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.

Globally nurses and midwives are working hard to detect cases of COVID‐19, to save lives or give comfort in the face of death, to educate themselves and the public about protective measures to stop the viral spread, while still caring for those not infected with the virus. In many countries nurses are working under virtual siege from this pandemic, with not enough resources or personal protective equipment, overwhelming numbers of patients, staff shortages, underprepared health systems and supply chain failures. Nurses and other health and emergency workers are suffering physical and emotional stress, and moral distress from conflicting professional values. They are faced with unpalatable and complex ethical issues in practice, with moral conflicts, high levels of acuity and patient deaths, and long working hours. A rising number of nurses are infected with SARS‐CoV‐2 or dying in the line of duty. Nurses need strong moral courage, stamina and resilience to work on the front lines of the pandemic, often while separated from their loved ones.

This article presents the derivation of moral competence in nursing practice by identifying its attributes founded on Thai culture. In this process moral competence is formed and based on the Thai nursing value system, including personal, social and professional values. It is then defined and its three dimensions (moral perception, judgment and behavior) are also identified. Additionally, eight attributes as indicators of moral competence are identified and selected from three basic values. The eight attributes are loving kindness, compassion, sympathetic joy, equanimity, responsibility, discipline, honesty, and respect for human values, dignity and rights. All attributes are discussed by addressing the three moral dimensions in order to present how to deal with ethical issues in nursing practice. As a summary, a model of moral competence is presented to demonstrate moral competence in nursing practice in Thailand.

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.

Nurses should work with management and policymakers to achieve safe staffing levels and good work environments in hospitals throughout the world.

A quasi-experimental, two-group pretest-post-test design was conducted to examine the effect of problem-based learning on the critical thinking skills of 46 Year 2 undergraduate nursing students in the People's Republic of China. The California Critical Thinking Skills Test Form A, Chinese-Taiwanese version was used as both a pretest and as a post-test for a semester-long nursing course. There was no significant difference in critical thinking skills at pretest, whereas, significant differences in critical thinking skills existed between the problem-based learning and lecture groups at post-test. The problem-based learning students had a significantly greater improvement on the overall California Critical Thinking Skills Test, analysis, and induction subscale scores compared with the lecture students. Problem-based learning fostered nursing students' critical thinking skills.

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.

Factors predicting fatigue in Chinese nurses were examined in a descriptive, correlational study. The participants were 581 nurses working in general hospitals in Chengdu City, China. The study instruments included the Occupational Fatigue Exhaustion Recovery Scale, the Job Content Questionnaire, the Exposure to Hazards in Hospital Work Environments Scale, the Pittsburgh Sleep Quality Index, the Job Dissatisfaction Scale, the Beck Anxiety Inventory, and the Beck Depression Inventory. The data were analyzed by using descriptive statistics, Pearson's correlation, F statistics, and multiple regression. The findings revealed that 61.7% of the variance in chronic fatigue and 54.9% of the variance in acute fatigue were explained by the independent variables. Intershift recovery was the most important variable in the explanation of acute fatigue, while acute fatigue was the most important variable in the explanation of chronic fatigue. Different intervention strategies should be implemented regarding the different influencing factors of acute and chronic fatigue.