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.

Purpose: The purpose of this study was to investigate the effect of nurse burnout on nurse-reported quality of care and patient adverse events and outcomes in Thai hospitals. Methods:Cross-sectional analysis of data from 2,084 registered nurses working in 94 community hospitals across Thailand. Data were collected through survey questionnaire, including the Maslach Burnout Inventory (MBI), which measures of nurse perceived quality of care and patient outcomes. Multiple logistic regression modeling was performed to explore associations between nurse burnout on quality of care and patient outcomes. Findings: Thirty-two percent of nurses reported high emotional exhaustion, 18% high depersonalization, and 35% low personal accomplishment. In addition, 16% of nurses rated quality of care on their work unit as fair or poor, 5% reported patient falls, 11% reported medication errors, and 14% reported infections. All three subscales of the MBI were associated with increased reporting of fair or poor quality of care, patient falls, medication errors, and infections. Every unit of increasing emotional exhaustion score was associated with a 2.63 times rise in reporting fair or poor quality of care, a 30% increase in patient falls, a 47% increase in medication errors, and a 32% increase in infection. Conclusions: Findings clearly indicate that nurse burnout is associated with increased odds of reporting negative patient outcomes. Implementing interventions to reduce nurse burnout is critical to improving patient care in Thai hospitals. Clinical Relevance: Hospital administrators, nurse managers, and health leaders urgently need to create favorable work environments supporting nursing practice in order to reduce burnout and improve quality of care.

Our findings add to increasing international evidence that nurses' poor working conditions result in negative outcomes for professionals, patients and health systems. Policymakers need to be aware of the issues regarding nurses' extended work hours, which has been found to contribute to burnout. Urgently, nurse and health administrators need to develop and implement appropriate nursing overtime policies and strategies to help reduce this phenomenon, including measures to overcome the nursing shortage.

The purpose of this descriptive study was to explain the levels of knowledge about and involvement in national health policy development by nurses in Thailand. The study used quantitative and qualitative means to gather data about the topic from two groups of professional nurses: 2121 nurses who worked in hospitals around the country and 26 nurse leaders who were members of steering committees in nursing professional organizations. A self-administered questionnaire and an interview guide regarding knowledge and involvement in national health policy were used for collecting the data. The content validity and reliability of the questionnaire were assured. The results showed that almost two-thirds of the sample had a high level of knowledge about national health policy development but that almost three-quarters of the sample had no involvement in national health policy development. The interviews of the nurse leaders showed that some of them had been involved directly in formulating health policy but most of them thought that they had not been involved directly. The results demonstrated that it is essential that nurses understand and be actively involved in national health policy development.

A growing body of research has shown an association between nurse staffing levels and a range of nurse outcomes. There is little empirical research evaluating this relationship in Thailand. This study evaluated the influence of nurse staffing levels on outcomes among nurses. A cross-sectional survey design was conducted at 92 community hospitals using a stratified random sampling design across Thailand during May and July 2012. Questionnaires included items focusing on nurse staffing levels; job dissatisfaction and emotional exhaustion, both related to nurse retention; and needlestick and sharps injuries. The study sample comprised 1412 registered nurses who provided direct patient care. The findings showed that each additional patient per nurse was associated with an additional 5% of nurses reporting dissatisfaction in their job; 8% of nurses reporting high emotional exhaustion, and 4% of nurses reporting needlestick and sharps injuries. This study provides evidence of how nurse staffing levels result in nurse outcomes. Nurses are significant healthcare providers that directly affect quality of care and patient safety in hospitals. Improvement of nurse staffing levels holds promise for improving nurse outcomes in Thailand.

Patient outcomes are important indicators of the quality of care. Occupancy rate is one factor that significantly affects adverse patient outcomes. The aim of the present study was to determine factors associated with adverse patient outcomes in Thailand. A retrospective study was conducted with 146 inpatient units from 16 general hospitals. Hospital characteristics and adverse patient outcomes were recorded, and data were analyzed by using frequency, percentage, and binomial logistic regression. The results revealed that the average number of beds per hospital was 430.5 (standard deviation [SD] = 108.6), the average number of beds per unit was 27.9 (SD = 8.9), and the average occupancy rate was 81.1% (SD = 20.6, range = 28.8-133.1%). Data were adjusted for hospital size, unit type, and number of beds in each unit; a 1% increase in occupancy rate increased the likelihood of pressure ulcers by 4.3% (P = 0.001), of hospital-acquired pneumonia by 2.4% (P = 0.032), and of hospital-acquired urinary tract infections by 2.1% (P = 0.033). The findings suggest that a higher level of occupancy rates predicted a greater likelihood of adverse patient outcomes.

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