Inventi Impact: Nursing Research

Inventi:hnr/22921/17

Predictors of Burnout, Work Engagement and Nurse Reported Job Outcomes and Quality of Care: A\nMixed Method Study

Background: High levels of work-related stress, burnout, job dissatisfaction, and poor health are common within\nthe nursing profession. A comprehensive understanding of nurses� psychosocial work environment is necessary to\nrespond to complex patients� needs. The aims of this study were threefold: (1) To retest and confirm two structural\nequation models exploring associations between practice environment and work characteristics as predictors of burnout\n(model 1) and engagement (model 2) as well as nurse-reported job outcome and quality of care; (2) To study staff nurses�\nand nurse managers� perceptions and experiences of staff nurses� workload; (3) To explain and interpret the two models\nby using the qualitative study findings.\nMethod: This mixed method study is based on an explanatory sequential study design. We first performed a crosssectional\nsurvey design in two large acute care university hospitals. Secondly, we conducted individual semi-structured\ninterviews with staff nurses and nurse managers assigned to medical or surgical units in one of the study hospitals. Study\ndata was collected between September 2014 and June 2015. Finally, qualitative study results assisted in explaining and\ninterpreting the findings of the two models.\nResults: The two models with burnout and engagement as mediating outcome variables fitted sufficiently to the data.\nNurse-reported job outcomes and quality of care explained variances between 52 and 62%. Nurse management at the\nunit level and workload had a direct impact on outcome variables with explained variances between 23 and 36% and\nbetween 12 and 17%, respectively. Personal accomplishment and depersonalization had an explained variance on job\noutcomes of 23% and vigor of 20%. Burnout and engagement had a less relevant direct impact on quality of care (�5%).\nThe qualitative study revealed various themes such as organisation of daily practice and work conditions; interdisciplinary\ncollaboration, communication and teamwork; staff nurse personal characteristics and competencies; patient centeredness,\nquality and patient safety. Respondents� statements corresponded closely to the models� associations.\nConclusion: A deep understanding of various associations and impacts on studied outcome variables such as risk factors\nand protective factors was gained through the retested models and the interviews with the study participants. Besides\nthe softer work characteristics � such as decision latitude, social capital and team cohesion� more insight and\nknowledge of the hard work characteristic workload is essential.