Analysis of the work environment and intention of perioperative nurses to quit work

Sillero-Sillero, Amalia; Zabalegui, Adelaida

doi:10.1590/1518-8345.3239.3256

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 28 • 2020 • https://doi.org/10.1590/1518-8345.3239.3256 copy

Analysis of the work environment and intention of perioperative nurses to quit work^* * The publication of this article in the Thematic Series “Human Resources in Health and Nursing: Training and Practice in the Americas” is part of Activity 2.2 of Reference Term 2 of the PAHO/WHO Collaborating Centre for Nursing Research Development, Brazil. Paper extracted from doctoral dissertation “Aplicación de los valores del magnetismo al área quirúrgica de un hospital de alta tecnología”, presented to Universidad Jaume I, Departamento de Ciencias de la Enfermería, Castellon, Spain.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to investigate how the perioperative work environment affects work dissatisfaction, professional exhaustion and the perception of the quality of care about the intention of abandoning the work of perioperative nurses.

Method:

cross-sectional study with 130 nurses working in the surgical area of a high-tech Spanish public university hospital. The scale of the nursing practice environment, Maslach’s exhaustion inventory, the questions about job satisfaction, the perception of the care quality and intention to abandon work to collect data were used. Descriptive, inferential and logistic regression statistics were made.

Results:

in general, 20% of perioperative nurses would want to quit their work. The dimension of the work environment of staff and resources, dissatisfaction and emotional exhaustion in nurses were factors that indicated the intention of perioperative nurses to abandon work.

Conclusion:

the implementation of strategies for the retention of perioperative nurses should be considered, improving the factors that indicate how the work environment, especially the allocation of personnel and resources, dissatisfaction and emotional exhaustion. Creating positive work environments based on magnetic values can be a key strategy.

Descriptors:
Nurse Turnover; Health Facility Environment; Perioperative Nursing; Job Satisfaction; Burnout, Professional; Retention

Subscales-Dimensions PES-NWI^* * PES-NWI = Practice Scale-Nursing Work Index;		M^† † M = Mean; DE^‡ ‡ SD = Standard Deviation.	Range
1: Staff allocation and adequate resources	2.12 (0.65)	2.01	2.23
There are adequate support services	2.67 (1.02)	2.49	2.85
There is enough time and opportunities to expose care problems to other nurses	1.94 (0.84)	1.79	2.08
There are enough nurses to provide care	1.95 (0.85)	1.81	2.10
There is enough staff to do the work	1.92 (0.81)	1.78	2.06
2: Nurse-physician work relationship	2.47 (0.68)	2.35	2.59
Physicians and nurses have a good working relationship	2.75 (0.67)	2.64	2.87
There is a lot of teamwork among medical nurses	2.35 (0.83)	2.21	2.50
There is (joint) collaboration between medical nurses	2.30 (0.89)	2.15	2.45
3: Skill, leadership and support of your guardians	2.27 (0.67)	2.15	2.39
Supervisors support from physicians	2.42 (0.81)	2.28	2.56
The supervisor is a good manager and leader	2.40 (0.89)	2.24	2.56
If they make compliments-recognitions to the work well done	1.92 (0.82)	1.77	2.06
The supervisor supports the decisions of the staff	2.39 (0.87)	2.24	2.54
Supervisors use the errors to learn	2.22 (0.88)	2.07	2.38
4: Nursing fundamentals and quality care	2.65 (0.52)	2.56	2.74
There is continued training for nurses	2.57 (0.93)	2.41	2.73
Management expects high quality nursing care	2.89 (1.18)	2.69	3.10
There is clear philosophy of nursing environment for the patient	2.75 (0.89)	2.60	2.91
If you work with clinically competent nurses	3.51 (0.65)	3.39	3.62
There is an active quality assurance program	2.78 (0.94)	2.62	2.95
There is a guidance program for new nurses	1.77 (0.90)	1.61	1.93
Nurse care is based on a nurse model	3.16 (0.91)	3.00	3.32
Carry out patient care and writing plans	2.59 (1.04)	2.41	2.77
If you plan care to foster your continuity	2.25 (1.06)	2.06	2.43
Nursing diagnoses are used	2.25 (1.04)	2.07	2.43
5: Participation of nurses in hospital matters	1.96 (0.43)	1.88	2.03
There are promotion opportunities at the professional level	1.88 (0.87)	1.73	2.04
There are opportunities in decisions on hospital management	1.33 (0.62)	1.22	1.44
The /A director of nursing is very visible and accessible	1.73 (0.90)	1.57	1.89
Authority nurse direction as other directions.	2.18 (0.94)	2.01	2.34
There are opportunities to ascend	1.65 (0.70)	1.53	1.78
The direction listens and responds to concerns	1.56 (0.73)	1.44	1.69
Nurses get involved in internal management.	2.32 (0.84)	2.18	2.47
Nurses have the opportunity to form the committees	2.75 (0.86)	2.60	2.89
The supervisor consults the staff of daily problems	2.20 (0.93)	2.04	2.36

PES-NWI^ * PES-NWI = Practice Scale-Nursing Work Index; Dimensions*		Mid-level
		Perioperative unit Spanish 2014-2015	RN4Cast^† † RN4Cast Spain (Forecasting Register Nurse in Spain); Hospitals Spain 2012	Magnetic hospitals USA^‡ ‡ USA = United States 2014
1	Allocation of adequate personnel and resources	2.01 - 2.23	2.44 - 2.56	2.65 - 2.88
2	Collegiate relationships between nurse and physician	2.35 - 2,59	1.99 - 2.08	2.99 - 3.07
3	Skill, Leadership and Support of those responsible	2.15 - 2.39	2.42 - 2.61	2.72 - 3.07
4	Nurse fundamentals for the quality of care	2.56 - 2.74	2.37 - 2.45	3.09 - 3.20
5	Nurse participation in hospital affairs	1.88 - 2.03	2.14 - 2.41	2.76 - 3.01
Global		2.20 - 2.40	2.27 - 2.42	2.92 - 3.00

Satisfaction	PES-NWI^* * PES-NWI = Practice Scale-Nursing Work Index;		r Spearman^† † r = Spearman Correlation Coefficient;	r Pearson^‡ ‡ r = Pearson Correlation Coefficient
Satisfaction	Staffing and resources adequacy	Collegial nurse-physician relations	Nurses manager ability, leadership and support of nurse	Nursing foundations for the quality of care	Nurse participation in hospital affairs
Job satisfaction	0.013^† † r = Spearman Correlation Coefficient;	0.135^† † r = Spearman Correlation Coefficient;	0.058^† † r = Spearman Correlation Coefficient;	0.062^† † r = Spearman Correlation Coefficient;	0.139^† † r = Spearman Correlation Coefficient;
Hourly flexibility	-0.127^† † r = Spearman Correlation Coefficient;	0.128^† † r = Spearman Correlation Coefficient;	-0.079^† † r = Spearman Correlation Coefficient;	-0.013^† † r = Spearman Correlation Coefficient;	-0.125^† † r = Spearman Correlation Coefficient;
Opportunity	0.131^† † r = Spearman Correlation Coefficient;	0.096^† † r = Spearman Correlation Coefficient;	0.064^† † r = Spearman Correlation Coefficient;	0.034^† † r = Spearman Correlation Coefficient;	-0.117^† † r = Spearman Correlation Coefficient;
Autonomy	0.083^† † r = Spearman Correlation Coefficient;	0.159^† † r = Spearman Correlation Coefficient;	0.057^† † r = Spearman Correlation Coefficient;	0.048^† † r = Spearman Correlation Coefficient;	0.075^† † r = Spearman Correlation Coefficient;
Salary	-0.184^† † r = Spearman Correlation Coefficient;	0.041^† † r = Spearman Correlation Coefficient;	-0.125^† † r = Spearman Correlation Coefficient;	0.119^† † r = Spearman Correlation Coefficient;	0.049^† † r = Spearman Correlation Coefficient;
Training	0.144 ^† † r = Spearman Correlation Coefficient;	0.076^† † r = Spearman Correlation Coefficient;	0.077^† † r = Spearman Correlation Coefficient;	0.110^† † r = Spearman Correlation Coefficient;	0.095^† † r = Spearman Correlation Coefficient;
Vacation	0.341^† † r = Spearman Correlation Coefficient;	-0.103^† † r = Spearman Correlation Coefficient;	0.033^† † r = Spearman Correlation Coefficient;	-0.072^† † r = Spearman Correlation Coefficient;	-0.057^† † r = Spearman Correlation Coefficient;
Low Diseases	-0.069^† † r = Spearman Correlation Coefficient;	0.044^† † r = Spearman Correlation Coefficient;	-0.113^† † r = Spearman Correlation Coefficient;	0.035^† † r = Spearman Correlation Coefficient;	-0.133^† † r = Spearman Correlation Coefficient;
License studies	0.209^† † r = Spearman Correlation Coefficient;	-0.099^† † r = Spearman Correlation Coefficient;	0.072^† † r = Spearman Correlation Coefficient;	-0.111^† † r = Spearman Correlation Coefficient;	0.052^† † r = Spearman Correlation Coefficient;
Burnout
Emotional exhaustion	-0.206^‡ ‡ r = Pearson Correlation Coefficient	-0.230^‡ ‡ r = Pearson Correlation Coefficient	-0.337^‡ ‡ r = Pearson Correlation Coefficient	-0.249^‡ ‡ r = Pearson Correlation Coefficient	-0.349^‡ ‡ r = Pearson Correlation Coefficient
Depersonalization	-0.098^‡ ‡ r = Pearson Correlation Coefficient	-0.205^‡ ‡ r = Pearson Correlation Coefficient	-0.170^‡ ‡ r = Pearson Correlation Coefficient	-0.202^‡ ‡ r = Pearson Correlation Coefficient	-0.105^‡ ‡ r = Pearson Correlation Coefficient
Personal achievement	-0.237^‡ ‡ r = Pearson Correlation Coefficient	-0.266^‡ ‡ r = Pearson Correlation Coefficient	-0.240^‡ ‡ r = Pearson Correlation Coefficient	-0.355^‡ ‡ r = Pearson Correlation Coefficient	-0.263^‡ ‡ r = Pearson Correlation Coefficient

Variable Intention to abandon work
	β^* * β = Estimated Parameter;	SE^† † SE = Standard Error;	p^‡ ‡ p = Chi-square;	OR^§ § OR risk
Emotional exhaustion	0.168	0.024	0.000	1.113
Dissatisfaction	0.894	0.225	0.000	2.304
Allocation of personnel and resources	-0.446	0.172	0.010	0.640
Constant	0.633	0.672	0.345	-

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding author: Amalia Sillero-Sillero E-mail: amaliasillero@hotmail.com https://orcid.org/0000-0001-6158-161X

*Emotional exhaustion*	N	%
Low level	74	56.9
Mid-level	31	24
High level	25	19
Depersonalization
Low level	102	78
Mid-level	18	14
High level	10	7.7
Personal achievement
Low level	61	46
Mid-level	48	37
High level	21	16
Burnout Global
Low level	77	59.2
Mid-level	47	36.2
High level	6	4.6
Satisfaction	Very Dissatisfied		Dissatisfied	Moderately Satisfied	Very Satisfied
Job satisfaction	3.7 %		74.3 %	22.0 %	0.0 %
Hourly flexibility	2.9 %		52.3 %	34.9 %	10.0 %
Opportunity	2.8%		92.1%	5.1%	0.0 %
Autonomy	5.1 %		77.4 %	9.7 %	7.8 %
Wages	1.3 %		94.6 %	4.1 %	0.0 %
Training	10.7 %		57.9 %	21.6 %	9.8 %
Vacation	1.7 %		78.1 %	20.3 %	0.0 %
Low illness	1.3 %		91.0 %	7.7 %	0.0 %
License for studies	0.0 %		97.9 %	2.1 %	0.0 %
Intention to abandon	Yes 20% (26)			No 80% (110)
Quality of Care	Bad 5% (6)		Regular 24% (30)	Good 61% (79)	Excellent 14% (11)