Grandfield Elizabeth M, Schlotzhauer Ann E, Cramer Emily, Warshawsky Nora E
Department of Methodology and Statistics, Utrecht University, Utrecht, Netherlands.
University of Central Florida, Orlando, Florida, USA.
Res Nurs Health. 2023 Jun;46(3):348-359. doi: 10.1002/nur.22307. Epub 2023 Apr 3.
The importance of nurse managers' practice environments in affecting outcomes for direct care nurses and patients has been well-researched. Nonetheless, much remains to be learned about the determinants of the nurse manager practice environment. In this study, 541 US nurse managers' survey responses were matched to unit-level aggregate data of their subordinates' responses on the National Database of Nursing Quality Indicators. A model relating job design and experience to the nurse manager's practice environment and direct care nurse (i.e., job satisfaction, intent to stay, and joy and meaning in work) and patient outcomes (i.e., nurse-reported quality of care and missed nursing care) was evaluated through multilevel path analysis. Nurse manager span of control, support staff, and experience influence nurse managers' perceptions of their practice environment and nurse and patient outcomes. Although support staff can offset some negative effects of wide spans of control, it does not fully compensate for wide spans. Thus, nurse manager job design factors and experience relate to nurse manager practice environments and valued downstream outcomes. The present research emphasizes the importance of a positive nurse manager practice environment and provides guidance for nurse manager hiring and job design decisions.
护士长的执业环境对直接护理护士和患者的影响已得到充分研究。尽管如此，关于护士长执业环境的决定因素仍有许多有待了解。在本研究中，541名美国护士长的调查回复与他们下属在国家护理质量指标数据库中的回复的单位层面汇总数据相匹配。通过多层次路径分析评估了一个将工作设计和经验与护士长的执业环境、直接护理护士（即工作满意度、留任意向以及工作中的快乐和意义）和患者结局（即护士报告的护理质量和遗漏的护理）相关联的模型。护士长的控制范围、辅助人员和经验会影响护士长对其执业环境以及护士和患者结局的认知。虽然辅助人员可以抵消控制范围过广带来的一些负面影响，但并不能完全弥补控制范围过广的问题。因此，护士长的工作设计因素和经验与护士长的执业环境及有价值的下游结局相关。本研究强调了积极的护士长执业环境的重要性，并为护士长招聘和工作设计决策提供了指导。
