The impact of work environment on workplace violence, burnout and work attitudes for hospital nurses: A structural equation modelling analysis.

We aimed to test a model examining the direct and indirect effects of the work environment on workplace violence, nurse burnout and work attitudes of Chinese hospital nurses. Work environment is a key factor related to nurses' work attitudes. There has been limited information about how the work environment influences nurses' work attitudes. This was a cross-sectional study that included 1,517 hospital nurses in 111 medical/surgical units in 23 hospitals from Guangdong province, China. Structural equation modelling was used to test a hypothesized model that supposed work environment has both direct and indirect effects on work attitudes (e.g. job satisfaction and intention to leave) through workplace violence and nurse burnout. Better work environment was related to higher job satisfaction and lower intention to leave both directly and indirectly through two mediators: workplace violence and burnout. Burnout mediated the association of workplace violence with job satisfaction and intention to leave. Improving work environment would promote nurse safety and subsequently contribute to stabilize the nurse workforce. To help nurses achieve safety and improved work attitudes, nurse managers should build a positive work environment and help nurses who have experienced workplace violence relieve their burnout.

Wu Y ，Wang J ，Liu J ，Zheng J ，Liu K ，Baggs JG ，Liu X ，You L ... -  《-》

Workplace violence against nurses, job satisfaction, burnout, and patient safety in Chinese hospitals.

Most nurses have experienced some form of workplace violence, which could lead to physical or psychological harm and reduced job performance. Previous studies have examined the effects of workplace violence on nurses' job satisfaction and patient safety, but there have been very few examinations of whether workplace violence affects patient safety through nurse job satisfaction and burnout. To investigate the relationships among workplace violence, nurse outcomes and patient safety. To explore whether nurse burnout and job satisfaction play mediating roles in the association of workplace violence and patient safety. A cross-sectional survey was conducted in 23 hospitals in Guangdong province in China to collect data from 1502 nurses. A structural equation model design was tested with validated measurement instruments. Nurse-reported workplace violence was found to be associated directly with higher incidences of burnout, less job satisfaction, lower patient safety and more adverse events. Nurse burnout was associated directly with lower patient safety and more adverse events. Higher nurse job satisfaction was associated directly with higher patient safety. Nurse burnout and job satisfaction played mediating roles in workplace violence and patient safety. The model explained 19.8% and 35.0% of nurse-reported patient safety and adverse events, respectively. It is important for administrators to consider how to protect nurses from workplace violence, to improve their wellbeing at work, and to deliver safe patient care. When nurses experience workplace violence, it is necessary to pay attention to their emotional reactions and job attitudes, and to provide them with support in order to avoid adverse impacts on patient safety. Further practices and research initiatives to support nurses' safety at work are recommended.

Liu J ，Zheng J ，Liu K ，Liu X ，Wu Y ，Wang J ，You L ... -  《-》

The relationship of workplace violence and nurse outcomes: Gender difference study on a propensity score matched sample.

To investigate workplace violence and nurse outcomes by comparing gender differences. A secondary analysis of cross-sectional survey data. Workplace violence was measured by four items from the International Hospital Outcome Study. Nurse outcomes were measured by tools including burnout, job satisfaction and intention to stay. We used propensity score matching to generate a sociodemographic balanced dataset of 108 male and 288 female nurses. A hypothetical relationship model was derived from the affective events theory. Comparative statistics and multi-group structural equation modelling were conducted to analyze gender differences. Data were collected in China from December 2013 - August 2014. Male nurses reported more workplace violence from staff and less intention to stay than females. Besides finding the mediation of burnout sharing with female nurses consistent with the affective events theory, workplace violence was directly linked to less intention to stay in male nurses. Male nurses experience more workplace violence by staff than female nurses. Besides responding emotionally to workplace violence like female nurses, male nurses also respond behaviourally. What problem did the study address? Gender differences in workplace violence and its relationship to nurse outcomes. What were the main findings? Male nurses experienced more workplace violence than female nurses, linked directly to less intention to stay. Workplace violence linked to less job satisfaction and intention to stay in nurses was mediated by burnout. Where and on whom will the research have impact? Gender-based prevention of and coping with workplace violence should be included in nursing training.

Li M ，Liu J ，Zheng J ，Liu K ，Wang J ，Miner Ross A ，Liu X ，Fu X ，Tang J ，Chen C ，You L ... -  《-》

Effects of nurse work environment on job dissatisfaction, burnout, intention to leave.

The nursing shortage is a critical issue in many countries. High turnover rates among nurses is contributing to the shortage, and job dissatisfaction, intention to leave, and burnout have been identified as some of the predictors of nurse turnover. A well-established body of evidence demonstrates that the work environment for nurses influences nurse job dissatisfaction, intention to leave, and burnout, but there never has been a study undertaken in Thailand to investigate this relationship. To investigate how work environment affects job dissatisfaction, burnout, and intention to leave among nurses in Thailand. The study used a cross-sectional survey to collect data from 1351 nurses working in 43 inpatient units in five university hospitals across Thailand. The participants completed the Practice Environment Scale of the Nursing Work Index, the Maslach Burnout Inventory, and measures of job dissatisfaction and intention to leave. Logistical regression models assessed the association between work environment and nurse-reported job dissatisfaction, burnout, and intent to leave. Nurses working in university hospitals with better work environments had significantly less job dissatisfaction, intention to leave, and burnout. The nurse work environment is a significant feature contributing to nurse retention in Thai university hospitals. Improving the work environment for nurses may lead to lower levels of job dissatisfaction, intention to leave, and burnout. Focusing on these nurse outcomes can be used as a strategy to retain nurses in the healthcare system. Addressing the challenges of poor work environments requires coordinated action from policymakers and health managers.

Nantsupawat A ，Kunaviktikul W ，Nantsupawat R ，Wichaikhum OA ，Thienthong H ，Poghosyan L ... -  《-》

Workplace violence, job satisfaction, burnout, perceived organisational support and their effects on turnover intention among Chinese nurses in tertiary hospitals: a cross-sectional study.

Our aims were to assess the relationship between workplace violence, job satisfaction, burnout, organisational support and turnover intention, and to explore factors associated with turnover intention among nurses in Chinese tertiary hospitals. The purposive sampling method was used to collect data from August 2016 through January 2017. A total of 1761 nurses from 9 public tertiary hospitals in 4 provinces (municipalities) located in eastern (Beijing), central (Heilongjiang, Anhui) and western (Shaanxi) regions of China completed the questionnaires (effective response rate=85.20%). A cross-sectional study was conducted using the Workplace Violence Scale, Chinese Maslach Burnout Inventory General Survey, Minnesota Job Satisfaction Questionnaire Revised Short Version, Perceived Organizational Support-Simplified Version Scale and Turnover Intention Scale. A total of 1216 of 1706 (69.1%) participants had high turnover intention. During the previous 12 months, the prevalence of physical violence and psychological violence towards nurses was 9.60% and 59.64%, respectively. As expected, the level of turnover intention was negatively correlated with participants' scores on job satisfaction (r=-0.367, p<0.001) and perceived organisational support (r=-0.379, p<0.001), respectively. Burnout was positively associated with turnover intention (r=0.444, p<0.001). Workplace violence was positively associated with turnover intention (β=0.035, p<0.001) in linear regression analysis. The total effect (β=0.53) of workplace violence on turnover intention comprised its direct effect (β=0.36) and its indirect effect (β=0.17). Perceived organisational support served as a mediator between workplace violence, job satisfaction, burnout and turnover intention, and it had a significantly negative impact on turnover intention. Therefore, nursing managers should understand the importance of the organisation's support and establish a reasonable incentive system to decrease turnover intention.

Liu W ，Zhao S ，Shi L ，Zhang Z ，Liu X ，Li L ，Duan X ，Li G ，Lou F ，Jia X ，Fan L ，Sun T ，Ni X ... -  《BMJ Open》