title: The relationships between nurses' perceptions of the hemodialysis unit work environment and nurse turnover, patient satisfaction, and hospitalizations.
abstract: While the nephrology nursing shortage persists despite the continued growth of the population of individuals with Stage 5 chronic kidney disease, there is a paucity of empirical data regarding nephrology nurses' perceptions of their work environments. Moreover, there are no studies that have examined the relationship of work environment attributes to patient and nurse outcomes in dialysis settings. The purpose of this study was to examine the relationships between staff nurses' perceptions of dialysis work environments, nurses' intentions to leave their current jobs, nurse turnover, patient satisfaction, and patient hospitalization rates. A descriptive, correlational design was used. Nurse level and facility level data were obtained. The sample for nurse-level data consisted of 199 registered nurses in staff nurse roles in 56 dialysis facilities of a national dialysis company. The sample for facility-level analysis consisted of 46 dialysis facilities, and nurse-level data were aggregated for facility-level analysis. The Practice Environment Scale-Nursing Work Index (PES-NWI) was used to measure nurses' perceptions of the dialysis work environment. Nurses' intention to leave their jobs and facility-level turnover rates were the nurse outcomes examined in this study. Facility-level patient satisfaction and hospitalization rates were the patient outcomes examined. Correlation coefficients were computed to measure the relationships between study variables, and independent t-tests were performed to examine subgroup differences in work environment perceptions. Overall, nurses rated the work environment somewhat favorably. Nurses who expressed intention to leave their jobs rated the work environment more negatively compared to nurses who intended to stay. Significant correlations were found between nurses' perceptions of the dialysis work environment, nurses' intention to leave their jobs, nurse turnover rates, and patient hospitalizations. Study findings suggest that nurses' perceptions of the dialysis work environment are important for nurse and patient outcomes in dialysis settings. Further research is needed to explore the predictive ability of the work environment for nurse and patient outcomes in hemodialysis units.
authors.affiliation: Renal Care Group, Nashville, TN, USA. jane_gardner@comcast.net
authors.forename: Jane K
authors.initials: JK
authors.lastname: Gardner
authors.forename: Charlotte
authors.initials: C
authors.lastname: Thomas-Hawkins
authors.forename: Louis
authors.initials: L
authors.lastname: Fogg
authors.forename: Carolyn E
authors.initials: CE
authors.lastname: Latham
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000592:standards*; D005260:Female; D019538:Health Care Surveys; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D033182:Intention; D007588:Job Satisfaction; D007676:Kidney Failure, Chronic / Q000451:nursing*; D008297:Male; D009740:Nursing Staff / Q000523:psychology / Q000600:supply & distribution*; D017060:Patient Satisfaction; D010559:Personnel Management; D010563:Personnel Turnover; D011787:Quality of Health Care; D006435:Renal Dialysis / Q000451:nursing* / Q000592:standards; D014481:United States; D000078329:Workforce; D017132:Workplace