apparent (73% of studies observed vs. 62% predicted to have statistically significant results; P = 0.011). This indicator of potential bias was most prominent for the least-rigorous quality measures of best practices and quality and safety. Limitation Studies were primarily observational; neither causality nor directionality could be determined. Conclusion Burnout in health care professionals frequently is associated with poor-quality care in the published literature. The true effect size may be smaller than reported. Future studies should prespecify outcomes to reduce the risk for exaggerated effect size estimates. Primary funding source Stanford Maternal and Child Health Research Institute.

231 citations

References
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Journal ArticleDOI
17 Nov 2001-BMJ
TL;DR: Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.
Abstract: Crossing the Quality Chasm identifies and recommends improvements in six dimensions of health care in the U.S.: patient safety, care effectiveness, patient-centeredness, timeliness, care efficiency, and equity. Safety looks at reducing the likelihood that patients are harmed by medical errors. Effectiveness describes avoiding over and underuse of resources and services. Patient-centeredness relates both to customer service and to considering and accommodating individual patient needs when making care decisions. Timeliness emphasizes reducing wait times. Efficiency focuses on reducing waste and, as a result, total cost of care. Equity looks at closing racial and income gaps in health care.

15,046 citations

Journal ArticleDOI
20 Mar 2012-BMJ
TL;DR: In European hospitals, improvement of hospital work environments might be a relatively low cost strategy to improve safety and quality in hospital care and to increase patient satisfaction.
Abstract: Objective To determine whether hospitals with a good organisation of care (such as improved nurse staffing and work environments) can affect patient care and nurse workforce stability in European countries. Design Cross sectional surveys of patients and nurses. Setting Nurses were surveyed in general acute care hospitals (488 in 12 European countries; 617 in the United States); patients were surveyed in 210 European hospitals and 430 US hospitals. Participants 33 659 nurses and 11 318 patients in Europe; 27 509 nurses and more than 120 000 patients in the US. Main outcome measures Nurse outcomes (hospital staffing, work environments, burnout, dissatisfaction, intention to leave job in the next year, patient safety, quality of care), patient outcomes (satisfaction overall and with nursing care, willingness to recommend hospitals). Results The percentage of nurses reporting poor or fair quality of patient care varied substantially by country (from 11% (Ireland) to 47% (Greece)), as did rates for nurses who gave their hospital a poor or failing safety grade (4% (Switzerland) to 18% (Poland)). We found high rates of nurse burnout (10% (Netherlands) to 78% (Greece)), job dissatisfaction (11% (Netherlands) to 56% (Greece)), and intention to leave (14% (US) to 49% (Finland, Greece)). Patients’ high ratings of their hospitals also varied considerably (35% (Spain) to 61% (Finland, Ireland)), as did rates of patients willing to recommend their hospital (53% (Greece) to 78% (Switzerland)). Improved work environments and reduced ratios of patients to nurses were associated with increased care quality and patient satisfaction. In European hospitals, after adjusting for hospital and nurse characteristics, nurses with better work environments were half as likely to report poor or fair care quality (adjusted odds ratio 0.56, 95% confidence interval 0.51 to 0.61) and give their hospitals poor or failing grades on patient safety (0.50, 0.44 to 0.56). Each additional patient per nurse increased the odds of nurses reporting poor or fair quality care (1.11, 1.07 to 1.15) and poor or failing safety grades (1.10, 1.05 to 1.16). Patients in hospitals with better work environments were more likely to rate their hospital highly (1.16, 1.03 to 1.32) and recommend their hospitals (1.20, 1.05 to 1.37), whereas those with higher ratios of patients to nurses were less likely to rate them highly (0.94, 0.91 to 0.97) or recommend them (0.95, 0.91 to 0.98). Results were similar in the US. Nurses and patients agreed on which hospitals provided good care and could be recommended. Conclusions Deficits in hospital care quality were common in all countries. Improvement of hospital work environments might be a relatively low cost strategy to improve safety and quality in hospital care and to increase patient satisfaction.

1,587 citations


"Hospital nursing, care quality, and..." refers result in this paper

  • ...We did not find, as in other research iken et al., 2012), that better nurse staffing was sociated with higher patient satisfaction....

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Journal ArticleDOI
TL;DR: This analysis of the global workforce proposes that mobilisation and strengthening of human resources for health, neglected yet critical, is central to combating health crises in some of the world's poorest countries and for building sustainable health systems in all countries.

1,402 citations

Journal ArticleDOI
TL;DR: This portrait of patients' experiences in U.S. hospitals offers insights into areas that need improvement, suggests that the same characteristics of hospitals that lead to high nurse-staffing levels may be associated with better experiences for patients, and offers evidence that hospitals can provide both a high quality of clinical care and a good experience for the patient.
Abstract: BACKGROUND Patients' perceptions of their care, especially in the hospital setting, are not well known. Data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey provide a portrait of patients' experiences in U.S. hospitals. METHODS We assessed the performance of hospitals across multiple domains of patients' experiences. We examined whether key characteristics of hospitals that are thought to enhance patients' experiences (i.e., a high ratio of nurses to patient-days, for-profit status, and nonacademic status) were associated with a better experience for patients. We also examined whether a hospital's performance on the HCAHPS survey was related to its performance on indicators of the quality of clinical care. RESULTS We found moderately high levels of satisfaction with care (e.g., on average, 67.4% of a hospital's patients said that they would definitely recommend the hospital), with a high degree of correlation among the measures of patients' experiences (Cronbach's alpha, 0.94). As compared with hospitals in the bottom quartile of the ratio of nurses to patient-days, those in the top quartile had a somewhat better performance on the HCAHPS survey (e.g., 63.5% vs. 70.2% of patients responded that they "would definitely recommend" the hospital; P<0.001). Hospitals with a high level of patient satisfaction provided clinical care that was somewhat higher in quality for all conditions examined. For example, those in the top quartile of HCAHPS ratings performed better than those in the bottom quartile with respect to the care that patients received for acute myocardial infarction (actions taken to provide appropriate care as a proportion of all opportunities for providing such actions, 95.8% vs. 93.1% in unadjusted analyses; P<0.001) and for pneumonia (90.5% vs. 88.6% in unadjusted analyses, P<0.001). CONCLUSIONS This portrait of patients' experiences in U.S. hospitals offers insights into areas that need improvement, suggests that the same characteristics of hospitals that lead to high nurse-staffing levels may be associated with better experiences for patients, and offers evidence that hospitals can provide both a high quality of clinical care and a good experience for the patient.

842 citations

Journal ArticleDOI
TL;DR: Although the positive effect of increasing percentages of Bachelors of Science in Nursing Degree nurses is consistent across all hospitals, lowering the patient-to-nurse ratios markedly improves patient outcomes in hospitals with good work environments, slightly improves them in hospitalswith average environments, and has no effect in hospitalsWith poor environments.
Abstract: Context:Better hospital nurse staffing, more educated nurses, and improved nurse work environments have been shown to be associated with lower hospital mortality. Little is known about whether and under what conditions each type of investment works better to improve outcomes.Objective:To determine t

650 citations


"Hospital nursing, care quality, and..." refers background or methods in this paper

  • ...%) of the spitals and at least 30 nurses responded in all hospitals, number our previous research suggests yields good liability of nurse-assessed variables (Aiken et al., 11a)....

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  • ...In other untries where computerized patient records are availle for study, more baccalaureate nurses have also been sociated with lower mortality (Aiken et al., 2011a; Van n Heede et al., 2009)....

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  • ...Measures The nurse work environment is measured by a composite of 4 of the five subscales of the Practice Environment Scale of Nursing Work Index (PES-NWI): Nurse Participation in Hospital Affairs; Nursing Foundations for Quality of Care; Nurse Manager Ability, Leadership, and Support of Nurses; and Collegial Nurse–Physician Relations (Aiken et al., 2011a)....

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  • ...The PES-NWI is a validated instrument used extensively in international research (Aiken et al., 2011a,b; Lake, 2007; Warshawsky and Havens, 2011)....

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  • ...An extensive international literature demon- rates that nurses’ reports of quality of care and nditions of the work environment track closely with dependent data on patient outcomes (Aiken et al., 11a,b, 2012; Kutney-Lee et al., 2009) and nurse tcomes (Liu et al., in press)....

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