Organization of nursing care in three Nordic countries: relationships between nurses’ workload, level of involvement in direct patient care, job satisfaction, and intention to leave

BMC Nursing

Carol Tishelman⁴  Maria Wiberg Tjønnfjord³  Christine Tvedt¹  Ingeborg Strømseng Sjetne⁵  Juha Kinnunen²  Virpi Jylhä²  Anneli Ensio²  Sara Runesdotter⁴  Lisa Smeds Alenius⁴  Rikard Lindqvist⁴ 

[1] Lovisenberg Diaconal University Collage, Oslo, Norway;Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland;Department of Health, Nutrition and Management, Oslo and Akershus University College of applied sciences, Faculty of Health Sciences, Akershus, Norway;Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden;Norwegian Knowledge Centre for the Health Services, Oslo, Norway

关键词: Workload;    Organization and administration;    Nursing;    Job satisfaction;    Health services research;   

Others  :  1090903
DOI  :  10.1186/1472-6955-13-27

 received in 2014-04-14, accepted in 2014-09-25,  发布年份 2014

【 摘 要 】

Background

Health care systems in Finland, Norway and Sweden share many similarities, e.g. full-coverage and tax-financed, with predominately public sector hospitals. Despite similarities, there are differences in the working situations for RNs within these Nordic countries. The aim of this study was to analyze associations between RNs’ patient workload and level of involvement in direct patient care, their job satisfaction and intention to leave in these countries.

Methods

A workforce survey was conducted through RN4CAST, an EU 7th framework project. The survey included 118 items derived from validated instruments or tested in prior research. Responses from 1133 RNs at 32 Finnish hospitals, 3752 RNs at 35 Norwegian hospitals, and 11 015 RNs at 71 Swedish hospitals comprise the database, which was analyzed using logistic and odds ratio regressions analyses.

Results

We found statistically significant differences in RNs’ level of involvement in direct patient care (p < 0.001, Sweden compared to Norway and Finland), in patient workload and in number of patients needing ADL assistance and surveillance. A U-formed relationship was found between level of involvement in direct patient care and intention to leave in Sweden, and more satisfaction among RNs in roles with more direct patient care (OR = 1.16, 1.02 ≤ CI_95% ≤ 1.32). Nearly half the Finnish sample report intention to leave, with significantly lower levels in Norway and Sweden (p < 0.001). Patient workload is associated with job satisfaction and intention to leave to some degree in all countries, i.e. greater patient workload, less job satisfaction and greater intention to leave.

Conclusions

This study suggests that more attention paid to patient mix, workload and role of RNs in patient care might potentially diminish intention to leave and increase job satisfaction in these Nordic countries.

【 授权许可】

   
2014 Lindqvist et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Magnussen J, Vrangbaeck K, Saltman RB: Nordic Healt Care Systems - Recent Reforms and Current Policy Challanges. Glasgow: World Health Organiziation; 2009.
• [2]Orvik A, Axelsson R: Organizational health in health organizations: towards a conceptualization. Scand J Caring Sci 2012, 26(4):796-802.
• [3]Sermeus W, Aiken LH, Van den Heede K, Rafferty AM, Griffiths P, Moreno-Casbas MT, Busse R, Lindqvist R, Scott AP, Bruyneel L, Brzostek T, Kinnunen J, Schubert M, Schoonhoven L, Zikos D, RN4CAST consortium: Nurse forecasting in Europe (RN4CAST): rationale, design and methodology. BMC Nurs 2011, 10:6. BioMed Central Full Text
• [4]Aiken LH, Sloane DM, Bruyneel L, Van den Heede K, Sermeus W: Nurses’ reports of working conditions and hospital quality of care in 12 countries in Europe. Int J Nurs Stud 2013, 50(2):143-153.
• [5]Linna M, Hakkinen U, Peltola M, Magnussen J, Anthun KS, Kittelsen S, Roed A, Olsen K, Medin E, Rehnberg C: Measuring cost efficiency in the Nordic hospitals–a cross-sectional comparison of public hospitals in 2002. Health Care Manag Sci 2010, 13(4):346-357.
• [6]OECD: OECD Health Data 2011. 2011. [http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT webcite]. Organisation for Economic Co-operation and Development
• [7]Raholm MB, Hedegaard BL, Lofmark A, Slettebo A: Nursing education in Denmark, Finland, Norway and Sweden - from Bachelor’s degree to PhD. J Adv Nurs 2010, 66(9):2126-2137.
• [8]Tehy [Union of Health and Social Care Professionals in Finland][http://www.tehy.fi/tehy webcite]
• [9]Aiken LH, Clarke SP, Sloane DM, Lake ET, Cheney T: Effects of hospital care environment on patient mortality and nurse outcomes. J Nurs Adm 2008, 38(5):223-229.
• [10]Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH: Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. J Am Med Assoc 2002, 288(16):1987-1993.
• [11]Sjetne IS, Tvedt C, Squires A: Måleinstrumentet “The Nursing Work Index-Revised” -oversettelse og utprøving av en norsk versjon. Sykepleien Forskning 2011, 6(4):358-365.
• [12]Polit DF, Beck CT, Owen SV: Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health 2007, 30(4):459-467.
• [13]Aiken LH, Sermeus W, Van Den Heede K, Sloane D, Smith H, Bruynee IL, Kutney-Lee A, Rafferty A, Griffiths P, Moreno-Casbas MT, Tishelman C, Scott A, Brzostek T, Kinnunen J, Schwendimann R, Heinen M, Zikos D, Sjetne IS, Smith HL, Kutney-Lee A: Patient safety, satisfaction, and quality of hospital care: cross-sectional surveys of nurses and patients in 12 countries in Europe and the United States. Br Med J 2012, 344:e1717.
• [14]Flinkman M, Laine M, Leino-Kilpi H, Hasselhorn HM, Salantera S: Explaining young registered Finnish nurses’ intention to leave the profession: a questionnaire survey. Int J Nurs Stud 2008, 45(5):727-739.
• [15]Hasselhorn HM, Müller BH, Tackenberg P (Eds): NEXT Scientific Report July 2005. Wuppertal: University of Wuppertal; 2005.
• [16]Sjogren K, Fochsen G, Josephson M, Lagerstrom M: Reasons for leaving nursing care and improvements needed for considering a return: a study among Swedish nursing personnel. Int J Nurs Stud 2005, 42(7):751-758.
• [17]NOMESKO: Health Statistics in the Nordic Countries with Data from 2008. København: Nordisk Medicinalstatistisk Komité; 2010.
• [18]Kalseth B, Sarheim Anthun K, Hope Ø, Kittelsen SAC, Persson BA: Spesialisthelsetjenesten i Norden: Sykehusstruktur, styringsstruktur og lokal arbeidsorganisering som mulig forklaring på kostnadsforskjeller mellom landene. Trondheim, Norway: SINTEF; 2011:127.
• [19]Aiken LH, Clarke SP, Sloane DM, Lake ET, Cheney T: Effects of hospital care environment on patient mortality and nurse outcomes. J Nurs Adm 2009, 39(7–8 Suppl):S45-S51.
• [20]Aiken LH, Clarke SP, Sloane DM, Sochalski JA, Busse R, Clarke H, Giovannetti P, Hunt J, Rafferty AM, Shamian J: Nurses’ reports on hospital care in five countries. Health Aff (Millwood) 2001, 20(3):43-53.
• [21]Baernholdt M, Mark BA: The nurse work environment, job satisfaction and turnover rates in rural and urban nursing units. J Nurs Manag 2009, 17(8):994-1001.
• [22]Chen YM, Johantgen ME: Magnet Hospital attributes in European hospitals: a multilevel model of job satisfaction. Int J Nurs Stud 2010, 47(8):1001-1012.