Factors influencing quality nursing care at hospitals in Indonesia

Abstract

The study investigated whether patient-to-nurse ratio, working hours, nurse competence, environment, nurse satisfaction, and turnover intention influence inpatient quality nursing care in Indonesian hospitals. Aiken’s model and empirical evidence were adapted to construct the framework. A cross-sectional design and multistage sampling were employed. Five hundred-fifty registered inpatient department nurses from June to October 2022. They were involved in completing the seven-part questionnaires, include a demographic questionnaire, nurse staffing measurement form, Good Nursing Care Scale, Nurse Competence Scale, Practice Environment Scale, McCloskey/Mueller Satisfaction Scale, and Anticipated Turnover Scale. All questionnaires had acceptable psychometric properties, which included content validity, construct validity, and internal consistency reliability. Structural equation modeling was used to find out the predictors of quality nursing care.

The results specified that the model fits the empirical data and explained 67% of the variance about nursing care quality (χ2 = 975.50, df = 351, χ2/df = 2.78, p-value = .00, GFI = .88, AGFI = .86, RMSEA = .06, SRMR = .03, and CFI = .99, NFI = .98). The structural equation modeling results showed nurse competence, work environment, and nurse satisfaction had a significant positive direct impact on quality nursing care (γ = .51 and .31, β = .12, p < .05 respectively). The environment had a significant indirect effect positively on quality nursing care through job satisfaction. However, the patient-to-nurse ratio and working hours had no impact on nursing care quality. Additionally, the turnover intention is against the hypothesis.