Gunnarsdóttir, Sigrún, Clarke, Sean P., Rafferty, Anne Marie and Nutbeam, Donald
Front-line management, staffing and nurse–doctor relationships as predictors of nurse and patient outcomes. A survey of Icelandic hospital nurses
International Journal of Nursing Studies, 46, (7), . (doi:10.1016/j.ijnurstu.2006.11.007).
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Objective: To investigate aspects of nurses' work environments linked
with job outcomes and assessments of quality of care in an Icelandic
Background: Prior research suggests that poor working environments in
hospitals significantly hinder retention of nurses and high quality
patient care. On the other hand, hospitals with high retention rates
(such as Magnet hospitals) show supportive management, professional
autonomy, good inter-professional relations and nurse job satisfaction,
reduced nurse burnout and improved quality of patient care.
Methods: Cross-sectional survey of 695 nurses at Landspitali University
Hospital, Reykjavik. Nurses' work environments were measured using the
nursing work index-revised (NWI-R) and examined as predictors of job
satisfaction, the Maslach burnout inventory (MBI) and nurse-assessed
quality of patient care using linear and logistic regression approaches.
Results: An Icelandic adaptation of the NWI-R showed a five-factor
structure similar to that of Lake (2002). After controlling for nurses'
personal characteristics, job satisfaction, emotional exhaustion and
nurse rated quality of care were found to be independently associated
with perceptions of support from unit-level managers, staffing
adequacy, and nurse-doctor relations.
Conclusions: The NWI-R measures elements of hospital nurses' work
environments that predict job outcomes and nurses' ratings of the
quality of patient care in Iceland. Efforts to improve and maintain
nurses' relations with nurse managers and doctors, as well as their
perceptions of staffing adequacy, will likely improve nurse job
satisfaction and employee retention, and may improve the quality of
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