title: Haemodialysis work environment contributors to job satisfaction and stress: a sequential mixed methods study.
abstract: BACKGROUND
  Haemodialysis nurses form long term relationships with patients in a technologically complex work environment. Previous studies have highlighted that haemodialysis nurses face stressors related to the nature of their work and also their work environments leading to reported high levels of burnout. Using Kanters (1997) Structural Empowerment Theory as a guiding framework, the aim of this study was to explore the factors contributing to satisfaction with the work environment, job satisfaction, job stress and burnout in haemodialysis nurses.
  
  
  METHODS
  Using a sequential mixed-methods design, the first phase involved an on-line survey comprising demographic and work characteristics, Brisbane Practice Environment Measure (B-PEM), Index of Work Satisfaction (IWS), Nursing Stress Scale (NSS) and the Maslach Burnout Inventory (MBI). The second phase involved conducting eight semi-structured interviews with data thematically analyzed.
  
  
  RESULTS
  From the 417 nurses surveyed the majority were female (90.9 %), aged over 41 years of age (74.3 %), and 47.4 % had worked in haemodialysis for more than 10 years. Overall the work environment was perceived positively and there was a moderate level of job satisfaction. However levels of stress and emotional exhaustion (burnout) were high. Two themes, ability to care and feeling successful as a nurse, provided clarity to the level of job satisfaction found in phase 1. While two further themes, patients as quasi-family and intense working teams, explained why working as a haemodialysis nurse was both satisfying and stressful.
  
  
  CONCLUSIONS
  Nurse managers can use these results to identify issues being experienced by haemodialysis nurses working in the unit they are supervising.
authors.affiliation: Haemodialysis Unit, Cairns Hospital, c/o Renal Unit, P.O. Box 902, Cairns, QLD Australia.
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Hayes
authors.affiliation: School of Nursing, Queensland University of Technology, Brisbane, Australia ; Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Australia.
authors.forename: Ann
authors.initials: A
authors.lastname: Bonner
authors.affiliation: School of Nursing, Queensland University of Technology, Brisbane, Australia.
authors.forename: Clint
authors.initials: C
authors.lastname: Douglas
keywords: Burnout; Haemodialysis; Job satisfaction; Job stress; Mixed-methods; Renal; Work environment