Nurse practice environment, workload, burnout, job outcomes, and quality of care in psychiatric hospitals: a structural equation model approach
Article first published online: 19 SEP 2012
© 2012 Blackwell Publishing Ltd
Journal of Advanced Nursing
Volume 69, Issue 7, pages 1515–1524, July 2013
How to Cite
2013) Nurse practice environment, workload, burnout, job outcomes, and quality of care in psychiatric hospitals: a structural equation model approach. Journal of Advanced Nursing 69(7), 1515–1524.doi: 10.1111/jan.12010, , & (
- Issue published online: 3 JUN 2013
- Article first published online: 19 SEP 2012
- Manuscript Accepted: 11 AUG 2012
- job satisfaction;
- mental health care;
- nurse practice environment;
- nurse retention;
- quality of care;
- structural equation modelling
To study the relationships between nurse practice environment, workload, burnout, job outcomes and nurse-reported quality of care in psychiatric hospital staff.
Nurses' practice environments in general hospitals have been extensively investigated. Potential variations across practice settings, for instance in psychiatric hospitals, have been much less studied.
A cross-sectional design with a survey.
A structural equation model previously tested in acute hospitals was evaluated using survey data from a sample of 357 registered nurses, licensed practical nurses, and non-registered caregivers from two psychiatric hospitals in Belgium between December 2010–April 2011. The model included paths between practice environment dimensions and outcome variables, with burnout in a mediating position. A workload measure was also tested as a potential mediator between the practice environment and outcome variables.
An improved model, slightly modified from the one validated earlier in samples of acute care nurses, was confirmed. This model explained 50% and 38% of the variance in job outcomes and nurse-reported quality of care respectively. In addition, workload was found to play a mediating role in accounting for job outcomes and significantly improved a model that ultimately explained 60% of the variance in these variables.
In psychiatric hospitals as in general hospitals, nurse–physician relationship and other organizational dimensions such as nursing and hospital management were closely associated with perceptions of workload and with burnout and job satisfaction, turnover intentions, and nurse-reported quality of care. Mechanisms linking key variables and differences across settings in these relationships merit attention by managers and researchers.