Embed Size (px)
Citation preview
Impact of nursing practice environment on job outcomes and safety climate:
testing a model
Gisele Hespanhol Dorigan
RN, PhD in Nursing
Registration ID: 92474658
Faculty DisclosureFaculty Name: Gisele Hespanhol Dorigan
University of Campinas (Unicamp, Brazil)
Conflicts of interest: None
Employer: University of Campinas, School of Nursing
Sponsorship/ Commercial Support: None
Faculty Name: Daniela Fernanda dos Santos AlvesUniversity of Campinas (Unicamp, Brazil)
Conflicts of interest: None
Employer: University of Campinas, School of Nursing
Sponsorship/ Commercial Support: None
Faculty Name: Edinêis de Brito GuirardelloUniversity of Campinas (Unicamp, Brazil)
Conflicts of interest: None
Employer: University of Campinas, School of Nursing
Sponsorship/ Commercial Support: None
Funding: Grant #483515/2013-2. National Council for Scientific and Technological Development (CNPq), Brazil.
Goals and Objectives
• Session Goal:
− To describe the results of a survey on nurses' practice environment and discussstrategies in order to improve job outcomes and safety climate in healthcareorganizations.
• Session Objectives:
− To test the theoretical model of the effect of nursing practice environment onsafety climate, job satisfaction, intention to stay in the job and in the nursingprofession, and burnout.
− To discuss strategies for improving the nursing practice environment, whichcould result in improving the nurses’ job satisfaction and perception of the safetyclimate.
Background
(Alenius et al., 2014; Kirwan et al., 2013; Van Bogaert et al., 2014)
Job satisfaction
Quality of care
Patient safety
Burnout levels
Intention to leave the job and the profession
Positive nursing practice environment
Whats this study adds?
• The theoretical model showed a direct and strong impact on safetyclimate, job satisfaction and reduced burnout levels
Background
Methods
• Design: cross-sectional correlational study
• Sample: probabilistic sample of 465 registered nurses (RN) from theState of São Paulo, Brazil
• Inclusion criteria: nurses who reported performing direct patient careactivities and with time experience of ≥ six months
• Exclusion criteria: nurses who reported work exclusively withmanagement or teaching activities, and nurses were in medical licensesfor any reasons
Data collection:
Ethical approval byEthical Review Board
Recruitment ofparticipants
Online data collection
Randomised by thenumber registration in the Regional NursingCouncil of São Paulo
State (COREN-SP, Brazil)
Protocol nº: 673228/ 2014 Period betweenDecember 2014 to
June 2015
Methods
Variables and measures
Nurse characteristics
Age, gender, time of experience in the institution, hour work perweek, and if there is another job
Intention to stay in the current job next year
Intention to stay in nursing
Ranges from 0 to 10 (Meaning: as closer from
“0”: no intention)
Methods
Variables and measures
Nursing practice environment
• Nursing Work Index – Revised (NWI-R)
Autonomy (5 items, α = 0.80)
Control over the work environment (7 items, α = 0.80)
Nurse-physician relationships (3 items, α = 0.88)
(Gasparino et al., 2011; Aiken & Patrician, 2000)
Methods
4-point Likert scale(Ranged from: 1 = strongly disagree to 4 = strongly agree)
Variables and measures
Job satisfaction and Safety climate
• Subscales of the Safety Attitudes Questionnaire (SAQ) – Short form2006
Safety climate (7 items, α = 0.77)
Job satisfaction (5 items, α = 0.85)
(Carvalho & Cassiani, 2012; Sexton & Thomas, 2003)
5-point Likert scale(Ranged from: 1 = strongly disagree to 5 = strongly agree)
Methods
Variables and measures
Burnout
• Maslach Burnout Inventory (MBI)Emotional exhaustion (9 items, α = 0.92)
Depersonalization (5 items, α = 0.68)
Personal accomplishment (8 items, α = 0.81)
(Tamayo, 1997; Maslach et al., 1986)
5-point Likert scale(Ranged from: 1 = never to 5 = ever)
Methods
Data analysis
• Structural Equation Modeling (SEM) with the Partial Least Squares Path Modelingapproach (PLS-PM): two stage approach:
(Hair et al., 2014; Ringle et al., 2014)
Convergent and discriminantvalidity
• Average Variance Extracted(AVE) values: > 0.5
• Cross loadings and Fornell & Larcker criterion
• Reliability (Compositereliability)
- Significance and values of pathcoefficients
- Indicators of quality of fit of the model
Explicated Variance (R2)
Predictive validity (Q2>0)
Effect size (f2)
Measuring modelevaluation
Structural modelevaluation
Low effect: 2%
Moderate: 13%
High effect: 26%
Low: 0.02
Moderate: 0.15
High: 0.35
Methods
Figure 1. Theoretical model
Results
Sample (n = 465)
• Mean age: 35.7 (SD = 8.8)
• Gender female: 84.1%
• Time of experience in the job ≥ four (4) years: 46.5%
• Average hours worked per week: 42.8 horas (SD = 13.2)
• No other job: 78.7%
• Percentual of nurses that intend to stay in the job: 65.0%
• Percentual of nurses that intend to stay in nursing: 73.9%
Measuring model evaluation
1º) Excluded four (4) items to ensure convergent validity
(Reference value for Average Variance Extracted (AVE): AVE > 0.5)
2º) Excluded one (1) item to ensure discriminant validity
3º) Composite reliability and Cronbach’s alpha coeficients: adequate(Reference value: ≥ 0.70)
Results
Variables Factorloadings
AVE Compositereliability
Autonomy 0.59 – 0.80 0.56 0.86Control over the work environment 0.58 – 0.82 0.56 0.86Nurse-physician relationships 0.85 – 0.93 0.81 0.93Job satisfaction 0.75 – 0.84 0.62 0.89Safety climate 0.51 – 0.79 0.50 0.85Emotional exhaustion 0.62 – 0.90 0.61 0.93Depersonalization 0.55 – 0.79 0.52 0.81Personal accomplishment 0.67 – 0.81 0.50 0.87
Table 1. Convergent validity of the model (factor loadings, values of Average VarianceExtracted (AVE) and reliability)
Values in bold font along the diagonal line are the square roots of the AVE values for each construct.Values below the diagonal line are Pearson’s correlation coefficients.
Table 2. Discriminant validity (Fornell & Larcker criterion)
Variables 1 2 3 4 5 6 7 8
1 Autonomy 0.75
2 Control over the work environment 0.70 0.75
3 Depersonalization 0.31 0.29 0.72
4 Emotional exhaustion 0.55 0.55 0.49 0.78
5 Personal accomplishment 0.50 0.45 0.52 0.63 0.71
6 Nurse-physician relationships 0.66 0.55 0.20 0.40 0.35 0.90
7 Safety climate -0.64 -0.58 -0.32 -0.44 -0.46 -0.45 0.71
8 Job satisfaction -0.63 -0.55 -0.32 -0.61 -0.58 -0.51 0.60 0.79
Results
Table 3. Quality adjustment values of the model
Constructs R2 Q2 f2
Nursing practice environment - - 0.38
Autonomy - 0.47 0.34
Control over the work environment - 0.42 0.33
Nurse-physician relationships - 0.54 0.60
Job satisfaction 0.43 0.25 0.42
Safety climate 0.42 0.20 0.30
Burnout 0.36 0.14 0.35
Emotional exhaustion - 0.52 0.51
Depersonalization - 0.23 0.21
Personal accomplishment - 0.35 0.33
Intention to stay in the job 0.22 0.22 -
Intention to stay in nursing 0.17 0.16 -
Reference value> 0.13 (median)
> 0.26 (large)Positive
> 0.15 (median)
> 0.35 (large)
Results
Hypothesis Pathway Path
coefficients
(Г)
Confidence
interval (95%)
Conclusion
H1 Work environment → Burnout -0.60* -0.53, -0.66 Supported
H2Work environment → Intention to stay
in the job0.47* 0.32, 0.49 Supported
H3Work environment → Intention to stay
in nursing0.41* 0.39, 0.54 Supported
H4 Work environment → Job satisfaction 0.65* 0.60, 0.70 Supported
H5 Work environment → Safety climate 0.65* 0.60, 0.70 Supported
Table 4. Evaluation of hypothesis
*p-value: p < 0,0001.
Results
Figure 2. Final structural model
Conclusions
Nursing practice environment has a strong impact:
In the job satisfaction and safety climate
In the reduction in burnout levels
A median impact:
In the intention to stay in the job
In the intention to stay in nursing
Implications for nursing practice:
Strategies to improve nurses’ autonomy, control over their practiceand good relationship between nurses and physicians showed apositive impact on perception of safety climate, job satisfaction andreduced burnout levels.
References1. Aiken, L.H., Patrician, P.A. (2000). Measuring organizational traits of hospitals: the revised nursing work index. Nursing
Research, 49, 146-53.2. Alenius, L.S., Tishelman, C., Runesdotter, S., & Lindqvist, R. (2014). Staffing and resource adequacy strongly related to RN’
assessment of patient safety: a national study of RNs working in acute-care hospitals in Sweden. BMJ Quality & Safety, 23,242-49. DOI: 10.1136/bmjqs-2012-001734
3. Carvalho, R.E.F.L., & Cassiani, S.H.B. (2012). Cross-cultural adaptation of the Safety Attitudes Questionnaire - Short Form2006 for Brazil. Revista Latino-Americana de Enfermagem, 20, 575-82. DOI: 10.1590/S0104-11692012000300020
4. Gasparino, R.C., Guirardello, E.B., & Aiken, L.H. (2011). Validation of the Brazilian version of the Nursing Work Index-Revised(B-NWI-R). Journal of Clinical Nursing, 20, 3494-501. DOI: 10.1111/j.1365-2702.2011.03776.x
5. Hair, J.F., Hult, T.M., Ringle, C.M., & Sarstedt, M. (2014). A Primer on Partial Least Squares Structural Equation Modeling(PLS-PM). Los Angeles: SAGE.
6. Kirwan, M., Matthews, A., & Scott, A.P. (2013). The impact of the work environment of nurses on patient safety outcomes: amulti-level modelling approach. International Journal of Nursing Studies, 50, 253-263. DOI: 10.1016/j.ijnurstu.2012.08.020
7. Maslach, C., Jackson, S.E., Leiter, M.P., Schaufeli, W.B., Schwab, R.L. (1986). Maslach Burnout Inventory: Sampler Set.Manual, General Survey, Human Services Survey, Educators Survey, & Scoring Guides. Mind Garden.
8. Ringle, C.M., Silva, D., & Bido, D. (2014). Structural equation modeling with the SmartPLS. Brazilian Journal of MarketingBJM, 13, 54-71. DOI: 10.5585/remark.v13i2.2717
9. Sexton, J.B., Thomas, E.J. (2003). The Safety Attitudes Questionnaire (SAQ): Guidelines for Administration. The University ofTexas Center of Excellence for Patient Safety Research and Practice. Technical Report 03-02. Jul. 11, 2003.
10.Tamayo, M.R. (1997). Relação entre a síndrome de burnout e os valores organizacionais no pessoal de enfermagem de doishospitais públicos (Unpublished master’s thesis). Brasília (DF): Universidade de Brasília. Brazil, 1997.
11.Van Bogaert, P., Heusden, D.V., Timmermans, O., & Franck, E. (2014). Nurse work environment impacts job outcome and nurse-assessed quality of care: model testing with nurse practice environment and nurse work characteristics as predictors. Frontiers inPsychology, 5, 1-11. DOI: 103389/fpsyg.2014.01261
