title: Importance of work environments on hospital outcomes in nine countries.
abstract: OBJECTIVE
  To determine the effect of hospital work environments on hospital outcomes across multiple countries.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Center for Health Outcomes and Policy Research, University of Pennsylvania, 418 Curie Blvd., Philadelphia, PA 19104-4217, USA. laiken@nursing.upenn.edu
authors.forename: Linda H
authors.initials: LH
authors.lastname: Aiken
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Sloane
authors.forename: Sean
authors.initials: S
authors.lastname: Clarke
authors.forename: Lusine
authors.initials: L
authors.lastname: Poghosyan
authors.forename: Eunhee
authors.initials: E
authors.lastname: Cho
authors.forename: Liming
authors.initials: L
authors.lastname: You
authors.forename: Mary
authors.initials: M
authors.lastname: Finlayson
authors.forename: Masako
authors.initials: M
authors.lastname: Kanai-Pak
authors.forename: Yupin
authors.initials: Y
authors.lastname: Aungsuroch
mesh_terms: D002055:Burnout, Professional; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D038622:Internationality; D007588:Job Satisfaction; D008297:Male; D009732:Nursing Care / Q000592:standards*; D009741:Nursing Staff, Hospital / Q000523:psychology*; D017063:Outcome Assessment, Health Care