International journal of nursing studies
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Nurses' work environments are associated with burnout experiences among nurses. The RN4CAST project provides data on these constructs within a four-level structure (nurse, nursing unit, hospital, and country), implying more complicated multilevel analysis strategies than have been used in previous efforts studying this relationship. ⋯ Nurse work environment dynamics are related to nurses' burnout experiences at both the nursing unit and the hospital level. This implies that both hospital-wide and unit-specific interventions should be considered to achieve excellent work environments. The correlation structure among the three burnout outcomes varies across countries, but is stable between hospitals within countries and between nursing units within hospitals.
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One strategy proposed to alleviate nursing shortages is the promotion of organizational efforts that will improve nurse recruitment and retention. Cross-sectional studies have shown that the quality of the nurse work environment is associated with nurse outcomes related to retention, but there have been very few longitudinal studies undertaken to examine this relationship. ⋯ Improvements in nurse work environments over time are associated with lower rates of nurse burnout, intention to leave current position, and job dissatisfaction.
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As other countries which have introduced diagnosis-related groups (DRGs) to pay their hospitals Germany initially expected that quality of care could deteriorate. Less discussed were potential implications for nurses, who might feel the efficiency-increasing effects of DRGs on their daily work, which in turn may lead to an actual worsening of care quality. ⋯ The DRG implementation in Germany has apparently had measurable negative effects on nurses and nurse-perceived patient outcomes, however, not as distinct as often assumed.
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Cost containment pressures underscore the need to better understand how nursing resources can be optimally configured. ⋯ Nurse shortages can be expected when national economies improve unless hospital work environments improve. Wide variation in nurse staffing and skill mix suggests a lack of evidence-based decision making. Additional research is warranted on the impact of these variations in nurse resources on patient outcomes.
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The importance of the practice environment in the provision of care and its relation with patient outcomes and nurse-reported outcomes, support the need to have an instrument to measure such practice environment. ⋯ The validation process indicates that the Spanish version of the PES-NWI is valid and reliable in its current version and it can be used to measure the practice environment of Spanish nurses working in clinical practice in hospitals of the Spanish NHS.