Nurses’ reports of working conditions and hospital quality of care in 12 countries in Europe

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Abstract

Background

Cost containment pressures underscore the need to better understand how nursing resources can be optimally configured.

Objectives

To obtain a snapshot of European nurses’ assessments of their hospital work environments and quality of care in order to identify promising strategies to retain nurses in hospital practice and to avoid quality of care erosions related to cost containment.

Design

Cross sectional surveys of 33,659 hospital medical–surgical nurses in 12 European countries.

Setting

Surveyed nurses provided care in 488 hospitals in Belgium, England, Finland, Germany, Greece, Ireland, the Netherlands, Norway, Poland, Spain, Sweden, and Switzerland.

Participants

All nurses were surveyed from medical-surgical units 30 or more hospitals from geographically representative samples of hospitals in each country, except for Ireland and Norway, where all hospitals were selected, and Sweden, where nearly all hospitals were included by sampling all medical–surgical nurses who were members of the Swedish Nursing Association.

Methods

Percentages are provided for each of the nurse and hospital characteristics reported.

Results

There was wide variation across countries in the percentages of hospital nurses that were bachelor's prepared (range 0–100%), in patient to nurse average workloads (3.7–10.2) and skill mix (54–82% nurses). More than one in five nurses (11–56%) were dissatisfied with their jobs in most countries, and dissatisfaction was pronounced with respect to wages, educational opportunities and opportunities for advancement. Sizable percentages (19–49%) of nurses intended to leave their jobs, though the percentage that thought it would be easy to find another job varied greatly across countries (16–77%). Nurse concerns with workforce management and adequate resources were widespread. While most nurses did not give their hospitals poor grades on patient safety, many doubted that safety was a management priority. Nurses reported that important nursing tasks were often left undone because of lack of time, and indicated that adverse events were not uncommon.

Conclusions

Nurse shortages can be expected when national economies improve unless hospital work environments improve. Wide variation in nurse staffing and skill mix suggests a lack of evidence-based decision making. Additional research is warranted on the impact of these variations in nurse resources on patient outcomes.

Section snippets

Data and methods

The data for this report are from nurse surveys undertaken as part of the RN4CAST study, a cross-sectional study of nurses and patients in 488 general acute care hospitals in 12 European countries (Belgium, England, Finland, Germany, Greece, Ireland, Netherlands, Norway, Poland, Spain, Sweden, and Switzerland). The countries include geographic representation from north, south, east and west in Europe, and include countries with varying levels of resources devoted to healthcare. The number of

Nurse characteristics

Table 1 shows that differences in the average age of the nurses were not pronounced between countries and varied in most countries between 35 and 40 years, with the average age in Poland and Finland being slightly older. Years of experience in nursing varied similarly across most countries within a reasonably tight range of 11–15 years, with the average being slightly less in Norway (8 years) and more in Germany (16 years). Male nurses were notably scarce in Poland and Finland (less than 5%),

Discussion

Nurses’ reports about hospital care in Europe call attention to substantial variation in nursing resources (patient to nurse ratios and skill mix), workforce management deficiencies, and quality of care challenges. While the 12 countries studied differ substantially in national economic conditions and resources devoted to healthcare, nurses in each country identified problems in human resources management in hospitals that if not addressed could substantially impact future hospital nurse

Conclusions

We see in these reports from close to 34,000 nurses practicing in hospitals in 12 European countries strains in the nurse workforce possibly the result of inadequate staffing and resources as well as deficiencies in human resources management. These strains may be the result of austerity measures that simultaneously condense hospital care into shorter stays while holding the size of the nurse workforce constant and/or substituting less expensive workers for nurses. A sizeable fraction of nurses

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