Work organization in hospital wards and nurses' emotional exhaustion: A multi-method study of observation-based assessment and nurses' self-reports.
BACKGROUND
Ward organization is a major determinant for nurses' well-being on the job. The majority of previous research on this relationship is based on single source methods, which have been criticized as skewed estimations mainly due to subjectivity of the ratings and due to common source bias.


OBJECTIVE
To investigate the association of ward organization characteristics and nurses' exhaustion by combining observation-based assessments with nurses' self-reports.


METHODS
Cross-sectional study on 25 wards of four hospitals and 245 nurses.


METHODS
Our multi-method approach to evaluate hospital ward organization consisted of on-site observations with a standardized assessment tool and of questionnaires to evaluate nurses' self-reports and exhaustion.


METHODS
After establishing the reliability of our measures, we applied multi-level regression analyses to determine associations between determinant and outcome variables.


RESULTS
We found substantial convergence in ward organization between the observation-based assessments and nurses' self-reports, which supports the validity of our external assessments. Furthermore, two observation-based characteristics, namely participation and patient-focused care, were significantly associated with lower emotional exhaustion among the nurses.


CONCLUSIONS
Our results suggest that observation-based assessments are a valid and feasible way to assess ward organization in hospitals. Nurses' self-reported as well as observation-based ratings on ward organization were associated with nurses' emotional exhaustion. This is of interest mainly for identifying alternative measures in evaluating nurses' work environments, to inform health promotion activities and to evaluate job redesign intervention.
Institute of General Psychology, Biological Psychology and Methods of Psychology, Work Unit "Knowledge-Action-Thinking", Technical University Dresden, Germany. Electronic address: nicolestab@gmx.de.
Nicole
N
Stab
Institute of General Psychology, Biological Psychology and Methods of Psychology, Work Unit "Knowledge-Action-Thinking", Technical University Dresden, Germany.
Winfried
W
Hacker
Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-University Munich, University Hospital, Munich, Germany.
Matthias
M
Weigl
D000293:Adolescent; D000328:Adult; D002055:Burnout, Professional; D003430:Cross-Sectional Studies; D017598:Efficiency, Organizational; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology*; D055815:Young Adult
Burnout; Hospital organization and administration; Nursing; Observation; Psychological; Stress