Background: Health care systems in Finland, Norway and Sweden share many similarities, e.g. full-coverage and\ntax-financed, with predominately public sector hospitals. Despite similarities, there are differences in the working\nsituations for RNs within these Nordic countries. The aim of this study was to analyze associations between RNs�\npatient workload and level of involvement in direct patient care, their job satisfaction and intention to leave in\nthese countries.\nMethods: A workforce survey was conducted through RN4CAST, an EU 7th framework project. The survey included\n118 items derived from validated instruments or tested in prior research. Responses from 1133 RNs at 32 Finnish\nhospitals, 3752 RNs at 35 Norwegian hospitals, and 11 015 RNs at 71 Swedish hospitals comprise the database,\nwhich was analyzed using logistic and odds ratio regressions analyses.\nResults: We found statistically significant differences in RNs� level of involvement in direct patient care (p < 0.001,\nSweden compared to Norway and Finland), in patient workload and in number of patients needing ADL assistance\nand surveillance. A U-formed relationship was found between level of involvement in direct patient care and\nintention to leave in Sweden, and more satisfaction among RNs in roles with more direct patient care (OR = 1.16,\n1.02 ? CI95% ? 1.32). Nearly half the Finnish sample report intention to leave, with significantly lower levels in Norway\nand Sweden (p < 0.001). Patient workload is associated with job satisfaction and intention to leave to some degree\nin all countries, i.e. greater patient workload, less job satisfaction and greater intention to leave.\nConclusions: This study suggests that more attention paid to patient mix, workload and role of RNs in patient care\nmight potentially diminish intention to leave and increase job satisfaction in these Nordic countries
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