Poor work environments and nurse inexperience are associated with burnout, job dissatisfaction and quality deficits in Japanese hospitals
Poor work environments and nurse inexperience are associated with burnout, job dissatisfaction and quality deficits in Japanese hospitals
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DOI：
10.1111/j.1365-2702.2008.02639.x
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发表时间：
2008-12-01
影响因子：
4.2
通讯作者：
Poghosyan, Lusine
中科院分区：
文献类型：
--
作者：
Kanai-Pak, Masako;Aiken, Linda H.;Poghosyan, Lusine
描述日本医院护士的职业倦怠、工作不满和护理质量，并确定这些结果与工作环境因素的关系。在其他国家，护士职业倦怠和工作不满与护士保留率低和护理质量参差不齐有关，但日本缺乏全面的数据。对日本19家急症医院302个科室5956名护士的横断面调查。向护士提供有关多年经验的信息，完成Maslach倦怠量表，并使用护理工作指数修订报告资源充足性和与医生的工作关系。56%的护士在职业倦怠方面得分很高，60%的护士对自己的工作不满意，59%的护士认为护理质量一般或较差。大约三分之一的人工作经验不足四年，超过三分之二的人工作经验不足10年。只有五分之一的护士表示有足够的注册护士提供高质量的护理，超过一半的人表示护士和医生之间缺乏团队合作。在拥有50%无经验护士的医院中，高倦怠、工作不满和护理质量不公平的几率是拥有20%无经验护士的医院的两倍，而在护士与医生关系不太满意的医院中，高倦怠、工作不满和护理质量不公平的几率高出40%。在人手不足的医院，护士表现出倦怠的可能性比人手充足的医院高50%，不满意的可能性是人手充足医院的两倍，报告护理质量差或质量公平的可能性比人手充足医院的护士高75%。改善护士人员配置和与医生的工作关系可以减少护士倦怠，工作不满和低护士评估的护理质量。在职护士应与主管和医务人员讨论如何在床边留住更多有经验的护士，实施加强临床人员配置的战略，并确定改善护士-医生工作关系的方法。
To describe nurse burnout, job dissatisfaction and quality of care in Japanese hospitals and to determine how these outcomes are associated with work environment factors.Nurse burnout and job dissatisfaction are associated with poor nurse retention and uneven quality of care in other countries but comprehensive data have been lacking on Japan.Cross-sectional survey of 5956 staff nurses on 302 units in 19 acute hospitals in Japan.Nurses were provided information about years of experience, completed the Maslach Burnout Inventory and reported on resource adequacy and working relations with doctors using the Nursing Work Index-Revised.Fifty-six per cent of nurses scored high on burnout, 60% were dissatisfied with their jobs and 59% ranked quality of care as only fair or poor. About one-third had fewer than four years of experience and more than two-thirds had less than 10. Only one in five nurses reported there were enough registered nurses to provide quality care and more than half reported that teamwork between nurses and physicians was lacking. The odds on high burnout, job dissatisfaction and poor-fair quality of care were twice as high in hospitals with 50% inexperienced nurses than with 20% inexperienced nurses and 40% higher in hospitals where nurses had less satisfactory relations with physicians. Nurses in poorly staffed hospitals were 50% more likely to exhibit burnout, twice as likely to be dissatisfied and 75% more likely to report poor or fair quality care than nurses in better staffed hospitals.Improved nurse staffing and working relationships with physicians may reduce nurse burnout, job dissatisfaction and low nurse-assessed quality of care.Staff nurses should engage supervisors and medical staff in discussions about retaining more experienced nurses at the bedside, implementing strategies to enhance clinical staffing and identifying ways to improve nurse-physician working relations.