Predictors of burnout, work engagement and nurse reported job outcomes and quality of care: a mixed method study

Abstract

BackgroundHigh levels of work-related stress, burnout, job dissatisfaction, and poor health are common within the nursing profession. A comprehensive understanding of nurses’ psychosocial work environment is necessary to respond to complex patients’ needs. The aims of this study were threefold: (1) To retest and confirm two structural equation models exploring associations between practice environment and work characteristics as predictors of burnout (model 1) and engagement (model 2) as well as nurse-reported job outcome and quality of care; (2) To study staff nurses’ and nurse managers’ perceptions and experiences of staff nurses’ workload; (3) To explain and interpret the two models by using the qualitative study findings.MethodThis mixed method study is based on an explanatory sequential study design. We first performed a cross-sectional survey design in two large acute care university hospitals. Secondly, we conducted individual semi-structured interviews with staff nurses and nurse managers assigned to medical or surgical units in one of the study hospitals. Study data was collected between September 2014 and June 2015. Finally, qualitative study results assisted in explaining and interpreting the findings of the two models.ResultsThe two models with burnout and engagement as mediating outcome variables fitted sufficiently to the data. Nurse-reported job outcomes and quality of care explained variances between 52 and 62%. Nurse management at the unit level and workload had a direct impact on outcome variables with explained variances between 23 and 36% and between 12 and 17%, respectively. Personal accomplishment and depersonalization had an explained variance on job outcomes of 23% and vigor of 20%. Burnout and engagement had a less relevant direct impact on quality of care (≤5%). The qualitative study revealed various themes such as organisation of daily practice and work conditions; interdisciplinary collaboration, communication and teamwork; staff nurse personal characteristics and competencies; patient centeredness, quality and patient safety. Respondents’ statements corresponded closely to the models’ associations.ConclusionA deep understanding of various associations and impacts on studied outcome variables such as risk factors and protective factors was gained through the retested models and the interviews with the study participants. Besides the softer work characteristics — such as decision latitude, social capital and team cohesion — more insight and knowledge of the hard work characteristic workload is essential.

Intensive care unit organisation and nurse outcomes: A cross-sectional study of traditional and “hot-floor” structures

“…[69][70][71] The presence of a nurse manager who is visible and communicates effectively, strengthens the organisational structure and protects the work environment reducing the risks associated with burnout. [27,72] A potentially positive influence of the hot-floor model was in relation to nurses being less likely to be redeployed to external wards on a short-term shift-by-shift basis than those in the conventional ICU. Intensive care nurses possess a broad range of skills applicable to complex patients in a majority of clinical specialties, and as such are highly mobile across the hospital.…”

“…[23][24][25] Modified structural factors may exacerbate management challenges, degrade the work environment and increase nurse dissatisfaction, burnout and turnover. [26][27][28] Organisational, emotional and professional factors have long been recognised as contributing factors to burnout in ICU and are increasingly being acknowledged by critical care societies internationally. [29,30] Nurse outcomes such as satisfaction, retention and burnout have been investigated extensively in acute care environments.…”

Métodos Mistos Na Pesquisa Em Enfermagem: Possibilidades De Aplicação À Luz De Creswell

“…In a later qualitative stage, i.e., in a (QUAN-qual) sequencing stage, the referred research deepened the interpretation of the findings through qualitative research techniques, demonstrating a relationship between previous numerical results. 11 Another research from Belgian-based scholars, 12 which clearly cited the sequential explanatory design (QUAN-qual) guided by Creswell's reference, focused on important aspects related to the health of hospital nursing workers, such as burnout, job satisfaction, work environment, among others, through a primary cross-sectional study of the survey type with a large sample (n=751) of professionals, using its own measurement scales for the research subjects andself-completed questionnaire data collection techniques. Subsequently, the researchers extended the statistical knowledge through semi-structured qualitative interviews with a sample (n = 19) of nursing assistants and managers, using a construction interview model guided by the primary quantitative stage.…”

“…Subsequently, the researchers extended the statistical knowledge through semi-structured qualitative interviews with a sample (n = 19) of nursing assistants and managers, using a construction interview model guided by the primary quantitative stage. 12 The sequential exploratory strategy involves a first phase of qualitative data collection and analysis (QUAL), followed by a second phase with the same procedures on quantitative data (quan). 9 The greater weight is generally attributed to the first step.…”

“…7,9 Although recent in the nursing area, mixed methods have potentialities that can add greater accuracy to the interpretations/inferences of the researches about their scope, i.e., care in different perspectives. 8,[10][11][12][13] . This is because the employability of a study based on the mixed approach incurs the search for more in-depth inferences about the research phenomenon, known as metainferences.…”