The Impact of Nursing Work Environments on Patient Safety Outcomes: The Mediating Role of Burnout Engagement
Abstract
OBJECTIVE: To test a theoretical model of professional nurse work environments linking conditions for professional nursing practice to burnout and, subsequently, patient safety outcomes. BACKGROUND: The 2004 Institute of Medicine report raised serious concerns about the impact of hospital restructuring on nursing work environments and patient safety outcomes. Few studies have used a theoretical framework to study the nature of the relationships between nursing work environments and patient safety outcomes. METHODS: Hospital-based nurses in Canada (N = 8,597) completed measures of worklife (Practice Environment Scale of the Nursing Work Index), burnout (Maslach Burnout Inventory-Human Service Scale), and their report of frequency of adverse patient events. RESULTS: Structural equation modeling analysis supported an extension of Leiter and Laschinger's Nursing Worklife Model. Nursing leadership played a fundamental role in the quality of worklife regarding policy involvement, staffing levels, support for a nursing model of care (vs medical), and nurse/physician relationships. Staffing adequacy directly affected emotional exhaustion, and use of a nursing model of care had a direct effect on nurses' personal accomplishment. Both directly affected patient safety outcomes. CONCLUSIONS: The results suggest that patient safety outcomes are related to the quality of the nursing practice work environment and nursing leadership's role in changing the work environment to decrease nurse burnout.
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Positive nurse-physician collaborations predict Personal Accomplishment.
“Leiter and Laschinger, who found that positive nurse-physician collaborations predicted Personal Accomplishment [57, 85]”
From Burnout in nursing: a theoretical review. (2020) · cites this paper as [85]
Effective leadership predicts staffing adequacy, which in turn predicts Emotional Exhaustion.
“Effective leadership predicted staffing adequacy, which in turn predicted Emotional Exhaustion [57, 85]”
From Burnout in nursing: a theoretical review. (2020) · cites this paper as [85]
Having the opportunity to participate in policy decisions is associated with reduced burnout on all subscales.
“Two studies on the same sample found that having the opportunity to participate in policy decisions was associated with reduced burnout (all subscales) [57, 85]”
From Burnout in nursing: a theoretical review. (2020) · cites this paper as [85]
When the hospital adopts nursing models of care rather than medical models of care, nurses are more likely to report high levels of Personal Accomplishment.
“When the hospital adopted nursing models of care rather than medical models of care, nurses were more likely to report high levels of Personal Accomplishment [57, 85]”
From Burnout in nursing: a theoretical review. (2020) · cites this paper as [85]
High Depersonalisation and low Personal Accomplishment predict a higher rate of adverse events.
“high DEP and low Personal Accomplishment predicted a higher rate of adverse events [85]”
From Burnout in nursing: a theoretical review. (2020) · cites this paper as [85]
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Early predictors of job burnout and engagement.
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“Fairness has also emerged as a critical factor in administrative leadership (e.g., Laschinger & Leiter, 2006; White, 1987).”
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“This was also found by Leiter and Laschinger, who found that positive nursephysician collaborations predicted Personal Accomplishment [57, 85].”
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- Authors
- Spence Laschinger, H. K., & Leiter, M. P.
- Affiliations
- Western University (CA)
- ORCID
- Leiter, Michael P.
- Venue
- JONA: The Journal of Nursing Administration
- Published
- 2006-05
- Volume
- 36
- Issue
- 5
- Pages
- 259-267
- ISSN
- 0002-0443 (ISSN-L)
- OpenAlex
- W2049298932
- Cited by
- 723
- References
- 5
- Citations by year
- 2026: 19 · 2025: 22 · 2024: 27 · 2023: 24 · 2022: 31 · 2021: 37 · 2020: 45 · 2019: 40 · 2018: 31 · 2017: 59 · 2016: 60 · 2015: 55 · 2014: 55 · 2013: 43 · 2012: 51
- FWCI
- 55.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JONA The Journal of Nursing Administration (publishedVersion)
- PubMed (publishedVersion)
- Figshare (submittedVersion)
- Funders
- U.S. Public Health Service (NRO4513)
- Topics
- Health Sciences › Nursing › Research and Theory › Nursing education and management
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Health Sciences › Nursing › Leadership and Management › Healthcare Education and Workforce Issues
- Keywords
- nursing work environment, patient safety, nurse burnout, emotional exhaustion, nursing leadership, staffing adequacy, nurse-physician relationship, adverse patient events, hospital restructuring, personal accomplishment
- MeSH terms
- Adult, Alberta, Burnout, Professional, Cross-Sectional Studies, Factor Analysis, Statistical, Female, Health Facility Environment, Hospital Restructuring, Humans, Iatrogenic Disease, Leadership, Male, Middle Aged, Models, Theoretical, Nursing Staff, Hospital, Ontario, Personnel Staffing and Scheduling, Models, Nursing, Safety Management
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