Introduction: Measures to improve nurses' work environments include ensuring adequate staffing levels, recognising the importance of nursing work, involving nurses in decision-making processes, and improving interprofessional communication. The aim of this study was to analyse the job characteristics reported by nurses and their association with the dimensions of clinical practice environments in hospitals.Methods: A cross-sectional explorative research design was employed. The Slovene-language version of the Practice Environment Scale of the Nursing Work Index (PES-NWI(SI)) and data on nurses' job characteristics were used. A total of 1,010 nurses (403 general care nurses and 605 healthcare assistants) from ten Slovenian general hospitals participated in the study. Permission to conduct the research was granted by the Commission of the Republic of Slovenia for Medical Ethics.Results: The mean score of the PES-NWI(SI) was low (2.64), and the scale reliability was 0.937. The original theoretical five-factor structure was confirmed. The regression model explained the five factors in 26–47% of cases. The explanatory variables included opportunities for advancement, educational opportunities, professional status, satisfaction with current job and work environment, independence at work, and study leave.Discussion and conclusion: The study revealed managers' inadequate ability to ensure sufficient staffing, insufficient involvement of both respondents and managers in hospital affairs, and the lack of promotion opportunities. Creating an optimal work environment for nurses is an important task for managers and leaders. National healthcare policy must consider nurses as equal healthcare professionals and nursing as both a professional and scientific discipline.

Background Healthcare literature suggests that leadership behavior has a profound impact on nurse work-related well-being. Yet, more research is needed to better conceptualize, measure, and analyse the concepts of leadership and well-being, and to understand the psychological mechanisms underlying this association. Combining Self-Determination and Job Demands-Resources theory, this study aims to investigate the association between engaging leadership and burnout and work engagement among nurses by focusing on two explanatory mechanisms: perceived job characteristics (job demands and resources) and intrinsic motivation. Methods A cross-sectional survey of 1117 direct care nurses (response rate = 25%) from 13 general acute care hospitals in Belgium. Validated instruments were used to measure nurses’ perceptions of engaging leadership, burnout, work engagement, intrinsic motivation and job demands and job resources. Structural equation modeling was performed to test the hypothesised model which assumed a serial mediation of job characteristics and intrinsic motivation in the relationship of engaging leadership with nurse work-related well-being. Results Confirmatory factor analysis indicated a good fit of the measurement model. The findings offer support for the hypothesized model, indicating that engaging leadership is linked to enhanced well-being, as reflected in increased work engagement, and reduced burnout. The results further showed that this association is mediated by nurses’ perceptions of job resources and intrinsic motivation. Notably, while job demands mediated the relationship between EL and nurses’ well-being, the relationship became unsignificant when including intrinsic motivation as second mediator. Conclusions Engaging leaders foster a favourable work environment for nursing staff which is not only beneficial for their work motivation but also for their work-related well-being. Engaging leadership and job resources are modifiable aspects of healthcare organisations. Interventions aimed at developing engaging leadership behaviours among nursing leaders and building job resources will help healthcare organisations to create favourable working conditions for their nurses. Trial Registration : The study described herein is funded under the European Union’s Horizon 2020 Research and Innovation programme from 2020 to 2023 (Grant Agreement 848031). The protocol of Magnet4Europe is registered in the ISRCTN registry (ISRCTN10196901).

BackgroundMagnet hospitals, a concept developed in the U.S., have been associated with improved nurse recruitment and retention, and better patient outcomes. Magnet principles may be useful to address workforce challenges in European hospitals, but they have not been implemented or evaluated on a large scale in the European hospital context.ObjectiveThis study aims to explore the initial phase of implementing Magnet principles in 11 acute care hospitals in six European countries. The specific objectives of the study were to investigate the type of work that characterises the early phase of implementation and how implementation leaders engage with their context.MethodsA multinational qualitative study was conducted, with data from 23 semi-structured, one-to-one interviews with implementation leaders in 11 acute care hospitals in six European countries. Thematic analyses guided the analysis of data.FindingsThree themes of core work processes during the early phase of implementing Magnet principles in European hospitals were identified. The first theme, ‘Creating space for Magnet’, describes how work was directed towards creating both political and organisational space for the project. The second theme, ‘Framing to fit: understanding and interpreting Magnet principles’, describes the translational work to understand what the Magnet model entails and how it relates to the local hospital context. Finally, the third theme, ‘Calibrating speed and dose’, describes the strategic work of considering internal and external factors to adjust the process of implementation.ConclusionsThe first phase of implementation was characterised by conceptual and relational work; translating the Magnet concepts, considering the fit into existing structures and practices and making space for Magnet in the local context. Understanding the local context played an important role in shaping and guiding the navigation of professional and organisational tensions. Hospitals employed diverse strategies to either emphasise or downplay the role of nurses and nursing to facilitate progress in the implementation.

OBJECTIVE:This study aimed to compare the prevalence of burnout, missed nursing care, and intention-to-leave the job among nurses working in general care units and intensive care units (ICUs), and to analyse the risk factors for these outcomes between the two groups. DESIGN:This was a cross-sectional study involving online surveys of nurses at participating hospitals conducted between November 2020 and July 2021 as part of the Magnet4Europe initiative. SETTING AND PARTICIPANTS:A convenience sample was recruited, consisting of 67 acute care hospitals in 6 countries: Belgium, England, Germany, Ireland, Norway, and Sweden. In total, data for 1,150 ICU nurses and 5,145 general ward nurses (1,901 from surgical wards and 3,250 from medical wards) were analysed. RESULTS:The prevalence of burnout was significantly lower among nurses in ICUs (27.1 % vs. 30.3 %), missed care from care was significantly less frequent (65.5 % vs. 75.4 %), while intention-to-leave was similar (28.1 % vs. 29.2 %) compared with nurses in general wards. Nurses working in a better work environment and with lower workloads had statistically significant lower rates of burnout and intention-to-leave their job compared to those working in a poorer work environment and with higher workloads. Country-specific analysis showed a higher burnout rate and the intention-to-leave the job for nurses working in Germany, Ireland, Scandinavia, and the England compared to Belgium. CONCLUSIONS:ICU nurses did not have a higher risk of burnout and had significantly lower risks of missing care and intention-to-leave, compared to nurses in general wards. A better work environment and lower perceived workload were consistently associated with reduced risks for all outcomes studied. IMPLICATIONS FOR CLINICAL PRACTICE:National policies should prioritize creating healthy work environments, reducing workloads, and addressing country-specific challenges to lower burnout rates, minimize missed care, and decrease the intention to leave the job among ICU and general ward nurses.

Objective: To examine the prevalence, antecedents and consequences of physician care left undone in acute care hospitals. Design: A multicentre, multinational, cross-sectional survey. An 11 -item scale measured physician reports of care left undone. Antecedent measures examined were work environment and perceived workload. Potential consequences examined included emotional exhaustion, job dissatisfaction and perceived quality of care. Generalized linear mixed models were estimated to quantify associations between physician care left undone and the theorized antecedents and consequences. Setting: 56 acute care hospitals in six European countries. Participants: 1 963 physicians providing direct patient care to adult in -patients. Results: Four in five (78.3 %) physicians left one or more care activities undone during their last shift. On average 3.1 (SD 1.0) of 11 activities were left undone. This varied between and within countries. A 10 % increase at the hospital level of physicians saying they have too much work to do, significantly increased the odds of one or more activities being left undone (OR 1.414, 95 % CI 1.268-1.578). Physicians' reports of care left undone were associated with increased odds of emotional exhaustion (OR 3.867, 95 %CI 2.683-5.575) and rating quality of medical care as poor or fair (OR 3.395, 95 % CI 2.215-5.204). Conclusion: Physicians frequently report leaving some necessary care undone. A shortage of resources compromises physicians' ability to do their jobs, impacting the quality of care they deliver and their job satisfaction and well-being. Ensuring adequate healthcare personnel resources should be a top priority for hospitals.

Objectives To determine the well-being of physicians and nurses in hospital practice in Europe, and to identify interventions that hold promise for reducing adverse clinician outcomes and improving patient safety.Design Baseline cross-sectional survey of 2187 physicians and 6643 nurses practicing in 64 hospitals in six European countries participating in the EU-funded Magnet4Europe intervention to improve clinicians’ well-being.Setting Acute general hospitals with 150 or more beds in six European countries: Belgium, England, Germany, Ireland, Sweden and Norway.Participants Physicians and nurses with direct patient contact working in adult medical and surgical inpatient units, including intensive care and emergency departments.Main outcome measures Burnout, job dissatisfaction, physical and mental health, intent to leave job, quality of care and patient safety and interventions clinicians believe would improve their well-being.Results Poor work/life balance (57% physicians, 40% nurses), intent to leave (29% physicians, 33% nurses) and high burnout (25% physicians, 26% nurses) were prevalent. Rates varied by hospitals within countries and between countries. Better work environments and staffing were associated with lower percentages of clinicians reporting unfavourable health indicators, quality of care and patient safety. The effect of a 1 IQR improvement in work environments was associated with 7.2% fewer physicians and 5.3% fewer nurses reporting high burnout, and 14.2% fewer physicians and 8.6% fewer nurses giving their hospital an unfavourable rating of quality of care. Improving nurse staffing levels (79% nurses) and reducing bureaucracy and red tape (44% physicians) were interventions clinicians reported would be most effective in improving their own well-being, whereas individual mental health interventions were less frequently prioritised.Conclusions Burnout, mental health morbidities, job dissatisfaction and concerns about patient safety and care quality are prevalent among European hospital physicians and nurses. Interventions to improve hospital work environments and staffing are more important to clinicians than mental health interventions to improve personal resilience.

ABSTRACT Introduction Higher nursing workload increases the odds of patient deaths, as the work environment has a significant effect on patient outcomes. The aim of the study was to explore the relation between patient outcomes and nurses’ working conditions in hospitals. Methods Administrative data on discharges of surgical patients for the year 2019 in eight general hospitals and two university medical centres in Slovenia were collected to determine in-hospital mortality within 30 days of admission. The RN4CAST survey questionnaire was used to gather data from nurses in these hospitals, with 1,010 nurses participating. Data was collected at the beginning of 2020. The number of nurses per shift and the nurse-to-patient ratio per shift were calculated. Univariate, bivariate and multivariate statistical methods were used to analyse the data. Results The 30-day in-hospital mortality for surgical patients was 1.00% in the hospitals sampled and ranged from 0.27% to 1.62%. The odds ratio for staffing suggests that each increase of one patient per RN is associated with a 6% increase in the likelihood of a patient dying within 30 days of admission. The mean patient-to-RN ratio was 15.56 (SD=2.50) and varied from 10.29 to 19.39. Four of the 13 tasks checked were not performed on patients during the last shift. Conclusion The results are not encouraging, with an extremely critical shortage of RNs and thus a high RN workload. The number of patients per RN is the highest in Europe and also higher than in some non-European countries, and represents an extreme risk to the quality of nursing and healthcare as a whole. The recommendation for acute non-emergency internal medicine and surgery departments is four patients per RN per shift.

BACKGROUND:Literature shows that the work environment is a main determinant of nurses' well-being and psychological strain; yet, the (psychological) mechanisms underlying this relationship remain understudied. OBJECTIVE:This study explored the underlying (psychological) mechanisms (why) and boundary conditions (when) by which characteristics present in the clinical work environment influence nurses' well-being. We investigated the mediating role of intrinsic motivation in the relationship of job demands and job resources with burnout vs. work engagement. In addition, we examined if job resources strengthen the relationship of job demands with intrinsic motivation and burnout. DESIGN:A cross-sectional survey study. SETTING(S):General acute care hospitals in Belgium (n = 14). PARTICIPANTS:Direct care nurses (n = 1729). METHODS:Data were collected by means of online questionnaires between October 2020 and July 2021. Study variables included burnout, work engagement, intrinsic motivation and a set of different job demands (workload, role conflicts, emotional demands, red tape) and job resources (performance feedback, autonomy, skill use, opportunity for growth, and value congruence). All variables were obtained using self-report measures. The central hypotheses were tested using structural equation modeling. RESULTS:Job resources appeared to be a crucial factor for nurses' health showing positive associations with work motivation (β = 0.513) and work engagement (β = 0.462) and negative associations with burnout (β = -0.216). Job demands remained an essential factor that harms psychological health and is associated with increased burnout (β = 0.489). Our results confirmed that intrinsic motivation mediated the relationship of job resources with work engagement (β = 0.170) and burnout (β = -0.135). In addition, job resources moderated the relationship of job demands with burnout (β = -0.039). Against our expectations, we found no associations between job demands and intrinsic motivation or a moderation effect of job resources on the respective relationship. CONCLUSIONS:A highly demanding work environment can be a source of significant stress which may put nurses' health at severe risk. Nurses who perceive sufficient job resources such as feedback, autonomy and opportunities for growth and development, are likely to feel intrinsically motivated at work. In addition, it will foster their work engagement and prevent them from burning out, particularly when job demands are high. REGISTRATION:The study described herein is funded under the European Union's Horizon 2020 Research and Innovation program from 2020 to 2023 (Grant Agreement 848031). The protocol of Magnet4Europe is registered in the ISRCTN registry (ISRCTN10196901). TWEETABLE ABSTRACT:Providing nurses with sufficient resources will not only increase their motivation and engagement at work but also reduce their feelings of burnout.

Abstract Background Nurses’ work environment influences nursing practice. Inappropriate working conditions are the result of underdeveloped workplace infrastructure, poor work organisation, inadequate education, and inappropriate staffing norms. The aim of this study was to describe and examine the predictors that affect nurses’ work environment using the Practice Environment Scale of the Nursing Work Index (PES-NWI). Methods The validation of the PES-NWI was made. Nurse-reported job characteristics were used as independent variables. The sample included 1,010 nurses from adult surgical and medical units at 10 Slovenian hospitals. The Nurse Forecasting (RN4CAST) protocol was used. Permission to conduct the study was obtained from the National Medical Ethics Committee. Results The PES-NWI mean (2.64) was low, as were job and career satisfaction at 2.96 and 2.89, respectively. The PES-NWI can be explained in 48% with ‘Opportunities for advancement’, ‘Educational opportunities’, ‘Satisfaction with current job’, ‘Professional status’, ‘Study leave’, and ‘Level of education’. A three-factor solution of PES-NWI yielded eight distinct variables. Conclusions The obtained average on the Nursing Work Index was one of the lowest among previously conducted surveys. Nurses should be recognized as equals in the healthcare workforce who need to be empowered to develop the profession and have career development opportunities. Inter-professional relations and equal involvement of nurses in hospital affairs are also very important. Trial registration This is a non-intervention study – retrospectively registered.

Introduction The increasing burden of mental distress reported by healthcare professionals is a matter of serious concern and there is a growing recognition of the role of the workplace in creating this problem. Magnet hospitals, a model shown to attract and retain staff in US research, creates positive work environments that aim to support the well-being of healthcare professionals.Methods and analysis Magnet4Europe is a cluster randomised controlled trial, with wait list controls, designed to evaluate the effects of organisational redesign, based on the Magnet model, on nurses’ and physicians’ well-being in general acute care hospitals, using a multicomponent implementation strategy. The study will be conducted in more than 60 general acute care hospitals in Belgium, England, Germany, Ireland, Norway and Sweden. The primary outcome is burnout among nurses and physicians, assessed in longitudinal surveys of nurses and physicians at participating hospitals. Additional data will be collected from them on perceived work environments, patient safety and patient quality of care and will be triangulated with data from medical records, including case mix-adjusted in-hospital mortality. The process of implementation will be evaluated using qualitative data from focus group and key informant interviews.Ethics and dissemination This study was approved by the Ethics Committee Research UZ/KU Leuven, Belgium; additionally, ethics approval is obtained in all other participating countries either through a central or decentral authority. Findings will be disseminated at conferences, through peer-reviewed manuscripts and via social media.Trial registration number ISRCTN10196901.

BackgroundManagement of temperature, glycaemia and dysphagia, reffered to as the Fever, Sugar, Swallowing (FeSS) protocol, improves outcome in patients with acute stroke. Electronic health records can assist in efficient alignment of such clinical treatment protocol with daily patient care.ObjectivesTo assess the association between the implementation of the FeSS protocol, facilitated by an advanced electronic health record (EHR), and protocol adherence and outcome 90 days after hospital admission.DesignA single centre pre- and post-intervention study amongst patients presenting in the stroke unit within 48 h of onset of symptoms.SettingThe stroke unit of the comprehensive stroke centre at the University Hospitals Leuven, where a standardized care programme for stroke patients is in place.Participants495 patients consecutively admitted in 2018 and 2019 with a diagnosis of ischaemic stroke or intracerebral haemorrhage admitted to the stroke unit, with following criteria: (1) ≥18 years of age on admission, (2) presented within 48 h of onset of symptoms to the stroke unit.MethodsAdvanced EHRs including electronic care planning and documentation offered nurses access to and support from FeSS guidelines at the point of care. We studied: (1) adherence to the protocol by nurses, (2) patient outcome as assessed by the modified Rankin Scale.ResultsThe rate of 90-day death and dependency (modified Rankin Scale ≥2) was lower in the post-intervention group (51.21%) compared to the pre-intervention group (60.34%) (adjusted OR 0.63, 95%CI 0.41-0.97). FeSS elements were more frequently documented in the post-intervention group, particularly temperature monitoring and glycaemia management. However, adherence remained suboptimal, and care plans within the electronic health record were frequently altered by nurses.Discussion and conclusionA multicomponent implementation strategy comprising of traditional implementation strategies and appended by the use of electronic health records facilitated implementation and detailed evaluation of a complex intervention. This implementation was associated with reduced death and dependency. However, a better understanding of the interaction between nurses and the EHR as a means to facilitate their work is of critical importance.