To Keep Nurses, Improve Their Work Environments

Nurses working in hospitals around the world are reporting they are burned out and dissatisfied with their jobs, reported researchers at the University of Pennsylvania School of Nursing's Center for Health Outcomes and Policy Research in a study of 100,000 nurses in nine countries.

Between 20 to 60 percent of nurses reported symptoms of burnout according to the study, published in the International Journal for Quality in Health Care, which collected data from nurses in more than 1,400 hospitals to determine the effect of hospital work environments on hospital outcomes.

"The percentage of nurses reporting high burnout was over a third in most countries and decidedly higher in South Korea and Japan, near 60 percent in both countries," said lead authors Linda Aiken, PhD, RN, director of the Center for Health Outcomes and Policy Research at Penn Nursing. "Job dissatisfaction varied from 17 percent in Germany to around a third of nurses in most countries and a high of 60 percent dissatisfied in Japan. Almost half of nurses in all countries, except in Germany, and many more than half of the nurses in a few of the countries, lacked confidence that patients could manage their care after discharge," said Dr. Aiken.

Hospitals with better work environments had lower burnout, lower likelihood of job dissatisfaction and a decrease in reports of little or no confidence of discharge readiness of patients. In hospitals with poor work environments the percentage of nurses who believed patients were not prepared for discharge ranged between 22 percent and 85 percent.

"How well nurses are faring in their jobs has been found to be a barometer of how well patients in those same hospitals are faring," said Dr. Aiken. "In all countries, more than one in ten nurses report that care is either fair or poor, and in three of four Asian countries studied, nurses' ratings of fair/poor care are much more frequent."

The nine countries that participated in the study were: China, South Korea, Thailand, Japan, New Zealand, Canada, Germany, the United Kingdom, and the United States.

Dr. Aiken and her colleagues point to hospital leaders and policy makers to improve the nurse workforce and quality of care by increasing staff, improving nurse and physician relations, involving nurses more in hospital decisions, and greater managerial support of those who provide clinical care at the bedside.

"Increased attention to improving work environments might be associated with substantial gains in stabilizing the global nurse workforce while also improving quality of hospital care throughout the world," said Dr. Aiken.

Using measurements developed by Dr. Aiken and colleagues, researchers tracked nurses' responses to questions about staffing-resource adequacy, nurse manager ability and leadership, nurse-physician relations, nurse participation in hospital affairs, and nursing foundations for quality of care.