Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, USA.
Int J Nurs Stud. 2013 Feb;50(2):195-201. doi: 10.1016/j.ijnurstu.2012.07.014. Epub 2012 Aug 14.
One strategy proposed to alleviate nursing shortages is the promotion of organizational efforts that will improve nurse recruitment and retention. Cross-sectional studies have shown that the quality of the nurse work environment is associated with nurse outcomes related to retention, but there have been very few longitudinal studies undertaken to examine this relationship.
To demonstrate how rates of burnout, intention to leave, and job dissatisfaction changed in a panel of hospitals over time, and to explore whether these outcomes were associated with changes in nurse work environments.
A retrospective, two-stage panel design was chosen for this study. Survey data collected from large random samples of registered nurses employed in Pennsylvania hospitals in 1999 and 2006 were used to derive hospital-level rates of burnout, intention to leave current position, and job dissatisfaction, and to classify the quality of nurses' work environments at both points in time. A two-period difference model was used to estimate the dependence of changes in rates of nurse burnout, intention to leave, and job dissatisfaction on changes in nurse work environments between 1999 and 2006 in 137 hospitals, accounting for concurrent changes in nurse staffing levels.
In general, nurse outcomes improved between 1999 and 2006, with fewer nurses reporting burnout, intention to leave, and job dissatisfaction in 2006 as compared to 1999. Our difference models showed that improvements in work environment had a strong negative association with changes in rates of burnout (β=-6.42%, p<0.01) intention to leave (β=-4.10%, p<0.01), and job dissatisfaction (β=-8.00%, p<0.01).
Improvements in nurse work environments over time are associated with lower rates of nurse burnout, intention to leave current position, and job dissatisfaction.
缓解护理人员短缺的策略之一是促进组织努力，以改善护士招聘和留用。横断面研究表明，护士工作环境的质量与与留用相关的护士结局有关，但很少有进行过纵向研究来检验这种关系。
展示在一段时间内，一组医院中倦怠、离职意向和工作不满的发生率如何变化，并探讨这些结果是否与护士工作环境的变化有关。
本研究选择了回顾性两阶段面板设计。1999 年和 2006 年从宾夕法尼亚州医院雇用的大量随机注册护士的调查数据用于得出医院层面的倦怠率、离开当前职位的意向率和工作不满率，并在这两个时间点对护士工作环境的质量进行分类。使用两期差值模型来估计在 137 家医院中，1999 年至 2006 年间护士工作环境变化对护士倦怠率、离职意向率和工作不满率变化的依赖性，同时考虑到护士人员配备水平的同期变化。
一般来说，1999 年至 2006 年间，护士的结果有所改善，与 1999 年相比，2006 年报告倦怠、离职意向和工作不满的护士人数减少。我们的差异模型表明，工作环境的改善与倦怠率（β=-6.42%，p<0.01）、离职意向率（β=-4.10%，p<0.01）和工作不满率（β=-8.00%，p<0.01）的变化呈强烈负相关。
随着时间的推移，护士工作环境的改善与护士倦怠率、离职意向率和工作不满率的降低有关。
