| Abstract |
The study of favourability in the hospital work environment is of high research value for gauging employee satisfaction. The feeling of job satisfaction would not be so important to researchers and public health professionals if it were not the reason for various significant impacts. These impacts directly affect safety and quality in patient care, as well as the health and performance of the professionals providing it. Work environment favourability is directly correlated to the satisfaction it offers and, correspondingly, with the level of patient care quality and safety.
The Practice Environment Scale (PES) has been identified by the most reputable organizations for the promotion of quality in health care as the most appropriate research tool in evaluating the Work Environment globally. This research field has attracted the attention of researchers from many countries, as a multitude of studies prove the impact of the organizational characteristics of the Nursing Practice Environment (NPE) on work outcomes for both patients and nursing staff. In Greece this field is still in its infancy, with only two reference studies. These studies used the PES-NWI tool to study hospitals in north and central Greece, while the present study covers the south of the country.
The study had two main aims. The first is to evaluate the magnetism of the Nursing Practice Environment in five public hospitals in Greece, classifying them as favourable, mixed or unfavourable and comparing them to Magnet or non-Magnet hospitals in the US. The second aim is to investigate the factors affecting nurses’ perceptions of their work environments in public hospitals in Crete, and specifically the influence of the work department (surgical or medical) and the effect of nurses’ educational level and professional experience, and to examine models for the evaluation of the nursing environment as the result of a series of factors.
The present study is a Cross Sectional Study designed as an exploratory analysis, conducted in five public hospitals in Crete, Greece. The hospitals under study are four general hospitals and one university hospital offering tertiary care. All include surgical, medical, psychiatric and intensive care units. The target population of the study was nurses and nursing assistants (1,607 in total) permanently employed in all units of the five hospitals. Only permanent-contract clinical nursing staff were covered, while nurses in administration, on leave and head nurses were excluded. The survey was conducted in 2011–2012 and had a response rate of 33.1% (a convenience sample of 532 staff members). The staff in all hospitals were approached at least four different times. All participants completed the self-administered questionnaire on site, anonymously and confidentially, after being informed about the aim of the research and giving their oral consent. The questionnaires were distributed and collected by the chief nurse of each unit. The study used the four-point Likert-type 32-item PES-NWI, modified by adding one additional item from the 31-item PES-NWI (Lake, 2002). A set of demographic and employment-related questions were also included to assess nurses’ characteristics (age, gender, family status, educational level, specialization in nursing, years of nursing experience and current nursing domain).
The PES-NWI research tool consists of five subscales, each representing an organizational sector of the hospital under study and consisting of 32 questions. The subscales are: Nurse Participation in Hospital Affairs; Nursing Foundations for Quality of Care); Nurse Manager Ability, Leadership and Support of Nurses; Staffing and Resource Adequacy; and Collegial Nurse-Physician Relations. Overall Cronbach’s a was .90, ranging from .60 to .88 for the five subscales.
Data were analyzed using the SPSS 19 statistical software package (IBM Corporation), applying descriptive statistics, non-parametric Chi-square test, two-way t-test, Spearman’s correlations and linear regression coefficients.
The study results showed that nurses in all the hospitals under study perceive their work environments as unfavourable, the only positive organizational factor being Collegial Nurse-Physician Relations. The least favourable organizational trait was Staffing and Resource Adequacy. The magnetism level of Greek hospital was evaluated as lower than that of US non-Magnet hospitals and even lower than US Magnet hospitals. Surgical departments appeared to be slightly more positive work environments than medical departments. Nurses’ perceptions of management, poor care quality, limited nurse involvement in hospital affairs and nursing shortage were affected in some cases by their education and experience levels, independent of work department. Linear regression analysis showed that the total PES-NWI scale is affected by gender, educational level, years of experience in the current department, specialization of certified nurses, and the hospital in which the nurses work.
These findings show a low level of favourability in the work environments under study and are in accordance with those of the previous two studies in Greek hospitals concerning the perceived favourability of the Nursing Practice Environment.
The five public hospitals evaluated are under unified healthcare administration (7th Health Region of Crete) and face low nurse staffing levels, confirming Greece’s high ranking in nursing shortages. This negative organizational characteristic leads to many problems in patient safety management and the provision of quality health care.
Lack of funding combined with stationary levels of nurse education and unclear delimitation of their professional duties have a negative impact on nurses’ day-to-day work. Lack of management support, limited nurse involvement in hospital strategy policies and limited involvement in formulating quality plans make up the picture of nurses’ current position in Greek hospitals, as basic health care providers.
The positive impact of collegial nurse-physician relations counterbalances nurses’ dissatisfaction, while the favorability of the surgical department compared the medical department requires further study. The critical points of the evaluation research field should also be investigated in order to create correction and improvement policies. Nursing resources play a catalytic role in this direction, with the provision of continuing education and nurses’ participation in strategies to formulate quality plans and policy decisions concerning them, and with the assistance of hospital management.
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