American Jewish Effects of Nurse Work Environment on Job Dissatisfaction Synopsis Draft

American Jewish Effects of Nurse Work Environment on Job Dissatisfaction Synopsis Draft American Jewish Effects of Nurse Work Environment on Job Dissatisfaction Synopsis Draft I’m working on a Nursing exercise and need support. For this activity, you will appraise and summarize a quantitative study located for the PICOT and Literature Search assignment and approved by your instructor to determine its potential usefulness to inform nursing practice. As part of this analysis, you need to determine the rigor of the investigation and appraise credibility. You can do this by answering some key questions about the integrity with which they collected and analyzed data and employed techniques to reduce bias I attached my PICOT question, article and For this activity, Quantitative Appraisal Tool and Synopsis Instructions and Grading Rubric.docx . Can you respond to all of the questions in this file “Quantitative Appraisal Tool and Synopsis Instructions and Grading Rubric.docx” based on article “Effects of nurse work environment on job dissatisfaction, burnout, intention to leave (involved Research Evidence Appraisal Tool ) I attached also sample article “PROPHYLACTIC SACRAL DRESSING FOR PRESSURE ULCER PREVENTION IN HIGH-RISK PATIENTS” that my professor attached and “sample completed synopsis” so you can have an idea how to do it. Please follow grading rubrics write it in APA format, and it has to be at least 2.5-3.5 pages . The table with grading rubric article.pdf my_picot_question.docx quantitative_appraisal_tool_and_synopsis_instructions_and_grading_rubric.docx sample_completed_synopsis.docx article_mark_up_for_sample_synopsis_draft.pdf ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Original Article Effects of nurse work environment on job dissatisfaction, burnout, intention to leave A. Nantsupawat1 RN, PhD, W. Kunaviktikul2 RN, PhD, FAAN, R. Nantsupawat3 RN, PhD, O.-A. Wichaikhum4 RN, PhD, H. Thienthong5 6 RN, PhD & L. Poghosyan RN, MPH, PhD, FAAN 1 Assistant Professor, 2 Professor, 3 Associate Professor, 4 Lecturer, Faculty of Nursing, Chiang Mai University, 5 Nursing Director, Nursing Service Division, Maharaj Nakorn Chiang Mai Hospital, ChiangMai, Thailand, 6 Assistant Professor, School of Nursing, Columbia University, New York, NY, USA NANTSUPAWAT A., KUNAVIKTIKUL W., NANTSUPAWAT R., WICHAIKHUM O.-A., THIENTHONG H. & POGHOSYAN L. (2017) Effects of nurse work environment on job dissatisfaction, burnout, intention to leave. International Nursing Review 64, 91–98 Background: The nursing shortage is a critical issue in many countries. High turnover rates among nurses is contributing to the shortage, and job dissatisfaction, intention to leave, and burnout have been identified as some of the predictors of nurse turnover. A well-established body of evidence demonstrates that the work environment for nurses influences nurse job dissatisfaction, intention to leave, and burnout, but there never has been a study undertaken in Thailand to investigate this relationship. Objectives: To investigate how work environment affects job dissatisfaction, burnout, and intention to leave among nurses in Thailand. Methods: The study used a cross-sectional survey to collect data from 1351 nurses working in 43 inpatient units in five university hospitals across Thailand. The participants completed the Practice Environment Scale of the Nursing Work Index, the Maslach Burnout Inventory, and measures of job dissatisfaction and intention to leave. Logistical regression models assessed the association between work environment and nurse-reported job dissatisfaction, burnout, and intent to leave. Results: Nurses working in university hospitals with better work environments had significantly less job dissatisfaction, intention to leave, and burnout. Conclusion: The nurse work environment is a significant feature contributing to nurse retention in Thai university hospitals. Implications for nursing and health policy: Improving the work environment for nurses may lead to lower levels of job dissatisfaction, intention to leave, and burnout. Focusing on these nurse outcomes can be used as a strategy to retain nurses in the healthcare system. Addressing the challenges of poor work environments requires coordinated action from policymakers and health managers. Keywords: Burnout, Intention to Leave, Job Dissatisfaction, Nurse Work Environment, Nurses, Nursing Policy, Thailand, University Hospitals Correspondence address: Apiradee Nantsupawat, Faculty of Nursing, Chiang Mai University, 110 Inthawaroros road, Sriphum, Chiang Mai 50200, Thailand; Tel: 6653949060; Fax: 6653-217145; E-mail: [email protected] Source of funding Faculty of Nursing, Chiang Mai University, Thailand. Conflict of interest No conflict of interest has been declared by the authors. © 2016 International Council of Nurses 91 92 A. Nantsupawat et al. Introduction The nursing shortage is a significant issue affecting healthcare systems globally. It also severely affects Thailand and can have a detrimental impact on patient care by preventing the healthcare system from providing high-quality safe care to patients. One of the causal factors for the nursing shortage is the high nurse turnover which can be a consequence of poor nurse work environments (Hayes et al. 2012; Kutney-Lee et al. 2013). Researchers have suggested improving nurse work environments as an effective strategy to reduce nurse turnover and improve nurse retention (Van den Heede et al. 2013). In order to develop strategies aimed at addressing the nursing shortage, it is essential to explore the relationship between the work environment and negative nurse outcomes such as job dissatisfaction, intent to leave, and burnout (Chen et al. 2008; Lu et al. 2012; Toren et al. 2012). American Jewish Effects of Nurse Work Environment on Job Dissatisfaction Synopsis Draft This study explored the nurse work environment and how it relates to job dissatisfaction, burnout, and intention to leave within the context of Thai university hospitals. Background Turnover, job dissatisfaction, and burnout are significant negative outcomes affecting the nursing workforce that require immediate attention and interventions by policymakers, managers and clinicians (Bria et al. 2013; Flinkman et al. 2010; Hayes et al. 2012). Nurse turnover has been categorized as either external or internal. According to the International Council of Nurses (2010 cited in Hayes et al. 2012, p. 888), external turnover refers to ‘a numerical value attached to the number of people who leave an organization for various reasons as opposed to internal, which involves job changes within an organization’. Both types of turnover can contribute to the nursing shortage. External turnover might lead to inadequate staffing at the hospital level, whereas internal turnover might leave certain units within the hospital understaffed. Many researchers including Kane et al. (2007), Zhu et al. (2012) and Aiken et al. (2012) have expressed concerns that the nursing shortage adversely impacts the quality of care and patient outcomes. Turnover reduces the quality of care by reducing patient contact time, losing experienced staff and weakening teamwork (Buchan 2010). Job satisfaction has been defined by Spector (1997, p. 2) as ‘the extent to which people like or dislike their jobs’. It can also be described as a related constellation of attitudes on various aspects of the job or as a general feeling about job. The facet approach explores which part of the job produced satisfaction or dissatisfaction as opposed to the global approach, which quantifies the overall attitude of nurses. The job satisfaction of nurses has been shown to affect nurses’ turnover © 2016 International Council of Nurses rate (Lui et al. 2015). Lake (1998) studied the factors predicting nurse turnover in the United States and the findings showed that job satisfaction, intention to stay with or leave the job, and resignation associated with nurse turnover. Another study found that job satisfaction was a substantial predictor of intentions to leave and high job satisfaction reduced turnover among nurses in an academic medical centre (Larrabee et al. 2003; Shader et al. 2001). Burnout is also an important phenomenon affecting the nursing workforce. Maslach et al. (1996, p. 4) defined burnout as a concept comprised of three dimensions: (1) emotional exhaustion – ‘feeling overextended and depleted of one’s emotional resources’; (2) depersonalization – ‘negative, cynical, detached and impersonal attitudes and feelings towards patients’; and (3) lack of personal accomplishment – ‘a decline of feelings of competence and successful achievement in one’s work’. Burnout can happen among individuals who work directly with people that need attention and support during a period of crisis. International work demonstrates that nurses in many countries experience high levels of burnout (Aiken et al. 2012). Notably, burnout is a serious issue leading to job turnover and absenteeism (Maslach et al. 1996) and turnover intentions among medical professionals (Bria et al. 2013). Although this study focused on turnover intentions, it is important to indicate that intentions are the most direct determinants of actual behaviour (Ajzen & Fishbein 1980; Igbaria & Greenhaus 1992). Intention to leave a job is defined as a person’s stated intention to leave the organization within some specific period of time (Dollar & Broach 2006). Nurses’ intention to leave has been established to forecast the actual decision to leave their profession (Flinkman et al. 2010). The actual leaving behaviour is the major concern for nurse managers. A study conducted by Murrells et al. (2008) found that intentions expressed by nurses are strong predictors of turnover rate and suggest ascertaining nurses displaying early signals of leaving. Improving work environments has been recommended as an effective strategy of solving the nursing shortage through promoting nurse job satisfaction and reducing burnout and nurses’ intentions to leave their job. According to Tregunno (2004), ‘work environment’ refers to the perception workers have regarding elements of the organization. American Jewish Effects of Nurse Work Environment on Job Dissatisfaction Synopsis Draft It has been acknowledged as a foundational place to shape the person’s behaviour, and also mirrored the character of a setting or organization. In 2002, p. 178, Lake defined nurse work environment as ‘the organizational characteristics of a work setting that facilitate or constrain professional nursing practice’. She further explained that these characteristics are influenced by managerial support for nursing, nurse participation in hospital affairs, promotion of care quality, staffing and resource adequacy and Nurse work environment and nurse outcomes doctor–nurse relations. Many international studies have been conducted to investigate nurse work environments in various healthcare settings, and results from these studies have illuminated how the nurse work environment affects nurse turnover (Aiken et al. 2012; El-Jardali et al. 2009; Mainz et al. 2015). Researchers have concluded that a better nurse work environment decreases the level of job dissatisfaction (Unruh & Zhang 2013; Van Bogaert et al. 2013; You et al. 2013), burnout (Li et al. 2013; Patrician et al. 2010; You et al. 2013) and intention to leave (Aiken et al. 2011; Coetzee et al. 2013; Van den Heede et al. 2013). Therefore, improving nurse work environment may be an effective method to address nursing shortage. Nursing shortage is a priority workforce problem in Thai hospitals (Srisuphan & Sawangdee 2012), especially in university hospitals, which are public hospitals under the authority of the Ministry of Education. They combine the services of a hospital with research and the education of healthcare students. University hospitals care for patients who have complex conditions and take on referrals from area secondary and primary care hospitals. These hospitals employ numerous interdisciplinary specialists with expertise in medical fields and are equipped with advanced technologies. However, these hospitals face major nurse turnover, and hospital managers struggle to retain existing nurses (Jaiboon et al. 2011; Jeawkok et al. 2015; Khunthar et al. 2013). To develop optimal ways to alleviate the nursing shortage, a better understanding of the effects of nurse work environments on job dissatisfaction, intent to leave job and burnout is needed. However, there is very little information about the work environment in Thai hospitals. The aim of this study was to investigate the nurse work environment in Thai university hospitals and how nurse work environment affects job dissatisfaction, intention to leave and burnout among these nurses. Methods Conceptual framework This study was guided by the Quality Health Outcomes Model (QHOM) (Mitchell et al. 1998), which was developed by modifying Donabedian’s (1966) quality of care model that demonstrates a linear relationship between structure, process and outcomes. According to the QHOM, the nurse practice environment is acknowledged as a structural factor that is closely associated with nurse outcomes. In this study, the outcomes were nurse job dissatisfaction, turnover and burnout. Design A cross-sectional survey design was applied to collect data with questionnaires. © 2016 International Council of Nurses 93 Sample Stratified sampling was used to randomly select among all hospitals in the country. Purposive sampling was used to select work units within each hospital. Nurses in the sampled units were invited to participate in the study. Participants included inpatient nurses with at least 2 years of bedside experience. Nurse managers were excluded from the study because of the differences in their job duties from that of bedside nurses. The questionnaires were distributed to 1,750 nurses and 1,450 nurses returned the questionnaires (82.86% response rate). Ultimately, 43 units were sampled from five participating hospitals, and 1351 questionnaires were filled out completely and were used in this study. American Jewish Effects of Nurse Work Environment on Job Dissatisfaction Synopsis Draft There were on average 30 responses from each nursing unit, which is a sufficient sample size for creating unit-level nurse-assessed variables (Aiken et al. 2011). Measurements Nurse work environment was measured with Lake’s Practice Environment Scale of the Nursing Work Index (PES-NWI). The PES-NWI is a validated instrument often used in international studies to measure the work environment of nurses (Aiken et al. 2011; Warshawsky & Havens 2011). Aiken et al. (2012) established the predictive and discriminant validity of the PES-NWI as it relates to nursing job outcomes. The validity of this index has been established in many international settings and used to differentiate work environments with different qualities. The PES-NWI was translated in Thai, and the translation was validated and verified by experts. The PESNWI consists of 31 items grouped in the following five subscales: (1) Nurse Participation in Hospital Affairs (nine items); (2) Nurse Manager Ability, Leadership, and Support of Nurses (five items); (3) Nurse Foundations for Quality of Care (ten items); (4) Collegial Nurse–Physician Relations (three items) and (5) Staffing and Resource Adequacy (four items; Lake 2002). The internal consistency reliability of each PES-NWI subscale, translated to Thai, has been established with Cronbach’s alphas ranging from 0.85 to 0.91 (Nantsupawat et al. 2011). Nurses rated each item on PES-NWI on a four-point Likert scale ranging from ‘strongly disagree’ (1) to ‘strongly agree’ (4). The higher scores show that nurses perceived that the organizational features were presented in their current job. The PES-NWI composite score was created by aggregating individual nurse-level responses with the unit level and then calculating the mean of the subscale means. Work environment were classified in three categories based on the PES-NWI composite score: worse (<25th percentile), mixed (25th–75th percentiles), or better (>75th percentile) (Aiken et al. 2008). 94 A. Nantsupawat et al. Job dissatisfaction was measured by asking nurses to rate how satisfied they were with their current job. Nurses were considered to be dissatisfied with their job if they reported being ‘very dissatisfied’ or ‘moderately dissatisfied’, as compared to nurses who reported being ‘somewhat satisfied’ or ‘very satisfied’ with their current job. Prior research has confirmed the validity and reliability of single-item measures, which are generally used when determining global job satisfaction (Wanous et al. 1997). Intention to leave was assessed by asking nurses to report whether they intended to leave their present nursing position in a year. Nurses’ intentions of leaving their job predicted the actual decision to leave the profession (Flinkman et al. 2010). Burnout was measured using the Emotional Exhaustion subscale of the Maslach Burnout Inventory, a widely used standardized tool with excellent psychometric properties to measure nurse burnout internationally (Poghosyan et al. 2009). The reliability and validity of the MBI subscales have been well established by Maslach & Jackson (1986). This study used the Thai version of the MBI-HSS translated by Mind Garden, Inc. Published internal consistency coefficients (Cronbach’s a) for the EE subscale in Thailand was 0.87 (Nantsupawat et al. 2011). Developed by Maslach et al. (1996), the emotional exhaustion subscale consisted of nine items that ask nurses to respond on each item on the subscale using a 7-point Likert-type scale which ranged from 0 = never to 6 = every day. Respondents with a total score of 27 or above on this nine-item subscale exceeded norms of burnout for healthcare workers and were considered to have high burnout. Ethical considerations The study was approved by the Chiang Mai University Faculty of Nursing Research Ethics Committee (approval – EXP: 016-2014) and the ethics committee of each hospital. All participants gave informed consent prior to study participation, and their anonymity was preserved. The questionnaires were coded to classify hospitals and units without identifying individuals who completed the questionnaires. Data collection The questionnaires were sent to staff in each hospital’s quality and accreditation development divisions. The division staff assisted the research team with the data collection. The staff dispersed the questionnaires to the registered nurses (RNs), in person, who met inclusion criteria in the selected units. Nurses returned the completed questionnaires in a sealed envelope to hospital staff and then staff provided completed questionnaires to the research team via mail. © 2016 International Council of Nurses Data analysis Descriptive statistics were computed on the participants’ demographic variables. American Jewish Effects of Nurse Work Environment on Job Dissatisfaction Synopsis Draft Unadjusted and adjusted logistic regression models, which accounted for the clustering of nurses within their hospitals and units, were used to predict the relationship between nurse work environment and job dissatisfaction, burnout and intention to leave. The adjusted models controlled for nurse characteristics including age, education, years as RN, and working unit. Stata statistical software (StataCorp LP College Station, Texas) version 10.1 was used to analyse the data. Results Participants’ demographics are presented in Table 1. Almost all participants were female (97%) with an average age of 34 years old. The majority of participants held bachelor’s degrees (87%). The majority of participants had 11 years of experience working as registered nurses and had been in their Table 1 Demographic characteristics (n = 1351) Demographic characteristics Age, Mean (SD), year 22–30 31–40 41–50 51–60 Gender Male Female Educational level Bachelor’s degree Master’s degree or higher Working Unit Medical Surgical Paediatrics Orthopaedic OB&GYN Critical care Private unit OR/recovery room Other Years registered as registered nurse, mean (SD), year Years working in the present unit, mean (SD), year Nurses reporting very dissatisfied ‘and ‘moderately dissatisfied’ Nurses reporting intent to leave their job in 6 and 12 months Nurses reporting high emotional exhaustion All respondents 34 564 313 225 76 (0.27) (47.88%) (26.57%) (19.1%) (6.45%) 35 (2.58%) 1320 (97.42%) 1178 (87.32%) 171 (12.68%) 116 153 125 93 160 183 150 177 179 11.4 9.5 226 (8.68%) (11.45%) (9.36%) (6.96%) (11.98%) (13.70%) (11.23%) (13.25%) (13.40%) (0.25) (0.21) (16.86%) 139 (10.37%) 689 (51.00%) Nurse work environment and nurse outcomes 95 current unit for about 10 years. Approximately one in six nurses (17%) reported being dissatisfied with their job, and one in ten (10%) expressed intent to quit their job within a year. Around half of the participants (51%) had high burnout. Subscale scores for the PES-NWI and classified work environment are presented in Table 2. The composite score, the mean of 5 PES-NWI subscales, is 2.91. The Nurse Foundations for Quality of Care subscale had the highest mean score (3.23). The subscale with the lowest mean scores was the Staffing Resources and Adequacy (2.56). Of the 43 units, 16 units were categorized as good and seven units were Table 2 Subscale scores for the PES-NWI* and classified work environment Variables No (%) Subscale scores for the PES-NWI Nurse foundations for quality of care Nurse participation in hospital affairs Nurse manager ability, leadership, and support Collegial nurse–physician relations Staffing resource and adequacy Composite score Classified work environment Best Mixed Poor Mean (SD) Range 3.23 (0.13) 2.80–3.48 2.79 (0.19) … Purchase answer to see full attachment Student has agreed that all tutoring, explanations, and answers provided by the tutor will be used to help in the learning process and in accordance with Studypool’s honor code & terms of service . Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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