Вы находитесь на странице: 1из 20

HEALTH SCIENCE JOURNAL VOLUME 8 (2014),ISSUE 3

SYSTEMATIC REVIEW Results: The results document evidence of the


effect of Professional Practice Environment (PPE)
Nurses’ perceptions of their on job satisfaction, burnout and intention to
leave. The PPE was correlated to the nurses’
professional practice ratings of the quality of nursing care. Nurse
environment in relation to job staffing levels and nurse-physician relations were
also correlated with job satisfaction.
satisfaction: a review of Conclusions: Hospital officials and decision makers
need to work towards the implementation of a
quantitative studies Positive Professional Environment so that the
professionals’ job satisfaction is secured at the
Persefoni Lambrou1, Anastasios Merkouris2, Nicos
highest possible level, particularly in this current
Middleton3 , Evridiki Papastavrou3
and worsening world financial crisis.
1. DDS, PhD(c), Department of Nursing, Cyprus
University of Technology Keywords: Professional practice environment,
2. RN, PhD, Associate Professor - Department of nurses, physicians, job satisfaction
Nursing, Dean of the School of Sciences of the
Corresponding author: Lambrou Persefoni, 25 Andreas
Cyprus University of Technology Zisimopoulos str., 2402, Nicosia, Cyprus,
3. PhD statistics, Assistant Professor , Email:persoula@cytanet.com.cy
Department of Nursing, Cyprus University of
Technology Introduction
4. RN, PhD, Assistant Professor , Department of
Under the Lisbon strategy1 the European Union
Nursing, Cyprus University of Technology
(EU) Member States have acknowledged the
Abstract major contribution that guaranteeing quality and
Aims: This systematic review aims at exploring the productivity at work can play a major role in
impact of the professional practice environment promoting economic growth and employment.
on nurses’ job satisfaction. Furthermore, the World Health Organization
Background: A growing body of research has (WHO)2 indicates that the work environment
documented an association between the quality constitutes an important factor in the recruitment
of nursing professional practice environments and and retention of health professionals, and the
nurse satisfaction, patient satisfaction and quality characteristics of the work environment affect the
of care. quality of care both directly and indirectly.
Method: Fourteen studies were identified through Addressing the work environment, therefore,
a systematic search of the literature. Eligibility plays a critical role in ensuring both the supply of
criteria included only quantitative studies that a health workforce as well as the enhancement,
examined factors correlating the nursing effectiveness and motivation of that workforce.
professional practice environment and job In the EU, improvement of the quality of work has
satisfaction. Quality assessments were completed been an integrative part of the European Social
on all studies according to predefined criteria. Agenda and the European Employment Guidelines
Data extraction and analysis of the studies since 2000. The Positive Practice Campaign3 jointly
examined revealed three main areas: correlations launched by several international health-
of the professional practice environment and professional associations, describes characteristics
nurses’ job satisfaction; resource adequacy; and of work environments that ensure the health,
quality of care. safety and well-being of staff, while

E-ISSN:1791-809x │hsj.gr Published by Department of Nursing , Technological Educational Institute of Athens


P a g e | 298
VOLUME 8 (2014),ISSUE 3 HEALTH SCIENCE JOURNAL

simultaneously supporting high-quality patient quality care, nurses’ job satisfaction and hence
care. The International Council of Nurses and their retention.10, 11 Improving the practice
other affiliated organizations suggest that, due to environment, including patient to nurse ratios
today’s global health workforce crisis, establishing holds promise for retaining a qualified and
positive practice environments across health committed nurse workforce, reducing the rates of
sectors worldwide is of paramount importance if nurse burnout and job dissatisfaction and
patient safety and health workers’ wellbeing are benefiting patients in terms of better quality
to be guaranteed. The complex social care.7 Nurses’ perceptions of their professional
environment where nurses carry out their environment influence their job satisfaction.
practice, and where there is a continuous need for Traditional job satisfaction relates to the feeling
health-care workers to make decisions an individual has about his/her job. It is affected
individually, as a group and together with by intrinsic (recognition, work itself or
patients, is called the professional practice responsibility) and extrinsic factors (working
environment.2 A nursing practice environment conditions, company policy or salary), which have
refers to the organizational characteristics of a an influence on job satisfaction.12 Inadequate
work setting that facilitates or constrains hospital nurse staffing contribute to uneven
professional nursing practice.2 Furthermore, there quality of care, medical errors, and adverse
are two similar general terms, “working patient outcomes.13
environment” and “working conditions”, but there
is no agreed definition of these terms. Job satisfaction can be defined as an
Nevertheless, the working environment generally employee’s affective reaction to a job, based on
could be described as the place, conditions and comparing actual outcomes with desired
surrounding influences in which people carry out outcomes and is a multifaceted construct inclusive
an activity. In the case of health care it refers to a of both intrinsic and extrinsic job factors. Extrinsic
set of concrete or abstract features of an factors include tangible aspects of the work like
organization, related to both the structures and salary and benefits while intrinsic factors include
processes in that organization that are perceived personal and professional development
7
by nurses as either facilitating or constraining opportunities and recognition. Hospitals with
their professional practice. 4-8 A healthy practice poorer staffing and less adequate resources tend
environment can be defined as a work setting to appear with higher levels of nurses’
where policies, procedures and systems are dissatisfaction and poorer quality patient care.14
designed in such a manner that they meet the Nurses in Chinese hospitals with better work
organizational objectives and succeed in personal environments had lower odds
satisfaction at work. 7 The theoretical foundation of job dissatisfaction and of reporting poor or fair
of the professional practice environment is quality patient care and patients in such hospitals
predicated on collaborative decision-making to were more likely to be satisfied with nursing
ensure that all stakeholders have the opportunity communications, and to recommend their
to knowingly participate in change. 9 hospitals.14 15
The nurses’ professional environment is The correlation between job satisfaction, nurse
receiving international interest, because there is a empowerment and the professional practice
growing consensus that identifying opportunities environment are at the foundation of the Magnet
for improving working conditions in hospitals is Recognition Model.16 17 In addition, the American
essential to maintain adequate staffing, high- Association of Critical Care Nurses has conducted

Nurses’ perceptions of their professional practice environment in relation to job satisfaction: a review of quantitative studies.Health Science
Journal.2014;8 (3) P a g e | 299
HEALTH SCIENCE JOURNAL VOLUME 8 (2014),ISSUE 3

considerable research on the topic of Healthy All papers were reviewed according to the
Work Environment.18 While there is already a following inclusion criteria:
substantial amount of literature on the
professional practice environment and job 1) correlational studies 2) measured nurses’
satisfaction, there are only fragmented pieces of perceptions about professional practice
knowledge on any correlations between these environment in relation with job satisfaction 3) a
issues. In more detail, what are critically missing sample including nurses, physicians or both 4)
or limited are correlational studies regarding measured job satisfaction or dissatisfaction 5)
professional practice environment as a whole and English language articles.
job satisfaction. Correlational studies were found Studies examining specific dimensions of the work
regarding only specific elements of the environment (e.g. leadership, intention to leave)
professional practice environment (i.e. nurses- or other outcomes related with the professional
physicians relationships or nursing leadership) and environment (e.g. burnout, and patients’
job satisfaction. satisfaction) were excluded, as they do not satisfy
To address the gap of linking PPE with job the criterion of correlating PPE and job
satisfaction, this review was conducted to gain an satisfaction.
in-depth understanding and explore the Screening
correlation between the professional practice
environment and nurse job satisfaction. The Each abstract was examined twice by two
purpose of this paper is to describe the findings of reviewers independently using the inclusion
a systematic review of studies that examined the criteria. Studies were excluded if they did not
correlation of the professional practice examine the relationship between nursing
environment and nurse job satisfaction. professional practice environment as a whole and
job satisfaction. The relevant studies were
Methodology classified according to the degree of relevance
Τhe search was performed between September with the scope of the study. The initial screening
and December 2012 and updated in June 2013. included the formation of a table with the
Relevant literature was searched across four following elements: author, title, objective, date
databases to identify studies on nursing of publication, instrument used, methodology and
professional practice environment and nurses’ job results. Then, the reviewers re-examined the
satisfaction. The database search included: studies, isolated and accepted or rejected them
Pubmed, Google Scholar, Embase and Cinahl. The accordingly. For each case, a decision was taken
aim was to find studies published between 2000 to either exclude the paper or select it for the
and June 2012 (as they focus on most recent next step. In-depth examination of each article
developments in this area) that examined and data extraction were completed by the first
correlations between nursing professional reviewer and then validated by the second. It was
practice environment and job satisfaction. The key still possible at this step to exclude a paper if it
search items used included professional was deemed irrelevant or methodologically
environment AND nurses AND physicians AND flawed according to the redefined criteria as
satisfaction. (We included the word physicians to presented in Table 1.
increase the number of studies). Combinations of Data extraction
the keywords in the title and abstract were used.
Data extracted from the studies included: author,
Inclusion criteria date of publication, aim, design, subjects/sample

E-ISSN:1791-809x │hsj.gr Published by Department of Nursing , Technological Educational Institute of Athens


P a g e | 300
VOLUME 8 (2014),ISSUE 3 HEALTH SCIENCE JOURNAL

testing, theoretical framework, when using “professional environment” AND


measurements/instruments, scorings, reliability “nurses” AND “physicians” AND “satisfaction” 83
and validity, according to the quality assessment articles were found and 233 articles when using
criteria stated in Table 1. “professional environment” AND “physicians”
AND “satisfaction”. Titles and abstracts were
Quality review assessment screened and checked excluding duplicates, of
All papers selected were assessed for which 33 were selected for second screening. Of
methodological quality prior to inclusion in the these 29 were judged to meet the inclusion
review using a standardized critical appraisal criteria and selected for full review. These were
instrument 19 especially adapted for correlational screened in greater depth using inclusion criteria,
studies. 20, 21 This assessment tool measured and finally 14 studies were retained. The relevant
overall quality based on research design, sampling studies were published between 2002 and 2012
method, measurement and statistical analysis. (See figure for summary of search results).
The tool comprised of 13 items, with a possible Quality assessment
maximum score of 13 and all items were given a
weight of 1 point each. An overall quality rating In the quality assessment of the 14 studies, all of
was assigned as low (0-4), moderate (5-9) and them were found to be of
high quality (10-13). Only 2 studies had a score of prospective/retrospective design, with 6 of them
11 and 6 studies a score of 10, which makes in having random or convenience samples. Three of
total 8 studies of high quality. This evaluation was them did not justify the sample size and only two
carried out to assess all eligible studies. The rest had sample drawn from more than one site.
of the studies were of moderate quality, in more Nearly in all studies anonymity was protected.
detail four studies had a score of 9, one of 8 and Only in 4 of the studies the response rates were
one of 6. A summary of the quality assessment is below 60%.
presented in table 1.
All 14 studies used a valid and reliable instrument
Synthesis of results to measure the variables, but internal consistency
was measured only in 5 of them. A big weakness
Content analysis was used to synthesize the of the studies was the absence of a theoretical
results from the studies. Two authors performed a model/framework except for one study. In all
preliminary synthesis to identify and summarize studies correlations were analyzed with multiple
shared and contested constructs between and factors, like PPE with nursing outcomes or quality
across the studies. Each author performed the of nursing care and others. Another weakness was
synthesis separately but simultaneously, as this is the omission of management of outliers, except
considered most informative, and the resulting for one study. In most of the studies (10) there is
themes were agreed through discussion. no mention of any validity evaluation. The
Results characteristics of the studies included are
presented in Table 2
Search results
Analytical findings
The database searches resulted in the following
citations: By using the key words “professional Seven studies were carried out in the USA and
environment” AND “nurses” AND “satisfaction” Canada, and only two in Europe. The other five
534 abstracts were found across all databases; took place in China, Japan, Thailand and South

Nurses’ perceptions of their professional practice environment in relation to job satisfaction: a review of quantitative studies.Health Science
Journal.2014;8 (3) P a g e | 301
HEALTH SCIENCE JOURNAL VOLUME 8 (2014),ISSUE 3

Africa. Only in two studies was the sample drawn between work environment characteristics and
from one hospital, the rest being multi-sited. The neonatal intensive care unit nurses’ perceptions
hospitals studied were mostly public ones and the of care rationing, job outcomes and quality of care
wards examined ranged from acute care units to in Canada. Nantsupawat13 refers to the impact of
oncology wards, nursing homes, medical and nurse work environment and staffing on nurse
surgical wards. outcomes, including job satisfaction and burnout
and on the quality of nursing care. The data were
The “Practice Environment Scale of the Nursing collected from 13 general and 26 regional
Work Index”(PES-NWI) 4 and “The Nursing Work hospitals in Thailand, with a sample of 5247
Index-Revised” (NWI) 17 were the instruments nurses. KeLiu29 examined the relationship
used in most studies. Perceptions about “practice between hospital work environments and job
environment” and “job satisfaction” of physician satisfaction, job-related burnout and intention to
assistants, nurse practitioners and primary care leave among 1104 nurses from 89 medical,
physicians were studied by Freeborn (2002) 22 in surgical and intensive care units in 21 hospitals in
the USA. Bakker 23 24 targeted only oncological China. Klopper in 2012 7 included in the study
nurses and the research design was prospective private hospitals as well as national referral
and descriptive. Nurses were surveyed twice with hospitals in South Africa in a sample of 935
a two year interval between data collection times. nurses. The objective of this study was to describe
The study carried out in Norway by Begat in 2005 the practice environment, job satisfaction and
25
measured the practice environment as well as burnout of critical-care nurses in South Africa and
nurses’ perceptions of moral sensitivity and well- the relationship between them. McGlynn (2012) 8
being. The targeted professionals worked in acute studied in the USA ‘job satisfaction’ and
medical and surgical units as well as in geriatric ‘satisfaction with the professional practice
wards of two hospitals. In Aiken’s study 26 the environment’ of registered nurses in places where
sample drawn was the biggest and comprised of a professional practice model was implemented
more than 10.000 nurses. In addition, in the same as well as the relationship between these two
study, the hospitals studied included 168 of the variables. The sample was drawn from only one
210 adult acute care hospitals. Heikkinen in 2008 hospital, from different types of wards, with a
27
examined the nurses’ work environment and response rate of 55%.
nursing outcomes in Finland. A cross sectional
survey of 664 registered nurses in 34 acute care Three main correlations were defined as “themes”
inpatient hospital wards was performed and to facilitate the analysis. In particular, these are:
patient data was collected from 4045 patients “Professional/working environment as related to
simultaneously. In 2008, Kanai-Pak 14 described nurses’ satisfaction and dissatisfaction”,
nurse burnout, job dissatisfaction and quality of “Professional environment and ratings of quality
care in Japanese hospitals in association with of nursing care” and “resource adequacy and job
work environment factors. The sample was satisfaction”. See Table 3.
collected from 5986 staff nurses in 302 units in 19
acute hospitals. Van Bogaert in 2009 28 a) Professional/working environment as related
investigated impacts of practice environment to nurses’ satisfaction and dissatisfaction
factors and burnout at the nursing unit level on Nurses perceived their Professional Working
job outcomes and nurse assessed quality of care Environment as stressful, which had a negative
in 4 Belgian hospitals in 42 units with a sample effect on their job satisfaction.25 In 5 studies,
546 staff nurses. higher percentages of the nurses in hospitals with
Rochefort in 20106 studied the relationship poor care environments reported dissatisfaction

E-ISSN:1791-809x │hsj.gr Published by Department of Nursing , Technological Educational Institute of Athens


P a g e | 302
VOLUME 8 (2014),ISSUE 3 HEALTH SCIENCE JOURNAL

and high burnout levels with their jobs.7, 27- 30. In were roughly 30% less likely than nurses in
more detail, registered nurses’ (RN) satisfaction hospitals with poor work environments to report
with their present job was positively related to that the quality of care was only poor or fair as
work environment 27 and likelihoods of having opposed to good or excellent.13 In one study
higher burnout and job dissatisfaction were lower contract nurses and nurses younger than 30 years
in units with good environments than in units with old were more likely to leave their job than
poor environments.29 Better work environments permanent nurses and those aged 30 years and
were associated with better nurse outcomes in over, 29 whereas other age and education levels
contrast to job-related burnout and job were not significant predictors of RN job
dissatisfaction.14 The overall nursing practice satisfaction. 30
environment was a significant predictor of RN job
satisfaction.30 c) Resource adequacy and job satisfaction

Nevertheless, in one study most surprising was The care environment and nurse staffing were
the high negative relationship between overall job found to have significant effects on burnout and
satisfaction with the professional practice job dissatisfaction. Nurse retention and patient
environment. Correlations between the total outcomes are improved when the nurse leaders
scores on the two instruments used by McGlynn,8 improve staffing.31 Higher ratings of nurse staffing
indicated a statistically negative correlation and resource adequacy were related to lower
between job satisfaction and satisfaction with the emotional exhaustion scores.6 Each 10% increase
practice environment. In more detail, where a in inexperienced nurses and each unit decrease in
professional practice model is in place, that is a staffing-resource adequacy and nurse-physician
strategy that aids hospitals in maintaining their relations increases the odds in nurses exhibiting
nursing workforce and increasing the quality of high nurse burnout and job dissatisfaction and the
nurses’ work life through its positive effect on odds of their reporting only poor or fair quality of
nurses’ job satisfaction, nurses reported care.14 39% of participants reported that there
moderately low overall work satisfaction. This were not enough registered nurses to provide
result may be due to the fact that the study was quality patient care and inadequate nurse staffing
carried out in only one hospital and only 55% of was identified as a predictor of job
the eligible nurses participated. dissatisfaction.23 Resource adequacy was
22, 30
positively associated with RN job satisfaction.
b) Professional environment and ratings of
quality of nursing care Discussion

The percentage of nurses reporting that the The results of this review provided evidence that
quality of care was poor or fair (rather than good nurses’ perceptions of their professional practice
or excellent) was twice as high in hospitals with environment and resource adequacy, are related
poor care environments as in hospitals with better to nurse satisfaction and patient outcomes such
ones26 and more favourable work environments as nurse perceived quality of care. Establishing
were related to better indicators of nurses’ job positive practice environments across health
outcomes and higher ratings of the quality of sectors worldwide is of paramount importance if
nursing care.6 The quality of nursing care was patient safety and health workers’ wellbeing are
significantly associated with the hospitals’ nurse to be guaranteed. Positive Practice Environments
work environments and staffing levels. Nurses in are settings that support excellence and decent
hospitals with favourable work environments work.2 In particular, they strive to ensure the

Nurses’ perceptions of their professional practice environment in relation to job satisfaction: a review of quantitative studies.Health Science
Journal.2014;8 (3) P a g e | 303
HEALTH SCIENCE JOURNAL VOLUME 8 (2014),ISSUE 3

health, safety and personal wellbeing of staff, to the available published literature on
support quality patient care and improve the professional practice environment and job
motivation, productivity and performance of satisfaction separately, little research has focused
individuals and organizations. Positive changes in exclusively on the correlation between the two
the work environment result in a higher employee variables. Intention to leave and burnout as well
retention rate, which leads to better teamwork, as building elements of the professional
increased continuity of patient care, and environment like nurses’ physicians relationships,
ultimately improvements in patient outcomes. quality of care, patients’ outcome are prominent
in many studies. On the other hand, the study of
Health care is changing. Ageing populations, the correlation between professional practice
new therapeutic possibilities and rising environment as a whole and job satisfaction is
expectations have made the provision of health limited. It is prominent in many of the selected
care much more complex than in the past. At the studies that increasing percentages of the nurses
heart of these changes are the health in hospitals with poor environments report high
professionals.32 burnout levels and dissatisfaction with their jobs.
The overall goal of every healthcare Nurses reported more positive job experiences
organization is to systematically develop and and fewer concerns with care quality and patients
reinforce organizational strategies, structures and had significantly lower risks of death and failure to
processes that improve the organization’s rescue in hospitals with better care environments.
26
effectiveness in achieving quality patient care and If nurses perceive their working environment as
employee job satisfaction. Thus, healthy work stressful, that has a negative impact on job
environments are linked to patients’ satisfaction satisfaction. 25. Many research reports support
and to retention, reduced turnover, increased that the key to the nursing shortage is attention
attraction, job satisfaction and lower degree of to nursing work environments. An important
job stress and burnout. aspect of the practice environment associated
with job satisfaction includes leadership and
Transitions in health care have globally sparked support for nurses. Nursing managers can
public and professional concern regarding the contribute to nurses’ satisfaction by ensuring
professional practice environment for nurses and among others that staff receive recognition for a
its effect on the quality of care. Nurses make up job well done. 30 Management and leadership are
the largest cohort of health providers. A important for the delivery of good health services.
professional practice environment is needed to These two terms are not the same thing but they
enhance and optimize nurses’ potentials to deliver are necessarily linked and complementary. The
quality patient care. Research supports the belief manager’s job is to plan, organize and coordinate.
that the nurses’ professional practice An effective nursing manager who consults with
environment significantly relates to nurse and staff and provides positive feedback is crucial in
patient outcomes. The professional practice increasing job satisfaction.34 As it is well known
environment has been implicated as a variable that nurses’ work environment is a major
that impacts patient outcomes.33 The professional determinant of patient and nurse welfare, we can
practice environment for nurses is an important fairly claim that nurses’ professional environment
topic of study across many health care systems. is of positive influence on nursing outcomes.27
An environment without support for nurses Furthermore, the subscales “nurse manager
performing professional practice hinders the ability, leadership and support” and “nurse
delivery of good health care for patients. From the participation in hospital affairs” had the strongest
studies retrieved, it is evident that in comparison correlations with the “job satisfaction” in the

E-ISSN:1791-809x │hsj.gr Published by Department of Nursing , Technological Educational Institute of Athens


P a g e | 304
VOLUME 8 (2014),ISSUE 3 HEALTH SCIENCE JOURNAL

studies reviewed, thus confirming that these In most studies it was evident that there is a
elements play a critical role in the development of positive relationship between nursing professional
a positive practice environment.7 Improving practice environment and job satisfaction.
nurses’ work environment from poor to better Nevertheless, further studies are needed to
was associated with a 50% decrease in job determine and measure the degree of such
dissatisfaction and a 33% decrease in burnout correlations. The knowledge gained from future
among nurses.29 Positive ratings of nurse practice studies that result in the development of
environment factors are also associated with theoretical concepts and theories will add to the
improved job outcomes and higher nurse ratings knowledge available in the area of nursing
of quality of care.28 management. Professional Practice Environments
demonstrate a commitment to safety in the
Limitations workplace, leading to overall job satisfaction.
The intention of this review was to examine the When health professionals are satisfied with their
available research studies that explored the jobs, rates of absenteeism and turnover decrease,
correlation of professional practice environment staff morale and productivity increase, and work
and nurse job satisfaction. Details of the performance as a whole improves. Safe patient
participants in the studies included were not fully care is directly and positively linked to the quality
described and were complicated by the various of nurses’ work environments.
titles used due to the fact that the studies had The insights gained from the synthesis of the
been carried out in different countries with studies reviewed allow us to have a better
different health systems. In some studies the understanding of the impact of the professional
participants were nurses as well as other health practice environment on job satisfaction and what
professionals, thus making the summarization of implications this relation might have on various
the results not so homogeneous. A major aspects of the provision of health care. Further
limitation can be the inclusion of only quantitative work is needed to investigate this relationship so
studies in this review. Thus, there is a need for that theoretical concepts could be developed and
examining the issue of the relation of the knowledge will be added in the area of an
professional practice environment with job efficient and effective professional practice
satisfaction through further exploration of studies environment that will contribute to the upgrade
that use different methodological approaches. of the quality of the health services provided.
Conclusions This review will provide health policy-makers
Evidence suggests that the work environment is and managers with an effective tool to promote a
an important factor in the recruitment and sound professional practice environment so that
retention of health workers. Furthermore, the job satisfaction is secured and ultimately health
work environment can influence the quality of organizations can achieve the goal of providing
care and patient safety. As a working definition, quality care for health consumers. These findings
an attractive and supportive workplace in this suggest that investing in a good professional
case can be described as an environment that practice environment is reflected in nurses’ well-
attracts individuals into the health professions, being and job satisfaction, thus improving the
encourages them to remain in the health outcomes for patients.
workforce and enables them to perform
effectively.

Nurses’ perceptions of their professional practice environment in relation to job satisfaction: a review of quantitative studies.Health Science
Journal.2014;8 (3) P a g e | 305
HEALTH SCIENCE JOURNAL VOLUME 8 (2014),ISSUE 3

Table 1: Summary of quality assessment of the quantitative studies

Criteria
Yes No/not
mentioned
Design
Prospective/retrospective studies 14 0
Probability sampling 6 8
Sample
Appropriate/justified sample 11 3
Sample drawn from more than one site 12 2
Anonymity protected 13 1
Response rate >60% 10 5
Measurement
Factor measured reliably 14 0
Factor measured using a valid instrument 13 1
Dependent variable measured using a reliable 14 0
instrument
Internal consistency of scale >70% 4 10
Theoretical model/framework 1 13

Statistical analysis
Correlations analysed when multiple factors studied 14 0
Management of outliers managed
1 13

E-ISSN:1791-809x │hsj.gr Published by Department of Nursing , Technological Educational Institute of


Athens
P a g e | 306
VOLUME 8 (2014),ISSUE 3 HEALTH SCIENCE
JOURNAL

Figure: Search and retrieval process


Web search

Pubmed, Google Scholar,


Embase, Cinahl

534 articles 83 articles 233 articles

By using the key words By using Professional By using Professional


“Professional environment environment AND environment AND
AND nurses AND nurses AND physicians physicians AND
satisfaction” AND satisfaction satisfaction

Titles and abstracts were screened, and


checked excluding duplicates of which 33
were selected for second screening

29 were judged to meet the inclusion criteria and selected for full
review.

14 studies were retained

Nurses’ perceptions of their professional practice environment in relation to job satisfaction: a review of quantitative studies.Health Science
Journal.2014;8 (3) Page
| 307
HEALTH SCIENCE JOURNAL VOLUME 8 (2014),ISSUE 3

Table 2: Characteristics of quantitative studies included

Reference Aim Design Subjects/sam Framework Measurements/instrument Scorings Reliability Validity


ple testing s
1. Freeborn (2002) Comparison of Self 483 High levels of Shorter version of a Each item had Not Not
perceptions about administered physicians clinician pretested structured 2-6 response reported reported
the practice mail survey and 264 dissatisfaction questionnaire used by categories to
environment and nonphysicia may adversely Center for Health select from
the job satisfaction n clinicians affect patient Research
of physician relationships,
assistants, nurse the quality of
practitioners and care and
primary care organizational
physicians in a effectivenes
large group model
HMO

2. Begat(2005) To examine Descriptive Nurses Nursing is 1)Work Environment 1)WEQ-6 1)α=.91 WEQ and
nurses’ satisfaction and selected stressful and Questionnaire(WEQ) point Likert 2)α=.73 MSQ
with their correlational from 2 the incidence 2) Moral Sensitivity scale Content
psychosocial work study hospitals of Questionnaire(MSQ) 2)MSQ-7 and
environment, their n=71 occupational point Likert construct
moral sensitivity stress-related scale validity
and differences in burnout in the reported
outcomes of profession is elsewhere
clinical nursing high
supervision in Factor
relation to nurses’ analysis
well-being by
systematically
comparing
supervised and
unsupervised
nurses
3. Aiken(2008) To analyse the Descriptive Nurses Practice 1)PES-NWI 1)4-point 1)α=.74, Favorable
effects of nurse and n=10184 environment 2)MBI Likert scale .82, .80 Psychomet
practice correlational scales of the 3)Patient deaths within 30 2) α=.92 ric
environments on study Surgical NWI-3 of 5 days of hospital properties
nurse and patient patients PES-NWI admission and deaths of the
E-ISSN:1791-809x │hsj.gr outcomes after n=232342 subscales withinInstitute
Published by Department of Nursing , Technological Educational 30 daysofof
Athens PES-NWI
P a g e | 308
VOLUME 8 (2014),ISSUE 3 HEALTH SCIENCE JOURNAL

accounting for in 168 (evidence admission among patients reported


nurse staffing and Pensylvania connects with complications elsewhere
education hospitals better staffing
(out of 210 to better
adult acute outcomes)
care
hospitals)
4. Heikkinen(2008) To assess the Cross 664 Link between 1)RN-WCBI from NWI- 1)4-point 1) α=.737- Explorator
relationship sectional registered nurses; job R for nurses 2)Humane Likert scale .838 y factor
between nurses’ survey nurses on 34 satisfaction Caring Scale-revised analysis
work environment acute care and patient
and nursing impatient outcomes such
outcomes hospital as mortality
wards rate and
4045 patient
patients satisfaction-
conceptual
framework
based on
earlier studies
5. Kanai-Pak(2008) To describe nurse Cross 5956 staff Nurse burnout 1)The survey instrument 1)4-point Not Not
burnout, job sectional nurses on and job was adapted from the Likert scale reported reported
dissatisfaction and survey/ 302 units in dissatisfaction broader instrument used 2)Scale 0-6
quality of care in logistic 19 acute are associated in the IHOS questionnaire
Japanese hospitals regression hospitals in with poor 2) MBI
and to determine Japan/ nurse retention
how these convenience and uneven
outcomes are sample quality of care
associated with
work environment
factors

Nurses’ perceptions of their professional practice environment in relation to job satisfaction: a review of quantitative studies.Health Science Journal.2014;8 (3)
P a g e | 309
HEALTH SCIENCE JOURNAL VOLUME 8 (2014),ISSUE 3

6. Van Bogaert(2009) To investigate Survey/ 546 staff Studies have 1)NWI-R 1)4-point Not Reported
impacts of practice regression nurses from highlighted Likert scale reported elsewhere
environment analysis 42 units of potential
factors and Belgian benefits of
burnout at the hospitals various 2)Job outcome variables: 2) Nurse
nursing unit level (random dimensions of nurse satisfaction with satisfaction
on job outcomes selection) supportive current job, intention to with 4 Likert
and nurse assessed practice stay and nurse-assessed scale,
quality of care in environments quality of care Intention to
acute hospital stay with
nurses 3)MBI dichotomous,
quality with 4
Likert scale

3)6-point
Likert scale

7. Rochefort(2010) Study of the A cross 553 nurses Attention to 1)NWI-R 1)4-point 1)α=.84, Construct
relationship sectional in all work Likert scale .91, .90 and
between work correlational neonatal environments 2)NEWRI 2) 4-point 2) α=.93, predictive
environment survey deign intensive might improve 3) MBI Likert scale .93, .83, validity
characteristics and care units in nurse 4)Job satisfaction 3) 7-point .81
neonatal intensive Quebec recruitment Likert scale
care unit nurses’ Canada and retention 4) 4-point
perceptions of care and the quality Likert scale
rationing, job of care
outcomes and
quality of care
8. Bakker(2010) To examine Prospective Nurses Healthy work 1)NWI-R(shorter version) 1) 4-point Not Pretested
oncology nursing descriptive n=2002 environments 2)Job satisfaction Likert scale mentioned for face
work research are positively 3)Perception of nursing and re- validity
environments and associated practice and quality of categorised
to determine the with safe care into
presence of patient care. 4)Intention to leave dichotomous
workplace and Quality agree or
professional workplaces disagree
practice factors are linked to 2) 4-point
increased Likert scale
recruitment 3)+4) 3 point
and retention scale

E-ISSN:1791-809x │hsj.gr Published by Department of Nursing , Technological Educational Institute of Athens


P a g e | 310
VOLUME 8 (2014),ISSUE 3 HEALTH SCIENCE JOURNAL

of nurses,
improved job
satisfaction,
less stress and
burnout and
increased
patient
satisfaction
9. Choi(2011) To examine A secondary 863 RNs as A supportive 1)Job satisfaction 1)+2)4-point 1)α=0.83 2)Content
relationships data analysis staff RNs in practice 2)PES-NWI Likert scale 2) α=0.95 validity
between aspects of a subset of 282 skilled environment is mentioned
the nursing nurse survey nursing significantly elsewhere
practice data collected facilities in associated
environment and in 2006- New Jersey with higher
job satisfaction multilevel job
among RNs in analysis satisfaction
nursing homes among RNs
working in
nursing
homes-The
nursing
organization
and outcomes
model(Aiken
2002)
10. Nantsupawat(2011) To determine the Correlational 5247 nurses Nurses in 1)Instrument adapted 2)4-point 2)α=.87, Face
impact of nurse design using across 39 hospitals with from IHOS Likert scale .90, .87, validity of
work environment secondary public supportive 4) 4-point .91, .85 the Thai
and staffing on data analysis hospitals in nurse work 2)PES-NWI Likert scale 5) α=.87 version of
nurse outcomes of the 2007 Thailand environments 3) Nurse staffing 6) 4-point IHOS
including job Thai Nurse and adequate Likert scale verified
satisfaction and Survey/ staffing are 4)Job dissatisfaction
burnout and on multivariate more satisfied
quality of nursing logistic with their jobs 5)MBI-HSS
care regression 6)Quality of nursing care
11. Bakker(2012) To examine Prospective Nurses Healthy work 1)NWI-R(shorter version) 1) 4-point Not Initial
oncology nursing descriptive n=525 environments 2)Job satisfaction Likert scale mentioned questionna
work research are positively 3)Perception of nursing and ire

Nurses’ perceptions of their professional practice environment in relation to job satisfaction: a review of quantitative studies.Health Science Journal.2014;8 (3)
P a g e | 311
HEALTH SCIENCE JOURNAL VOLUME 8 (2014),ISSUE 3

environments and associated practice and quality of recategorised pretested


to determine the with safe care into for face
presence of patient care. 4)Intention to leave dichotomous validity
workplace and Quality agree or
professional workplaces disagree
practice factors are linked to 2) 4-point
increased Likert scale
recruitment 3)+4) 3 point
and retention scale
of nurses,
improved job
satisfaction,
less stress and
burnout and
increased
patient
satisfaction
12. Ke Liu(2012) Examine the Cross 1104 Association The China Hospital Nurse 1)4-point 1) α=.93 Not
relationship sectional bedside between the Survey including the Likert scale reported
between hospital study/logistic nurses in 89 quality of Practice Environment 2)Four
work regression medical, nurse Scale of the NWI and response
environments and analysis surgical and environments MBI categories
job satisfaction, intensive and nurse 1)PES-NWI 3)Scores 27
job related burnout care units in satisfaction 2) Nurse job satisfaction or greater
and intention to 21 and turnover, 3)MBI considered as
leave among hospitals/stra patient 4)Intention to leave high burnout
nurses in China tified satisfaction 4) single
convenience and quality of dichotomous
sample care response
13. Klopper(2012) To describe the Cross 935 nurses The practice 1)PES-NWI 1) 4-point 1) α>.75 Factor
practice sectional environment, 2)Job satisfaction Likert scale analysis
environment, job study job 3)Intention to leave 2)
satisfaction and satisfaction 4)MBI 3)
burnout of critical and burnout 5)Nurse reported quality 4)7 scale
care nurses are associated of care
and that 6)Patient safety issues
positive
practice
environments
increase job

E-ISSN:1791-809x │hsj.gr Published by Department of Nursing , Technological Educational Institute of Athens


P a g e | 312
VOLUME 8 (2014),ISSUE 3 HEALTH SCIENCE JOURNAL

satisfaction
and lower
levels of
burnout
14. McGlynn(2012) Describes the Descriptive 101 Herzberg 1)Job satisfaction 1)7Likert 1) α=.77 The
initial assessment cross participants Motivation measured with Index of scale 2) α=.85 discrimina
of job satisfaction sectional from 4 Theory Work Satisfaction 2)4 Likert nt validity
and satisfaction patient care 2)PES-NWI-4 Likert scale of the scale
with the units scale was
professional supported
practice in Magnet
environment of hospitals
registered nurses

Nurses’ perceptions of their professional practice environment in relation to job satisfaction: a review of quantitative studies.Health Science Journal.2014;8 (3)
P a g e | 313
HEALTH SCIENCE JOURNAL VOLUME 8 (2014),ISSUE 3

Table 3: Themes and findings

Themes Findings Source


Professional/working environment Nurses’ perceive their PWE as stressful Begat (2005)
as related to nurses’ satisfaction and which has a negative effect on their job
dissatisfaction satisfaction
Higher percentages of the nurses in hospitals Aiken (2008)
with poor care environments reported high
burnout levels and dissatisfaction with their
jobs
The study confirmed that RNs satisfaction Heikkinen( 2008)
with their present job was positively related
to work environment. When professional
environment attributes were evaluated to be
better, also nurses’ work stress decreased
and nurses’ satisfaction indicators increased
linearly
Better work environments were associated Kanai-Pak (2008)
with better nurse outcomes (job-related
burnout and job dissatisfaction)
Higher unit-level ratings of the three nurse Van Bogaert(2009)
practice environment dimensions were
significantly associated with lower levels of
burnout measured on each of the three
dimensions as well as with job satisfaction,
intent to stay in nursing and positive
assessments of the quality of care at the unit
and the last shift
The overall nursing practice environment Choi(2011)
was a significant predictor of RN job
satisfaction. For each 1 unit increase in the
composite score of the PEW-NWI TN’s job
satisfaction increased 586 points on average
The odds ratios implied that in fully adjusted Ke Liu(2011)
models, the likelihoods of having higher
burnout and job dissatisfaction were lower in
units with good environments than in units
with poor environments by OR of 0,67 and
0,50 respectively
There is a weak to strong correlation Klopper(2012)
between all the subscales of the practice
environment, job satisfaction and burnout
Correlations between the total scores on the McGlynn (2012)
two instruments indicated a statistically
negative correlation between job satisfaction
and satisfaction with the practice
environment (r=-0,49, P<0,0001). Most
surprising was the high negative relationship
between overall job satisfaction with the
professional practice environment
Professional environment and The percentage of nurses who reported that Aiken (2008)
ratings of quality of nursing care the quality of care was poor or fair (rather
than good or excellent) was twice as high in
hospitals with poor care environments as in
hospitals with better ones
More favourable work environments were Rochefort (2010)

E-ISSN:1791-809x │hsj.gr Published by Department of Nursing , Technological Educational Institute of Athens


P a g e | 314
VOLUME 8 (2014),ISSUE 3 HEALTH SCIENCE JOURNAL

related to better indicators of nurses’ job


outcomes and higher ratings of the quality
of nursing care
Age and education level were not significant Choi (2011)
predictors of RN job satisfaction
Professional environment was related with Ke Liu(2011)
dissatisfaction, burnout and intention to
leave The study indicated that permanent
nurses experienced more severe job
dissatisfaction and high burnout
Contract nurses and nurses younger than 30 Ke Liu(2011)
years old were more likely to leave their job
than permanent nurses and those aged 30
years and over
The quality of nursing care was significantly Nantsupawat(2011)
associated with the hospitals’ nurse work
environments and staffing levels. Nurses in
hospitals with favourable work environments
were roughly 30% less likely than nurses in
hospitals with poor work environments to
report that the quality of care was only poor
or fair as opposed to good or excellent
Resource adequacy and job Common areas of dissatisfaction included Freeborn (2002)
satisfaction patient load and amount of time spent with
patients
More nurses with a higher cancer workload Bakker (2010)
(>80%)indicated that they were satisfied
being a nurse
39% of participants reported that there were Bakker (2010)
not enough registered nurse to provide
quality patient care and inadequate nurse
staffing was identified as a predictor of job
dissatisfaction
Nurses who indicated an intention to leave Bakker (2012)
also reported satisfaction being a
nurse(surprising)
The care environment and nurse staffing had Aiken (2008)
significant effects on burnout and job
dissatisfaction
Each 10% increase in inexperienced nurses Kanai-Pak (2008)
and each unit decrease in staffing-resource
adequacy and nurse-physician relations
increases the odds in nurses exhibiting high
nurse burnout and job dissatisfaction and
the odds of their reporting only poor or fair
quality of care
Higher ratings of nurse staffing and resource Rochefort (2010)
adequacy were related to lower emotional
exhaustion scores
Resource adequacy was positively associated Choi( 2011)
with RN job satisfaction

Nurses’ perceptions of their professional practice environment in relation to job satisfaction: a review of quantitative studies.Health Science
Journal.2014;8 (3) P a g e | 315
HEALTH SCIENCE JOURNAL VOLUME 8 (2014),ISSUE 3

References and satisfaction with the professional practice


model. J Nurs Manag 2012;20(2):260–5.
1. Commission of the European Communities. 9. Erickson JI, Duffy ME, Ditomassi M, Jones D.
Improving quality and productivity at work: Psychometric evaluation of the Revised
Community strategy 2007-2012 on health and Professional Practice Environment (RPPE)
safety at work [Internet]. Brussels 21.2.2007; scale. J Nurs Adm 2009;39(5):236–43.
2007. Report No.: COM(2007) 62 final. 10. Hinno S, Partanen P, Vehviläinen-Julkunen K,
Available from: http://eur- Aaviksoo A. Nurses’ perceptions of the
lex.europa.eu/legal- organizational attributes of their practice
content/EN/ALL/;jsessionid=vpT8TvyTxMXKyy environment in acute care hospitals. J Nurs
VZBm0TzL5ZwD6rYLl0hc9L6jJJGYnpsQPpxknm Manag 2009;17(8):965–74.
!428133741?uri=CELEX:52007DC0062 11. Rafferty A M, Ball J, Aiken LH. Are teamwork
2. Wiskow C, Albreht T, Pietro C De. How to and professional autonomy compatible, and
create an attractive and supportive working do they result in improved hospital care? Qual
environment for health professionals. Health Care 2001;10 Suppl 2(Suppl II):ii32–7.
Copenhagen; 2010. Report No.: Policy Brief 12. Szecsenyi J, Goetz K, Campbell S, Broge B,
15. Reuschenbach B, Wensing M. Is the job
3. International Council of Nurses, International satisfaction of primary care team members
Hospital Federation, International associated with patient satisfaction? BMJ Qual
Pharmaceutical Federation, World Saf 2011;20(6):508–14.
Confederation for Physical Therapy, World 13. Nantsupawat A, Srisuphan W, Kunaviktikul W,
Dental Federation WMA. Positive practice Wichaikhum O-A, Aungsuroch Y, Aiken LH.
environments for health care professionals Impact of nurse work environment and
[Internet]. 2008. Available from: staffing on hospital nurse and quality of care
http://www.icn.ch/images/stories/documents in Thailand. J Nurs Scholarsh 2011;43(4):426–
/publications/fact_sheets/17d_FS- 32.
Positive_Practice_Environments_HC_Professi 14. Kanai-Pak M, Aiken LH, Sloane DM, Poghosyan
onals.pdf L. Poor work environments and nurse
4. Lake ET. Development of the practice inexperience are associated with burnout, job
environment scale of the Nursing Work Index. dissatisfaction and quality deficits in Japanese
Res Nurs Health 2002;25(3):176–88. hospitals. J Clin Nurs 2008;17(24):3324–9.
5. Hoffart N, Woods CQ. Elements of a nursing 15. You L, Aiken LH, Sloane DM, Liu K, He G, Hu
professional practice model. J Prof Nurs Y.Hospital nursing, care quality, and patient
1996;12(6):354–64. satisfaction: cross-sectional surveys of nurses
6. Rochefort CM, Clarke SP. Nurses’ work and patients in hospitals in China and Europe.
environments, care rationing, job outcomes, Int J Nurs Stud 2013;50(2), 154-161.
and quality of care on neonatal units. J Adv 16. Aiken LH, Buchan J, Ball J, Rafferty AM.
Nurs 2010;66(10):2213–24. Transformative impact of Magnet designation:
7. Klopper HC, Coetzee SK, Pretorius R, Bester P. England case study. J Clin Nurs
Practice environment, job satisfaction and 2008;17(24):3330–7.
burnout of critical care nurses in South Africa. 17. Aiken L, Patrician P. Measuring organizational
J Nurs Manag 2012;20(5):685–95. traits of hospitals: the Revised Nursing Work
8. McGlynn K, Griffin MQ, Donahue M, Index. Nurs Res 2000; 49(3), 146-153.
Fitzpatrick JJ. Registered nurse job satisfaction 18. Erickson J, Jones D, Ditomassi M. Fostering
Nurse-led Care: Professional Practice for the

E-ISSN:1791-809x │hsj.gr Published by Department of Nursing , Technological Educational Institute of Athens


P a g e | 316
VOLUME 8 (2014),ISSUE 3 HEALTH SCIENCE JOURNAL

Bedside Leader from Massachusetts General environment and nursing outcomes: a survey
Hospital Sigma Theta Tau 2012 Chapter 2 study among Finnish university hospital
19. Cummings GG, MacGregor T, Davey M, Lee H, registered nurses. Int J Nurs Pract
Wong C a, Lo E, et al. Leadership styles and 2008;14(5):357–65.
outcome patterns for the nursing workforce 28. Van Bogaert P, Clarke S, Roelant E,
and work environment: a systematic review. Meulemans H, Van de Heyning P. Impacts of
Int J Nurs Stud 2010;47(3):363–85. unit-level nurse practice environment and
20. Thorpe C, Ryan B, McLean SL, Burt a, Stewart burnout on nurse-reported outcomes: a
M, Brown JB, et al. How to obtain excellent multilevel modelling approach. J Clin Nurs
response rates when surveying physicians. 2010;19(11-12):1664–74.
Fam Pract 2009;26(1):65–8. 29. Liu K, You L-M, Chen S-X, Hao Y-T, Zhu X-W,
21. Papastavrou E, Andreou P, Tsangari H, Zhang L-F, et al. The relationship between
Schubert M, De Geest S. Rationing of Nursing hospital work environment and nurse
Care Within Professional Environmental outcomes in Guangdong, China: a nurse
Constraints: A Correlational Study. Clin Nurs questionnaire survey. J Clin Nurs 2012;21(9-
Res 2014;23(3):314-35. 10):1476–85.
22. Freeborn DK, Hooker RS, Pope CR. Satisfaction 30. Choi SP-P, Pang SM-C, Cheung K, Wong TK-S.
and Well-Being of Primary Care Providers in Stabilizing and destabilizing forces in the
Managed Care. Eval Health Prof nursing work environment: a qualitative study
2002;25(2):239–54. on turnover intention. Int J Nurs Stud
23. Bakker D, Conlon M, Fitch M, Green E. 2011;48(10):1290–301.
Canadian oncology nurse work environments: 31. Aiken L, Clarke S, Sloane D. Effects of hospital
part I. Nursing Leadership 2010;22(4):50-68. care environment on patient mortality and
24. Bakker D, Conlon M, Fitch M, Green E, Butler nurse outcomes. J Nurs Adm 2008; 38(5):223–
L, Olson K, et al. Canadian Oncology Nurse 9
Work Environments: Part II. Nursing 32. Rechel B, Dubois C, McKee M. The health care
Leadership 2012;25(1):68-89. workforce in Europe: learning from
25. Bégat I, Ellefsen B, Severinsson E. Nurses’ experience. 2006
satisfaction with their work environment and 33. Siedlecki S, Hixson E. Development and
the outcomes of clinical nursing supervision Psychometric Exploration of the Professional
on nurses' experiences of well-being - a Practice Environment Assessment Scale. J
Norwegian study. J Nurs Manag Nurs Scholarsh 2011;43(4), 421-425.
2005;13(3):221–30. 34. Roche M, Duffield C, White E. Factors in the
26. Aiken LH, Clarke SP, Sloane DM, Lake ET, practice environment of nurses working in
Cheney T. Effects of hospital care inpatient mental health: A partial least
environment on patient mortality and nurse squares path modeling approach. Int J Nurs
outcomes. J Nurs Adm 2008;38(5):223–9. Stud 2011;48(12):1475–86.
27. Tervo-Heikkinen T, Partanen P, Aalto P,
Vehviläinen-Julkunen K. Nurses’ work

Nurses’ perceptions of their professional practice environment in relation to job satisfaction: a review of quantitative studies.Health Science
Journal.2014;8 (3) P a g e | 317