Nurses' work environment and job satisfaction

Abstract

Background. Transforming nurses' work environment has become a concern for nurses, hospital administrators, policy makers, and consumers. Magnet Hospital accreditation is increasingly recognized as a symbol of hospitals that promote a positive nursing work environment which supports quality patient care and nurse satisfaction. While research from nursing, organizational, patient safety, and occupational health perspectives has examined many work environment factors, no research has simultaneously examined the effect of Magnet hospital attributes and occupational health models on nurse satisfaction. Purposes. (1) explore the relative influence of the Magnet hospital attributes and psychosocial work environment models on nurses' job satisfaction, and (2) identify the potential moderation effects of occupational health models. Methods. Using a cross-sectional design, the study examined baseline data from the European Nurses Early Exit (NEXT) Study, a multi-country study of nurses' work conditions and turnover conducted between 2002 and 2005. Registered staff nurses working in acute care settings from 31 hospitals in Belgium and Germany (N=3182) were studied. Measurement models were established using structural equation modeling and a multilevel approach that accounts for the nesting of nurses within hospitals. Magnet hospital attributes [MH] and job satisfaction [JS] were modeled as latent factors and demand-control-support [DCS] and effort-reward imbalance [ERI] were modeled as latent classes. Analysis was conducted with Mplus 4.21 and SPSS 12.0. Results. Consistent with findings in other countries, about 70% of these European hospital nurses reported high job demand and 40% reported high job strain. Variation in satisfaction was significantly explained by most MH attributes. At the individual level, personnel policies (primarily representing pay and organizational support) had the strongest influence on satisfaction. At the hospital level, management style had the strongest influence. When the occupational health models (DCS and ERI) and MH models were examined simultaneously, no moderation effects were found. The main effect of ERI had the strongest influence on JS as compared to DCS and MH, supporting the imbalance between nurses high work demands (effort) and control and support (reward). Conclusion. While the Magnet hospital attributes evolved in the U.S., they are relevant to European hospital nursing practice in Belgium and Germany. Likewise, these hospital nurses face high demands and experience high job strain, which must be addressed by nursing leaders and hospital administrators. Hospital nurse environment research must use multilevel modeling to better isolate the effects at the individual, work group, and hospital level.