FACTORS INFLUENCING NURSE-ASSESSED QUALITY OF NURSING CARE IN CHINESE HOSPITALS

Abstract

This survey research design for causal modeling aimed to examine the factors of nurse staffing, nurse work environment, job satisfaction, burnout, and intention to leave influencing quality nursing care in Chinese hospitals. The conceptual framework was modified from the Aiken’s Nurse Work Environment, Nurse Staffing, Outcome Model (2002) and empirical studies. A multi-stage random sampling was used for data collection, which conducted from August, 2014 to January, 2015. Five hundred and ten inpatient departments’ registered nurses represented the four out of six Chinese regional tertiary general hospitals were recruited for main study. All of participants completed six questionnaires, including demographic data combining nurse staffing, work environment, burnout, anticipated turnover, nurses’ job satisfaction, and nurse-assessed quality of nursing care. All questionnaires had acceptable psychometric properties, which included content validity, construct validity, and internal consistency reliability. Structural equation modeling (LISREL 8.72) was used to find out the predictors of quality of nursing care. The results showed that the hypothesis model fit the empirical data and explained 74% of the variance about quality nursing care. (χ2 = 175.73, df = 149, p-value = .052, GFI = .97, AGFI = .95, RMSEA = .02, SRMR = .04, and CFI = 1.00). Nurse work environment directly affected quality nursing care, job satisfaction, intention to leave (.50, .84, -.30, p < .05, respectively). It indirectly affected burnout (-.56, p < .05) through job satisfaction; and intention to leave (-.20, p < .05) through job satisfaction and burnout. Patient to nurse ratio directly affected quality nursing care and intention to leave (-.16, .10, p < .05, respectively). Job satisfaction directly affected burnout (-.67, p < .05), indirect affected quality nursing care through burnout and intention to leave (.42, p < .05), and indirect affected intention to leave (-.38, p < .05) through burnout. Burnout directly affected quality nursing care and intention to leave (-.67, .57, p < .05, respectively). The results indicated that the highest impact factor influencing quality nursing care was the direct effect of burnout, followed by the indirect effect of job satisfaction through burnout and intention to leave and the direct effect of nurse work environment and nurse staffing. Therefore, managers should consider the improvement of all studying variables to increase quality nursing care.