Researchers at the University of Pennsylvania School of Nursing (UPSN; Philadelphia, USA) collected survey data from 98,116 bedside care nurses practicing in 1,406 hospitals in 9 countries between 1999 and 2009; the nine countries that participated in the study were China, South Korea, Thailand, Japan, New Zealand, Canada, Germany, the United Kingdom, and the United States. The researchers tracked nurses' responses to questions about staffing-resource adequacy, nurse manager ability and leadership, nurse-physician relations, nurse participation in hospital affairs, and nursing foundations for quality of care.

The results showed that the percentage of nurses reporting high burnout was over a third in most countries and decidedly higher in South Korea and Japan, nearing 60% percent in both countries. Job dissatisfaction varied from 17% in Germany to around a third of nurses in most countries, and a high of 60% dissatisfied in Japan. Almost half of nurses in all countries, except in Germany, and many more than half of the nurses in a few of the countries, lacked confidence that patients could manage their care after discharge.

The researchers also identified that in hospitals with poor work environments the percentage of nurses who believed patients were not prepared for discharge ranged between 22% and 85%. On the other hand, hospitals with better work environments had lower burnout, lower likelihood of job dissatisfaction, and a decrease in reports of little or no confidence of discharge readiness of patients. The researchers suggested that hospital leaders and policy makers improve the nurse workforce and quality of care by increasing staff, improving nurse and physician relations, involving nurses more in hospital decisions, and greater managerial support of those who provide clinical care at the bedside. The study was published in the August 2011 issue of the International Journal for Quality in Health Care.

“How well nurses are faring in their jobs has been found to be a barometer of how well patients in those same hospitals are faring,” said lead author Linda Aiken, PhD, RN, director of the USPN Center for Health Outcomes and Policy Research. “In all countries, more than one in ten nurses report that care is either fair or poor, and in three of four Asian countries studied, nurses' ratings of fair/poor care are much more frequent.”

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