Nursing unit teams matter: Impact of unit-level nurse practice environment, nurse work characteristics, and burnout on nurse reported job outcomes, and quality of care, and patient adverse events--a cross-sectional survey.
OBJECTIVE
To investigate the impact of nurse practice environment factors, nurse work characteristics, and burnout on nurse reported job outcomes, quality of care, and patient adverse events variables at the nursing unit level.


BACKGROUND
Nurse practice environment studies show growing insights and knowledge about determining factors for nurse workforce stability, quality of care, and patient safety. Until now, international studies have primarily focused on variability at the hospital level; however, insights at the nursing unit level can reveal key factors in the nurse practice environment.


METHODS
A cross-sectional design with a survey.


METHODS
In a cross-sectional survey, a sample of 1108 nurses assigned to 96 nursing units completed a structured questionnaire composed of various validated instruments measuring nurse practice environment factors, nurse work characteristics, burnout, nurse reported job outcomes, quality of care, and patient adverse events. Associations between the variables were examined using multilevel modelling techniques.


RESULTS
Various unit-level associations (simple models) were identified between nurse practice environment factors, nurse work characteristics, burnout dimensions, and nurse reported outcome variables. Multiple multilevel models showed various independent variables such as nursing management at the unit level, social capital, emotional exhaustion, and depersonalization as important predictors of nurse reported outcome variables such job satisfaction, turnover intentions, quality of care (at the unit, the last shift, and in the hospital within the last year), patient and family complaints, patient and family verbal abuse, patient falls, nosocomial infections, and medications errors.


CONCLUSIONS
Results suggested a stable nurse work force, with the capability to achieve superior quality and patient safety outcomes, is associated with unit-level favourable perceptions of nurse work environment factors, workload, decision latitude, and social capital, as well low levels of burnout. Nurses, physicians, nursing leaders, and executives share responsibility to create an environment supportive of interdisciplinary team development.
Division of Nursing and Midwifery Sciences, Centre for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk, Belgium; Department of Nursing, Antwerp University Hospital, Wilrijkstraat 10, B-2650 Edegem, Belgium. Electronic address: peter.vanbogaert@uantwerpen.be.
Peter
P
Van Bogaert
Division of Nursing and Midwifery Sciences, Centre for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk, Belgium; HZ University of Applied Sciences, Academia for Welfare and Health, Edisonweg 4, 4382 NW Vlissingen, Netherlands. Electronic address: olaf.timmermans@uantwerpen.be.
Olaf
O
Timmermans
TCU Center for Evidence-Based Practice & Research: A Collaborating Center of the Joanna Briggs Institute, Texas Christian University, TCU Box 298620, Fort Worth, TX 76129, United States. Electronic address: s.weeks@tcu.edu.
Susan Mace
SM
Weeks
Division of Nursing and Midwifery Sciences, Centre for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk, Belgium; Department of Nursing, Antwerp University Hospital, Wilrijkstraat 10, B-2650 Edegem, Belgium. Electronic address: danny.vanheusden@uantwerpen.be.
Danny
D
van Heusden
Department of Scientific Coordination, University Hospital Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium. Electronic address: kristien.wouters@uza.be.
Kristien
K
Wouters
Division of Nursing and Midwifery Sciences, Centre for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk, Belgium; Karel de Grote University College, Department of Health Care, Van Schoonbekestraat 143, B-2018 Antwerp, Belgium. Electronic address: erik.franck@uantwerpen.be.
Erik
E
Franck
D000328:Adult; D002055:Burnout, Professional; D003430:Cross-Sectional Studies; D006801:Humans; D007588:Job Satisfaction; D009741:Nursing Staff, Hospital / Q000523:psychology; D010348:Patient Care Team; D061214:Patient Safety; D011787:Quality of Health Care; D011795:Surveys and Questionnaires
Burnout; Job satisfaction; Multilevel modelling; Nurse practice environment; Nurse retention; Quality of care