Department of Biostatistics, Erasmus Medical Centre, Erasmus University Rotterdam, The Netherlands.
Int J Nurs Stud. 2013 Feb;50(2):281-91. doi: 10.1016/j.ijnurstu.2012.07.001. Epub 2012 Jul 24.
Nurses' work environments are associated with burnout experiences among nurses. The RN4CAST project provides data on these constructs within a four-level structure (nurse, nursing unit, hospital, and country), implying more complicated multilevel analysis strategies than have been used in previous efforts studying this relationship.
First, to explore and investigate the effect of the nursing unit, hospital, and country level variability on the relationship between dimensions of nurses' work environment and dimensions of burnout. Second, to explore the significance of the nursing unit, hospital, and country level variability among the burnout dimensions.
Data from the RN4CAST project were available from a cross-sectional survey among 23,446 nurses in 2087 nursing units in 352 hospitals in 11 countries.
Nurse-reported information on their work environment (managerial support for nursing, doctor-nurse collegial relations, and promotion of care quality) and burnout experiences (emotional exhaustion, depersonalization and personal accomplishment) were available. We specified ecological measures of the nurse work environment dimensions at the three organizational levels and combined these with individual-level outcomes within a series of multilevel statistical models. The final model was a multivariate multilevel probit model in which we modeled the work environment and burnout dimensions jointly.
Doctor-nurse collegial relations affected all burnout dimensions, but at the unit level only. For the dimension of promotion of care quality, the effect of the ecological exposure on burnout was pronounced at both the nursing unit and the hospital level for all three burnout dimensions. Findings for the dimensions of managerial support for nursing were ambiguous.
Nurse work environment dynamics are related to nurses' burnout experiences at both the nursing unit and the hospital level. This implies that both hospital-wide and unit-specific interventions should be considered to achieve excellent work environments. The correlation structure among the three burnout outcomes varies across countries, but is stable between hospitals within countries and between nursing units within hospitals.
护士的工作环境与护士的倦怠经历有关。RN4CAST 项目提供了这些结构在四级结构（护士、护理单元、医院和国家）中的数据，这意味着比以前研究这种关系的研究需要更复杂的多层次分析策略。
首先，探讨和研究护理单元、医院和国家层面的变异性对护士工作环境维度与倦怠维度之间关系的影响。其次，探讨倦怠维度中护理单元、医院和国家层面变异性的意义。
RN4CAST 项目的数据来自对 11 个国家 352 家医院 2087 个护理单元的 23446 名护士进行的横断面调查。
护士报告了他们的工作环境（护理管理支持、医生-护士同事关系和护理质量促进）和倦怠经历（情绪衰竭、去人性化和个人成就感）。我们确定了三个组织层面护士工作环境维度的生态测量，并在一系列多层次统计模型中结合个体层面的结果。最终模型是一个多变量多层次概率模型，我们在该模型中联合模拟了工作环境和倦怠维度。
医生-护士同事关系影响所有倦怠维度，但仅在单位层面。对于护理质量促进维度，生态暴露对所有三个倦怠维度的倦怠影响在护理单元和医院层面都很明显。护理管理支持维度的结果则不明确。
护士工作环境动态与护士在护理单元和医院层面的倦怠经历有关。这意味着应该考虑在医院范围内和单位特定的干预措施来实现良好的工作环境。三个倦怠结果之间的相关结构在国家之间有所不同，但在国家内的医院之间以及医院内的护理单元之间是稳定的。
