Effects of nursing work environment on work-related outcomes among psychiatric nurses: A mediating model

WHAT IS KNOWN ON THE SUBJECT?: The shortage of psychiatric nurses has become a focus problem attracting widespread concern. And the continuous improvement of quality of psychiatric care has always been a priority in psychiatric units. Previous studies about nurses from general hospitals indicated nursing work environment was a key factor affecting work-related outcomes, but little attention was paid to psychiatric nurses and few studies focused on the five specific dimensions of nursing work environment. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Nurse participation in hospital affairs was the dimension with the highest proportion of participants dissatisfied. Nursing work environment and all its five dimensions had significant effects on work-related outcomes, which were partly mediated by work engagement. For nurse-perceived quality of care, collegial nurse-physician relations showed the largest effect; while for turnover intention, the two dimensions of nurse participation in hospital affairs and nursing foundations for quality of care showed larger effects. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Corresponding measures should be taken to improve nursing work environment, especially in the aspect of nurse participation in hospital affairs by promoting nurses' ability to participate, arousing their motivation to participate and offering them more opportunities to participate. Harmonious collegial relationship should be built by creating an atmosphere of equality, respect and collaboration, and enhancing the communication between doctors and nurses. Nursing foundations for quality of care need to be further improved through setting appropriate rules and regulations to ensure the quality of care and offering more opportunities to support nursing staff's growth and development. ABSTRACT: Introduction With the increasing demand for high-quality psychiatric care, it is imperative to improve psychiatric nurses' work engagement and work-related outcomes. Nursing work environment has been identified as a protective factor in non-psychiatric nurses, but little was known about psychiatric nurses. Aims To identify the situation of nursing work environment, work engagement, nurse-perceived quality of care and turnover intention among psychiatric nurses, and examine the relationship among them. Methods A cross-sectional design was adopted. Questionnaire investigation was implemented among psychiatric nurses from 43 clinical units. Structural equation modelling and path analysis were used to examine the causal relationship among variables. Results The results showed 19.06% of participants were not satisfied with the overall work environment and 24.34% were not satisfied with the dimension of nurse participation in hospital affairs. Hypothesis testing results indicated that nursing work environment and its five dimensions had positive effects on nurse-perceived quality of care and negative effects on turnover intention, which were both partly mediated by work engagement. Discussion Supportive nursing work environment could improve nurses' work engagement, enhance nurse-perceived quality of care and reduce nurses' turnover intention. Implications for Practice Continuous efforts should be paid to the improvement of nursing work environment in psychiatric hospitals.