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Original article

Vol. 142 No. 5152 (2012)

A multi-method study on the quality of the nurse work environment in acute-care hospitals: positioning Switzerland in the Magnet hospital research

  • Mario Desmedt
  • Sabina De Geest
  • Maria Schubert
  • René Schwendimann
  • Dietmar Ausserhofer
DOI
https://doi.org/10.4414/smw.2012.13733
Cite this as:
Swiss Med Wkly. 2012;142:w13733
Published
16.12.2012

Summary

BACKGROUND: Magnet hospitals share nurse work environment characteristics associated with superior patient, nurse and financial outcomes. In Switzerland, however, it is uncertain how nurses appraise their work environments.

OBJECTIVES: To describe the quality of the nurse work environment in 35 Swiss acute care hospitals and to benchmark findings based on international Magnet hospital research.

METHOD: This study used two data sources: (1) the Swiss arm of the RN4CAST study; and (2) a structured literature review. Hospitals were categorised based on Magnet and non-Magnet data. Our outcome variable of interest was the quality of nurse work environment measured with the Practice Environment Scale of the Nurse Work Index (PES-NWI).

RESULTS: We reviewed 13 American, Canadian, and Australian studies of acute-care hospitals. Three provided Magnet hospitals’ nurse work environment data, and all included non-Magnet hospitals’ data. Swiss hospitals’ evaluations on nurse work environment quality varied widely, but 25% achieved scores indicating “Magnet nurse work environments”. Swiss hospitals’ average “Nursing manager ability” subscale scores fulfilled Magnet hospital criteria, although “Nurse participation in hospital affairs” and “Nursing staffing and resource adequacy” scores neared non-Magnet levels.

CONCLUSION: On average, our results indicated high quality nurse work environments in Swiss hospitals. Implementing Magnet model organisational principles might be a valuable approach for Swiss acute-care hospitals to both improve mixed and unfavourable nurse work environments and to improve nurse and patient outcomes. National benchmarking of nurse work environments and other nurse-sensitive indicators may facilitate evaluating the impact of current developments in Swiss healthcare.

 

Key words: nurse work environment; practice environment scale; Magnet status; acute care hospitals; Switzerland

References

  1. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington D.C.: The National Academies Press; 2010.
  2. Aiken LH, Poghosyan L. Evaluation of “magnet journey to nursing excellence program” in Russia and Armenia. J Nurs Scholarsh. 2009;41(2):166–74.
  3. Kelly LA, McHugh MD, Aiken LH. Nurse Outcomes in Magnet¬Æ and Non-Magnet Hospitals. J Nurs Adm. 2011;41(10):428–33 10.1097/NNA.0b013e31822eddbc.
  4. Lake ET, Friese CR. Variations in nursing practice environments: relation to staffing and hospital characteristics. Nurs Res. 2006;55(1):1–9.
  5. Cowden T, Cummings G, Profetto-McGrath J. Leadership practices and staff nurses’ intent to stay: a systematic review. J Nurs Manag. 2011;19(4):461–77.
  6. Flinkman M, Leino-Kilpi H, Salantera S. Nurses’ intention to leave the profession: integrative review. J Adv Nurs. 2010;66(7):1422–34.
  7. Stone PW, Hughes R, Dailey M. Creating a safe and high-quality health care environment patient safety and quality: an evidence-based handbook for furses. Hughes RG, editor. Rockville MD2008.
  8. Shermont H, Krepcio D. The impact of culture change on nurse retention. J Nurs Adm. 2006;36(9):407–15.
  9. Needleman J, Buerhaus P, Pankratz VS, Leibson CL, Stevens SR, Harris M. Nurse staffing and inpatient hospital mortality. N Engl J Med. 2011;364(11):1037–45.
  10. Blegen MA, Goode CJ, Spetz J, Vaughn T, Park SH. Nurse staffing effects on patient outcomes: safety-net and non-safety-net hospitals. Med Care. 2011;49(4):406–14.
  11. Lucero RJ, Lake ET, Aiken LH. Nursing care quality and adverse events in US hospitals. J Clin Nurs. 2010;19(15-16):2185–95.
  12. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002;288(16):1987–93.
  13. Aiken LH, Clarke SP, Cheung RB, Sloane DM, Silber JH. Educational levels of hospital nurses and surgical patient mortality. JAMA. 2003;290(12):1617–23.
  14. Aiken LH, Clarke SP, Sloane DM, Lake ET, Cheney T. Effects of hospital care environment on patient mortality and nurse outcomes. J Nurs Adm. 2008;38(5):223–9.
  15. Spence Laschinger HK, Leiter MP. The impact of nursing work environments on patient safety outcomes: the mediating role of burnout/engagement. J Nurs Adm. 2006;36(5):259–67.
  16. Cummings GG, Midodzi WK, Wong CA, Estabrooks CA. The contribution of hospital nursing leadership styles to 30-day patient mortality. Nurs Res. 2010;59(5):331–9.
  17. Dewing J. Implications for nursing managers from a systematic review of practice development. J Nurs Manag. 2008;16(2):134–40.
  18. McGillis Hall L, Peterson J, Baker GR, Brown AD, Pink GH, McKillop I, et al. Nurse staffing and system integration and change indicators in acute care hospitals: evidence from a balanced scorecard. J Nurs Care Qua. 2008;23(3):242–52.
  19. Lundmark VA. Magnet environments for professional nursing practice patient safety and quality: an evidence-based handbook for nurses. Hughes RG, editor. Rockville MD2008.
  20. Newhouse RP. Examining the support for evidence-based nursing practice. J Nurs Adm. 2006;36(7-8):337–40.
  21. Kramer M, Maguire P, Brewer BB. Clinical nurses in Magnet hospitals confirm productive, healthy unit work environments. J Nurs Manag. 2011;19(1):5–17.
  22. Tschannen D, Kalisch BJ. The impact of nurse/physician collaboration on patient length of stay. J Nurs Manag. 2009;17(7):796–803.
  23. Gajewski BJ, Boyle DK, Miller PA, Oberhelman F, Dunton N. A multilevel confirmatory factor analysis of the Practice Environment Scale: a case study. Nurs Res. 2010;59(2):147–53.
  24. Lake ET. Development of the practice environment scale of the Nursing Work Index. Res Nurs Health. 2002;25(3):176–88.
  25. Aiken LH, Patrician PA. Measuring organizational traits of hospitals: the Revised Nursing Work Index. Nurs Res. 2000;49(3):146–53.
  26. Warshawsky NE, Havens DS. Global use of the Practice Environment Scale of the Nursing Work Index. Nurs Res. 2011;60(1):17–31.
  27. Middleton S, Griffiths R, Fernandez R, Smith B. Nursing practice environment: how does one Australian hospital compare with magnet hospitals? Int J Nurs Pract. 2008;14(5):366–72.
  28. Kim H, Capezuti E, Boltz M, Fairchild S. The nursing practice environment and nurse-perceived quality of geriatric care in hospitals. West J Nurs Res. 2009;31(4):480–95.
  29. Chen YM, Johantgen ME. Magnet hospital attributes in European hospitals: a multilevel model of job satisfaction. Int J Nurs Stud. 2010;47(8):1001–12.
  30. Aiken LH, Buchan J, Ball J, Rafferty AM. Transformative impact of Magnet designation: England case study. J Clin Nurs. 2008;17(24):3330–7.
  31. Gunnarsdottir S, Clarke SP, Rafferty AM, Nutbeam D. Front-line management, staffing and nurse-doctor relationships as predictors of nurse and patient outcomes. a survey of Icelandic hospital nurses. Int J Nurs Stud. 2009;46(7):920–7.
  32. Van Bogaert P, Meulemans H, Clarke S, Vermeyen K, Van de Heyning P. Hospital nurse practice environment, burnout, job outcomes and quality of care: test of a structural equation model. J Adv Nurs. 2009;65(10):2175–85.
  33. Van Bogaert P, Clarke S, Roelant E, Meulemans H, Van de Heyning P. Impacts of unit-level nurse practice environment and burnout on nurse-reported outcomes: a multilevel modelling approach. J Clin Nurs. 2010;19(11-12):1664–74.
  34. Rafferty AM, Clarke SP, Coles J, Ball J, James P, McKee M, et al. Outcomes of variation in hospital nurse staffing in English hospitals: cross-sectional analysis of survey data and discharge records. Int J Nurs Stud. 2007;44(2):175–82.
  35. Sanderson S, Tatt ID, Higgins JP. Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: a systematic review and annotated bibliography. Int J Epidemiol. 2007;36(3):666–76.
  36. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007;4(10):e296.
  37. Aiken LH, Sermeus W, Heede KVd, Sloane DM, Busse R, McKee M, et al. Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ. 2012 2012-03-20 00:00:00;344.
  38. Sermeus W, Aiken LH, Van den Heede K, Rafferty AM, Griffiths P, Moreno-Casbas MT, et al. Nurse Forecasting in Europe (RN4CAST): Rationale, design and methodology. BMC Nurs. 2011;10(1):6.
  39. De Pedro-Gomez J, Morales-Asencio JM, Sese-Abad A, Bennasar-Veny M, Pericas-Beltran J, Miguelez-Chamorro A. Psychometric testing of the Spanish version of the Practice Environment Scale of the Nursing Work Index in a primary healthcare context. J Adv Nurs. 2011 Jun 29.
  40. Liou S, Cheng C. Using the Practice Environment Scale of the Nursing Work Index on Asian nurses. Nurs Res. 2009;58(3):218–25.
  41. Parker D, Tuckett A, Eley R, Hegney D. Construct validity and reliability of the Practice Environment Scale of the Nursing Work Index for Queensland nurses. Int J Nurs Pract. 2010;16(4):352–8.
  42. Jones PS, Lee JW, Phillips LR, Zhang XE, Jaceldo KB. An adaptation of Brislin’s translation model for cross-cultural research. Nurs Res. 2001;50(5):300–4.
  43. Squires A, Aiken LH, van den Heede K, Sermeus W, Bruyneel L, Lindqvist R, et al. A systematic survey instrument translation process for multi-country, comparative health workforce studies. Int J Nurs Stud. 2012 Mar 23.
  44. Lee H, Cummings GG. Factors influencing job satisfaction of front line nurse managers: a systematic review. J Nurs Manag. 2008;16(7):768–83.
  45. Brady Germain P, Cummings GG. The influence of nursing leadership on nurse performance: a systematic literature review. J Nurs Manag. 2010;18(4):425–39.
  46. Wong CA, Cummings GG. The relationship between nursing leadership and patient outcomes: a systematic review. J Nurs Manag. 2007;15(5):508–21.
  47. Center ANC. Magnet Recognition Program: Application Manual. 2008.
  48. Cummings GG, MacGregor T, Davey M, Lee H, Wong CA, Lo E, et al. Leadership styles and outcome patterns for the nursing workforce and work environment: a systematic review. Int J Nurs Stud. 2010;47(3):363–85.
  49. Martin JS, McCormack B, Fitzsimons D, Spirig R. Evaluation of a clinical leadership programme for nurse leaders. J Nurs Manag. 2012;20(1):72–80.
  50. Patrician PA, Loan L, McCarthy M, Fridman M, Donaldson N, Bingham M, et al. The association of shift-level nurse staffing with adverse patient events. J Nurs Adm. 2011;41(2):64–70.
  51. Kane RL, Shamliyan T, Mueller C, Duval S, Wilt TJ. Nurse staffing and quality of patient care. Evid Rep Technol Assess (Full Rep). 2007;(151):1–115.
  52. Rothberg MB, Abraham I, Lindenauer PK, Rose DN. Improving nurse-to-patient staffing ratios as a cost-effective safety intervention. Med Care. 2005;43(8):785–91.
  53. Van den Heede K, Simoens S, Diya L, Lesaffre E, Vleugels A, Sermeus W. Increasing nurse staffing levels in Belgian cardiac surgery centres: a cost-effective patient safety intervention? J Adv Nurs. 2010;66(6):1291–6.
  54. Havens DS, Johnston MA. Achieving Magnet hospital recognition: chief nurse executives and Magnet coordinators tell their stories. J Nurs Adm. 2004;34(12):579–88.
  55. Drenkard K. The business case for Magnet. J Nurs Adm. 2010;40(6):263–71.
  56. Nursing PMsCotFo. Front line care: the future of nursing and midwifery in England. Report of the Prime Minister’s Commission on the future of nursing and midwifery in England 2010.2010: Available from: http://webarchive.nationalarchives.gov.uk/20100331110400/http://cnm.independent.gov.uk/wp-content/uploads/2010/03/front_line_care.pdf.
  57. Imhof L, Rüesch P, Schaffert R, Mahrer-Imhof R, Fringer A, Kerker-Specker C. Professionelle Pflege Schweiz: Perspektive 2020. Ein Grundlagenbericht.2010: Available from: http://www.sbk-asi.ch/pflege2020/201012_Lit_Perspektiven_2020_D.pdf.
  58. Simon M. Stellenabbau im Pflegedienst der Krankenhäuser. Eine Analyse der Entwicklung zwischen 1991 und 2005.2007: Available from: http://www.fakultaet5.fh-hannover.de/fileadmin/media/doc/f5/papers/07-001.pdf.
  59. Weinberg DB. Code green: money-driven hospitals and the dismantling of nursing: ILR Press; 2003.
  60. Montalvo I. The National Database of Nursing Quality IndicatorsTM (NDNQI®). The Online Journal of Issues in Nursing [serial on the Internet]. 2007; 12(3): Available from: http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/NursingQualityIndicators.aspx.
  61. Schubert M, Clarke SP, Aiken LH, de Geest S. Associations between rationing of nursing care and inpatient mortality in Swiss hospitals. Int J Qual Health Care. 2012 Mar 28.
  62. Schubert M, Clarke SP, Glass TR, Schaffert-Witvliet B, De Geest S. Identifying thresholds for relationships between impacts of rationing of nursing care and nurse- and patient-reported outcomes in Swiss hospitals: a correlational study. Int J Nurs Stud. 2009;46(7):884–93.
  63. Schubert M, Glass TR, Clarke SP, Aiken LH, Schaffert-Witvliet B, Sloane DM, et al. Rationing of nursing care and its relationship to patient outcomes: the Swiss extension of the International Hospital Outcomes Study. Int J Qual Health Care. 2008;20(4):227–37.
  64. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62(10):e1–34.
  65. American Nurses Credentialing Center. Magnet Recognition Program: application manual: American Nurses Credentialing Center; 2008.

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