title: Hospital nurse practice environment, burnout, job outcomes and quality of care: test of a structural equation model.
abstract: OBJECTIVE
  The aim of the study was to investigate relationships between nurse practice environment, burnout, job outcomes and nurse-assessed quality of care.
  
  
  BACKGROUND
  A growing line of work confirms that, in countries with distinctly different healthcare systems, nurses report similar shortcomings in their work environments and the quality of care in hospitals. Neither the specific work environment factors most involved in dissatisfaction, burnout and other negative job outcomes, and patient outcomes, nor the mechanisms tying nurse job outcomes to quality of care are well understood.
  
  
  METHODS
  A Nurse Practice Environment and Outcome causal structure involving pathways between practice environment dimensions and outcome variables with components of burnout in a mediating position was developed. Survey data from 401 staff nurses across 31 units in two hospitals (including the Revised Nursing Work Index, the Maslach Burnout Inventory, and job outcome and nurse-assessed quality of care variables) were used to test this model using structural equation modelling techniques. The data were collected from December 2006 to January 2007.
  
  
  RESULTS
  Goodness of fit statistics confirmed an improved model with burnout dimensions in mediating positions between nurse practice environment dimensions and both job outcomes and nurse-assessed quality of care, explaining 20% and 46% of variation in these two indicators, respectively.
  
  
  CONCLUSIONS
  These findings suggest that hospital organizational properties, including nurse-physician relations, are related to quality of care assessments, and to the outcomes of job satisfaction and turnover intentions, with burnout dimensions appearing to play mediating roles. Additionally, a direct relationship between assessments of care quality and management at the unit level was observed.
authors.affiliation: Department of Nursing, University Hospital Antwerp, Belgium. peter_van_bogaert@hotmail.com
authors.forename: Peter
authors.initials: P
authors.lastname: Van Bogaert
authors.forename: Herman
authors.initials: H
authors.lastname: Meulemans
authors.forename: Sean
authors.initials: S
authors.lastname: Clarke
authors.forename: Karel
authors.initials: K
authors.lastname: Vermeyen
authors.forename: Paul
authors.initials: P
authors.lastname: Van de Heyning
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002055:Burnout, Professional / Q000209:etiology* / Q000523:psychology; D002983:Clinical Competence; D003627:Data Interpretation, Statistical; D005163:Factor Analysis, Statistical; D005260:Female; D006272:Health Facility Environment / Q000458:organization & administration*; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D015401:Nursing Administration Research; D009741:Nursing Staff, Hospital / Q000458:organization & administration* / Q000523:psychology; D010563:Personnel Turnover; D019555:Physician-Nurse Relations; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D016526:Workload / Q000523:psychology; D017132:Workplace / Q000458:organization & administration / Q000523:psychology; D055815:Young Adult