Nurse Practice Environments and Outcomes: Implications for Oncology Nursing
Purpose/Objectives: To examine practice environments and outcomes of nurses working in oncology units or Magnet hospitals and to understand the association between the two.
Design: Secondary analysis of survey data collected in 1998.
Setting: Medical and surgical units of 22 hospitals, of which 7 were recognized by the American Nurses Credentialing Center Magnet program.
Sample: 1,956 RNs, of whom 305 worked in oncology units.
Methods: Chi-square tests compared nurse-reported outcomes by work setting, analysis of variance tested practice environment differences by setting, and logistic regression estimated the effects of practice environment, specialty, and Magnet status on outcomes.
Main Research Variables: Practice environments, emotional exhaustion, job satisfaction, and quality of care.
Findings: Oncology nurses had superior outcomes compared with nononcology nurses. Emotional exhaustion was significantly lower among oncology nurses working in Magnet hospitals. Scores on the Collegial Nurse-Physician Relations subscale were highest among oncology nurses. Outcomes were associated with Practice Environment Scale of the Nursing Work Index scores and Magnet status. Oncology nurses with favorable collegial nurse-physician relations were twice as likely to report high-quality care.
Conclusions: Oncology nurses benefit from working in American Nurses Credentialing Center Magnet hospitals. Adequate staffing and resources are necessary to achieve optimal outcomes. Collegial nurse-physician relations appear to be vital to optimal oncology practice settings.
Implications for Nursing: In addition to pursuing American Nurses Credentialing Center Magnet recognition, nurse managers should assess practice environments and target related interventions to improve job satisfaction and retention. High-priority areas for interventions include ensuring adequate staff and resources, promoting nurse-physician collaboration, and strengthening unit-based leadership.
Jump to a section
References
Aiken, L.H., Clarke, S.P., & Sloane, D.M. (2000). Hospital restructuring: Does it adversely affect care and outcomes? Journal of Nursing Administration, 30, 457-465.
Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J., & Silber, J.H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA, 288, 1987-1993.
Aiken, L.H., Havens, D.S., & Sloane, D.M. (2000). The Magnet nursing services recognition program. American Journal of Nursing, 100(3), 26-35.
Aiken, L.H., Lake, E.T., Sochalski, J.A., & Sloane, D.M. (1997). Design of an outcomes study of the organization of hospital AIDS care. Research in the Sociology of Health Care, 14, 3-26.
Aiken, L.H., & Patrician, P.A. (2000). Measuring organizational traits of hospitals: The revised nursing work index. Nursing Research, 49, 146-153.
Aiken, L.H., & Sloane, D.M. (1997a). Effects of organizational innovations in AIDS care on burnout among urban hospital nurses. work and Occupations, 24, 453-477.
Aiken, L.H., & Sloane, D.M. (1997b). Effects of specialization and client differentiation on the status of nurses: The case of AIDS. Journal of Health and Social Behavior, 38, 203-222.
Aiken, L.H., Sloane, D.M., & Lake, E.T. (1997). Satisfaction with inpatient acquired immunodeficiency syndrome care. A national comparison of dedicated and scattered-bed units. Medical Care, 35, 948-962.
Aiken, L.H., Sloane, D.M., Lake, E.T, Sochalski, J., & Weber, A.L. (1999). Organization and outcomes of inpatient AIDS care. Medical Care, 37, 760-772.
Aiken, L.H., Smith, H.L., & Lake, E.T. (1994). Lower Medicare mortality among a set of hospitals known for good nursing care. Medical Care, 32, 771-787.
American Hospital Association. (2002). In our hands: How hospital leaders can build a thriving workforce. Chicago: Author.
American Nurses Association. (2002). Nursing's agenda for the future: A call to the nation. Washington, DC: Author.
American Nurses Credentialing Center. (2004). Magnet Recognition Program®: Frequently asked questions. Retrieved May 6, 2005, from http://nursingworld.org/ancc/magnet/faqs.html
Cho, S.H., Ketefian, S., Barkauskas, V.H., & Smith, D.G. (2003). The effects of nurse staffing on adverse events, morbidity, mortality, and medical costs. Nursing Research, 52, 71-79.
Clarke, S.P, Sloane, D.M., & Aiken, L.H. (2002). Effects of hospital staffing and organizational climate on needlestick injuries to nurses. American Journal of Public Health, 92, 1115-1119.
Fox, R.C., Aiken, L.H., & Messikomer, C.M. (1990). The culture of caring: AIDS and the nursing profession. Milbank Quarterly, 68(Suppl. 2). 226-256.
Henke-Yarbro, C. (1996). The history of cancer nursing. In R. McCorkle, M. Grant, M. Frank-Stromborg, & S.B. Baird (Eds.), Cancer nursing: A comprehensive textbook (2nd ed., pp. 12-24). Philadelphia: Saunders.
Huber, P.J. (1967). The behavior of maximum likelihood estimates under non-standard conditions. In Proceedings of the Fifth Berkeley Symposium on Mathematical Statistics and Probability (vol. 1, pp. 221-233). Berkeley CA: University of California Press.
Hughes, E.G. (1971). The sociological eye: Selected papers. Chicago: Aldine-Atherton.
Hughes, B.C., Hughes, H.M., & Deutscher, I. (1958). Twenty thousand nurses tell their story: A report on studies of nursing functions: Sponsored by the American Nurses' Association. Philadelphia: Lippincott.
Joint Commission on Accreditation of Healthcare Organizations. (2002). Health care at the crossroads: Strategies for addressing the evolving nursing crisis. Chicago: Author.
Justice, A.C., Aiken, L.H., Smith, H.L., & Turner, B.J. (1996). The role of functional status in predicting inpatient mortality with AIDS: A comparison with current predictors. Journal of Clinical Epidemiology, 49, 193-201.
Kimball, B., & O'Neil, E. (2002). Health care's human crisis: The American nursing shortage. Princeton, NJ: Robert Wood Johnson Foundation.
Kovner, C., Jones, C., Zhan, C., Gergen, P.J., & Basu, J. (2002). Nurse staffing and postsurgical adverse events: An analysis of administrative data from a sample of U.S. hospitals, 1990-1996. Health Services Research, 37, 611-629.
Kramer, M., & Hafner, L.P. (1989). Shared values: Impact on staff nurse job satisfaction and perceived productivity. Nursing Research, 38, 172-177.
Lake, E.T. (1998). Advances in understanding and predicting nurse turnover. Research in the Sociology of Health Care, 15, 147-171.
Lake, E.T. (2002). Development of the Practice Environment Scale of the Nursing Work Index. Research in Nursing and Health, 25, 176-188.
Lamkin, L., Rosiak, J., Buerhaus, P., Mallory, G., & Williams, M. (2001). Oncology Nursing Society workforce survey part I: Perceptions of the nursing workforce environment and adequacy of nurse staffing in outpatient and inpatient oncology settings. Oncology Nursing Forum, 28, 1545-1552.
Lamkin, L., Rosiak, J., Buerhaus, P., Mallory, G., & Williams, M. (2002). Oncology Nursing Society workforce survey part II: Perceptions of the nursing workforce environment and adequacy of nurse staffing in outpatient and inpatient oncology settings. Oncology Nursing Forum, 29, 93-100.
Maslach, C., Jackson, S.E., & Leiter, M.P. (1996). Maslach burnout inventory manual (3rd ed.). Palo Alto, CA: Consulting Psychological Press.
McClure, M.L., Poulin, M.A., Sovie, M.D., & Wandelt, M.A. (1983). Magnet hospitals: Attraction and retention of professional nurses. Kansas City MO: American Nurses Publishing.
Morrison, C. (1987). Nursing perspectives in the care of patients with AIDS: Experience from the AIDS units of the San Francisco General Hospital. In G.P. Wormser (Ed.), AIDS and other manifestations of HIV infection (pp. 1082-1094). Parkridge, NJ: Noyes Publications.
Needleman, J., Buerhaus, P., Mattke, S., Stewart, M., & Zelevinsky, K. (2002). Nurse-staffing levels and the quality of care in hospitals. New England Journal of Medicine, 346, 1715-1722.
Norrish, B.R., & Rundall, T.G. (2001). Hospital restructuring and the work of registered nurses. Milbank Quarterly, 79, 55-79.
Page, A. (Ed.). (2004). Keeping patients safe: Transforming the work environment of nurses. Washington, DC: National Academies Press.
Pearlin, L.I. (1962). Alienation from work: A study of nursing personnel. American Sociological Review, 27, 314-326.
Shortell, S.M., Zimmerman, J.E., Rousseau, D.M., Gillies, R.R., Wagner, D.P., Draper, E.A., et al. (1994). The performance of intensive care units: Does good management make a difference? Medical Care, 32, 508-525.
Spratley, E., Johnson, A., Sochalski, J., Fritz, M., & Spencer, W. (2002). The registered nurse population: March 2000: Findings from the national sample survey of registered nurses. Washington, DC: U.S. Department of Health and Human Services.
Thomas-Hawkins, C., Denno, M., Currier, H., & Wick, G. (2003). Staff nurses' perceptions of the work environment in freestanding hemodialysis facilities. Nephrology Nursing Journal, 30, 169-178.
Urden, L.D., & Monarch, K. (2002). The ANCC Magnet Recognition Program: Converting research findings into action. In M.L. McClure & A.S. Hinshaw (Eds.), Magnet hospitals revisited: Attraction and retention of professional nurses (pp. 103-116). Washington, DC: American Nurses Publishing.
U.S. General Accounting Office. (2001). Nursing workforce: Emerging nurse shortages due to multiple factors (No. GAO-01-944). Washington. DC: Author.
Vahey, D.C., Aiken, L.H., Sloane, D.M., Clarke, S.P., & Vargas, D. (2004). Nurse burnout and patient satisfaction. Medical Care, 42(2, Suppl.). II57-II66.
van Servellen, G., & Leake, B. (1993). Burn-out in hospital nurses: A comparison of acquired immunodeficiency syndrome, oncology, general medical, and intensive care unit nurse samples. Journal of Professional Nursing, 9, 169-177.
White, H. (1982). Maximum likelihood estimation of misspecified models. Econometrica, 50, 1-25.