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Nurses’ intention to leave their jobs in relation to work environment factors in Polish hospitals: Cross-sectional study

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Malinowska-Lipień I., Gabryś T., Kózka M., Gniadek A., Brzostek T.
Medycyna Pracy
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2023
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vol. 74
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issue 5
377-387
EN
Background The lack of nursing staff is a current problem not only in Poland, but also in the world. The decision of nurses to leave the workplace, apart from the financial aspect, often results from unfavourable working conditions related to the work environment. Material and Methods The study was multicentre, cross-sectional. The study was conducted among a group of 1509 nurses employed in surgical and internal medicine wards in 21 hospitals in Poland. The key variables of the study were: the intention of the nurses to leave their jobs, the nurses’ working environment, the level of satisfaction, the level of occupational burnout and the number of patients cared for on the last shift, the number of nurses on the last shift. The Practice Environment Scale of the Nursing Work Index (PES-NWI) and the Maslach Burnout Inventory (MBI) questionnaire were used in the research. Results Almost half of the surveyed nurses (48.84%) declared their willingness to leave their current workplace. The statistical analysis showed that nurses declaring their willingness to quit their job in the hospital where they were employed were significantly younger (42.88 vs. 45.04, p = 0.000), had shorter total length of service overall (19.96 vs. 23.20), and also in the hospital where they were employed (15.86 vs. 18.50, p = 0.000). The increase in the number of patients by one was significantly associated with a 1% increase in the risk of leaving work (OR = 1.01, 95% CI 1.00–1.02). An increase in emotional exhaustion significantly increased the risk of leaving work by 2% (OR = 1.02, 95% CI 0.99–1.03). Conclusions Younger age of nurses, greater workload resulting from more patients and occupational burnout – emotional exhaustion is correlated with the risk of leaving work in the hospital. A lower risk of leaving the job is associated with a higher level of job satisfaction in the hospital, salary and promotion opportunities.
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Podwójna praktyka pielęgniarek w Polsce na tle aktualnych zasobów kadrowych

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Malinowska-Lipień I., Gabryś T., Kózka M., Gniadek A., Wadas T., Ozga E., Brzostek T.
Medycyna Pracy
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2021
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vol. 72
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issue 2
113-121
EN
Background: Employment of health care workers simultaneously in 2 workplaces (the so called dual practice) is a common phenomenon in almost every country. In Poland, a possibility of employment in 2 or more workplaces arose with the socio-political changes and the reform of the health care system. In Poland, the scale of the phenomenon, as well as its motifs and potential effects influencing both employees and the whole health care system, are still not known despite numerous studies being conducted to that end. Material and Methods: The study group consisted of 1023 nurses (males and females) employed in public and non-public health care facilities in the territory of the Lesser Poland Voivodeship. The research tool was the authors’ poll questionnaire. In the statistical elaboration, the non-parametric Mann-Whitney U test and the χ2 independence test were used. For all the analyses, the maximum permissible error of type I, α = 0.05, was accepted, and p ≤ 0.05 was recognized as statistically significant. Results: Work experience of the nurses studied ranged 1–43 years, on average it was 23.1 years (SD = 11.1). Persons aged >40 years accounted for 77.5% (N = 793), out of whom 38.2% (N = 391) were aged 41–years and 39.3% (N = 402) >50 years. In the study group, 450 (44%) people were employed in 2 workplaces, out of whom 93.5% in the nurse position, working >160 h/month (39%). A decisive reason to take up an additional job (93.3% of the study group) were financial matters. Conclusions: Financial matters are the main reason for which almost half of the studied nurses undertake additional employment, in the scope twice as high as the work load. Research suggests the need to verify the Central Registry of Nurses and Midwives in order to precisely estimate the number of dual practice positions and the number of persons employed as nurses not only in the south of Poland but also in whole country. The results point to the necessity of further research concerning both the reasons for and consequences of dual practice for nurses, and the impact of this phenomenon on the quality of care and patient safety.
PL
Wstęp: Zatrudnienie pracowników sektora opieki zdrowotnej równolegle w 2 miejscach pracy (tzw. podwójna praktyka) jest powszechnym zjawiskiem niemal we wszystkich krajach. W Polsce możliwość zatrudnienia w ≥2 miejscach pracy pojawiła się wraz ze zmianami polityczno-społecznymi i reformą sytemu opieki zdrowotnej. Mimo że problem ten podlega licznym badaniom, w Polsce nadal nie jest znana skala tego zjawiska, motywy i potencjalne skutki mogące mieć wpływ zarówno na pracowników, jak i na cały system opieki zdrowotnej. Materiał i metody: Badaną grupę stanowiło 1023 pielęgniarek zatrudnionych w publicznych i niepublicznych zakładach opieki zdrowotnej na terenie województwa małopolskiego. Narzędziem badawczym był autorski kwestionariusz (ankieta). W opracowaniu statystycznym wykorzystano nieparametryczny test U Manna-Whitneya oraz test niezależności χ2. Dla wszystkich analiz przyjęto maksymalny dopuszczalny błąd I rodzaju α = 0,05, za statystycznie istotne uznano p ≤ 0,05. Wyniki: Staż pracy badanych pielęgniarek/pielęgniarzy wynosił 1–43 lat, średnio – 23 lata (SD = 11,1). Osoby >40 r.ż. stanowiły 77,5% (N = 793) grupy badanej, w tym 38,2% (N = 391) było między 41 a 50 r.ż. oraz 39,3% (N = 402) to osoby >50 r.ż. Spośród badanych 44,0% (N = 450) pracowało w 2 miejscach pracy, w tym 93,5% na stanowisku pielęgniarki, realizując ponad 160 godz. w miesiącu (39%). Decydującym powodem podjęcia dodatkowego zatrudnienia (93,3% badanych) były względy materialne. Wnioski: Względy finansowe są głównym powodem, dla których prawie połowa badanych pielęgniarek podejmuje dodatkowe zatrudnienie w wymiarze dwukrotnie przekraczającym obciążenie zawodowe. Badania sugerują potrzebę weryfikacji Centralnego Rejestru Pielęgniarek i Położnych (CRPiP) w celu wskazania liczby podwójnych etatów i osób pracujących w zawodzie pielęgniarek nie tylko w południowym regionie Polski, ale i całego kraju. Wyniki obrazują potrzebę prowadzenia dalszych badań dotyczących przyczyn i konsekwencji podwójnego zatrudnienia zarówno dla pielęgniarek, jak i wpływu tego zjawiska na jakość opieki i bezpieczeństwo pacjentów.
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Obciążenie pracą podczas ostatniego dyżuru w opiniach pielęgniarek pracujących w szpitalach objętych projektem RN4CAST

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Cisek M., Przewoźniak L., Kózka M., Brzostek T., Brzyski P., Ogarek M., Gabryś T., Gajda K., Ksykiewicz-Dorota A.
Zdrowie Publiczne i Zarządzanie
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2013
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vol. 11
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issue 2
PL
Workload during the last shift in the opinion of hospital nurses involved in RN4CAST projectBackground The issue of workload is one of the most important ones as far as the nurses’ profession is concerned. Numerous analyses prove the relationship between excessive workload and job dissatisfaction, which may lead to low morale, absenteeism, high rotation and low work efficiency and, consequently, result in deterioration of the care provided to the patient and even put the patient’s safety at risk. RN4CAST project is aimed at the evaluation of the workload which the nurses are exposed to during their shifts. Such a survey focuses on all structural determinants of hospital workload depending on: type of the ward, professional role, number of patients and their health condition as well as work conditions and organization: the number of working hours and shift staffing.Aim of the survey The survey is aimed at determining the factors responsible for the workload which the nurses are exposed to during their shifts in hospitals involved in RN4CAST project.Material and Methods The study included 2605 nurses working in 30 acute hospitals in Poland. The respondents were mainly women. Men made up only 0.4% of the population examined. The average age was 40.3 (SD = 7.8 years old). 23.5% of the respondents had the Bachelor’s degree in nursing. The average seniority was 18.6 years (SD = 8,6), and the seniority in the hospital involved in the survey – 15.6 years (SD = 9,2). The material was collected by means of a survey and a structurised questionnaire completed by the nurses on their own. A correlational model was used to evaluate the workload determinants.Results During their last shift 84% of the nurses worked, on average, 11.3 hours (SD = 2.4). The number of patients on the ward was 31.1, on average (SD = 12.6) it varied significantly (p = 0.000) depending on the ward type. The nursing care was provided by 3.4 qualified nurses on average (SD = 2.2). One nurse was responsible for 20.4 patients on average (SD = 11.1), [median = 18, first quartile (Q1) = 12, third quartile (Q3) = 29)]. It was proved that the increase in the total number of the patients on the ward was accompanied by the increase in the number of patients who required assistance with everyday routines (tau-b = 0.17; p = 0.000) and in the number of patients who required monitoring or hourly (or even more frequent) treatment (tau-b=0.37; p=0.000). Close examination of the variables responsible for individual workload showed that there is a little but noticeable correlation between the increase of the total number of patients on the ward (tau-b = 0.28; p = 0.000) and the increase in the number of patients each nurses was directly responsible for on her shift. There was a positive correlation (tau-b = 0.40; p = 0.000) between the total number of patients and the total number of qualified nurses providing direct care to these patients during their shifts. Also a slight negative correlation was observed (tau-b = –0.061; p = 0.000) between the total number of nurses and the number of patients each nurse was directly responsible for. There was also a slight positive correlation (tau-b = 0.18; p = 0.000) between the number of nurses and the number of helping staff who provided direct care to the patients during their shifts. And also a slight correlation was observed (tau-b = 0.061; p = 0.000) between the number of patients and the number of helping staff during the shifts. The analysis of the findings from both wards leads to the conclusion that the seven most frequent and common routines, which did not require nursing qualifications constituted a significant workload for nurses on all shifts (p = 0,000) and that the nurses who solely provided care to the patients were significantly more often responsible for routines which did not require any professional skills. The nurses examined, evaluated their hospital working conditions as poor – 28.9%; satisfactory – 46.8%; good – 23.2%; excellent – 1.1%. Majority of nurses (59.3%) claim that the number of hospital staff is definitely too low to work efficiently; 64.5% pointed out the lack of qualified nurses and 31.7% the lack of technical and helping staff. Vast majority of nurses (64%) claim that they can rely on the hospital management support only in some situations. Most nurses (77%) complained that their relations with the doctors were not always good, whereas 13.6% complained about lack of good professional relations between nurses and doctors.Conclusions 1. The analysis of the findings shows that structural factors (such as type of the ward, professional role, number and condition of patients) as well as organisational factors (such as number of shift hours, shift staffing and work environment) determined the nurses’ workload. 2. The shift survey as a device for evaluating nurses’ workload should be recommended to ward nurses and hospital management because of the simplicity with which particular elements can be observed. The observation can be carried out during a relatively short period of time (8–12-hour shift), which allows for a better and faster explanation of the reasons of excessive workload and consequently may lead to implementing solutions, which would eliminate this negative phenomenon
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Factors affecting Polish nurses’ willingness to recommend the hospital as a place of care

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Kózka M., Brzostek T., Cisek M., Brzyski P., Przewoźniak L., Gabryś T., Ogarek M., Gajda K., Ksykiewicz-Dorota A.
Medycyna Pracy
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2016
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vol. 67
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issue 4
447-454
PL
Wstęp Pielęgniarki są znaczącą grupą zawodową personelu szpitalnego, która obejmuje pacjentów stałą opieką. Gotowość pielęgniarek do polecenia szpitala, w którym pracują, jako miejsca opieki odzwierciedla ich zaufanie do oferowanej w nim opieki, satysfakcję z pracy i identyfikację z miejscem pracy. Celem badania było określenie, które czynniki środowiska pracy i związane z nimi czynniki zawodowe i/lub osobiste sprawiają, że pielęgniarki rekomendują szpital jako miejsce opieki. Materiał i metody Przekrojowe badania korelacyjne bazowały na anonimowych ankietach uzyskanych od 1723 pielęgniarek pracujących w 30 polskich szpitalach. Dane analizowano przy użyciu modelu regresji logistycznej szacowanego za pomocą uogólnionych równań estymujących. Wyniki Około 25% pielęgniarek nie poleciłoby swojego szpitala jako miejsca opieki. Wynikało to z negatywnej oceny bezpieczeństwa pacjenta (iloraz szans (odds ratio – OR) = 0,28; 95-procentowy przedział ufności (confidence interval – CI): 0,18–0,46; p = 0,00), pogorszenia jakości opieki w roku poprzedzającym badanie (OR = 0,62; 95% CI: 0,41–0,93; p = 0,02), niezadowalających warunków pracy (OR = 0,35; 95% CI: 0,22–0,57; p = 0,00), niezadowalającej współpracy lekarzy z pielęgniarkami (OR = 0,37; 95% CI: 0,25–0,54; p = 0,00), mało elastycznego czasu pracy (OR = 0,74; 95% CI: 0,55–0,99; p = 0,04), ograniczonych możliwości dokształcania się (OR = 0,71; 95% CI: 0,54–0,95; p = 0,02) i wysokiego poziomu depersonalizacji badanych (OR = 1,78; 95% CI: 1,18–1,68; p = 0,00). Wnioski Zarządzający szpitalami powinni wdrożyć strategie, które poprawią bezpieczeństwo pacjentów i warunki pracy personelu. Pozwoli to również stworzyć lepszy i bardziej konkurencyjny wizerunek szpitala w społeczności lokalnej. Med. Pr. 2016;67(4):447–454
EN
Background Nurses constitute the major professional group offering constant hospital patients’ care. Willingness to recommend their hospital reflects confidence in the offered care, satisfaction and identification with the work place. The aim of the present study has been to investigate which elements of hospital environment and nurse personal related factors predict recommendation of the hospital as a place of care by employed nurses. Material and Methods Cross-sectional, correlation study was, based on 1723 self-reported, anonymous questionnaires of nurses working in 30 acute hospitals. Data was analyzed using the logistic regression model, with general estimation equations. Results About 25% of nurses were unwilling to recommend their hospital as the place of care. The odds ratio (OR) of the lack of willingness to recommend the hospital was related to assessment of patients’ safety (OR = 0.28, 95% confidence interval (CI): 0.18–0.46, p = 0.00), decrease in the quality of patient care during the preceding year (OR = 0.62, 95% CI: 0.41–0.93, p = 0.02), overall work conditions (OR = 0.35, 95% CI: 0.22–0.57, p = 0.00), weak cooperation between nurses and physicians (OR = 0.37, 95% CI: 0.25–0.54, p = 0.00), poor work schedule flexibility (OR = 0.74, 95% CI: 0.55– 0.99, p = 0.04) and educational opportunities (OR = 0.71, 95% CI: 0.54–0.95, p = 0.02) and the level of nurses depersonalization (OR = 1.78, 95% CI: 1.18–1.68, p = 0.00). Conclusions The hospital manager should consider strategies which improve patients’ safety and the staff working conditions. Thanks to that they will also achieve better and more competitive image of the hospital in the local community. Med Pr 2016;67(4):447–454
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Organizacja i zakres badań RN4CAST (Registered Nurse Forecasting) dotyczących planowania zatrudnienia w pielęgniarstwie w Polsce

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Przewoźniak L., Kózka M., Cisek M., Gajda K., Brzyski P., Ogarek M., Gabryś T., Brzostek T.
Zdrowie Publiczne i Zarządzanie
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2012
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vol. 10
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issue 4
267–277
PL
The study was conducted as part of European RN4CAST project, with participation of 16 countries, including 12 from Europe. Aim: To develop universal and modern assumptions for the policy of effective nurse employment and management in hospital. Material and method: The study was conducted on a nationally representative sample of 30 hospitals, selected through multi-stage group sampling. Professional satisfactions of nurses working at internal and surgical wards, as well as satisfaction of patients of these wards were tested in a questionnaire study. Data on patient treatment outcomes, and hospital organisation and operation were also collected. Hierarchical linear modelling (HLM) and generalised estimating equations (GEE) were used for statistical analysis. Conclusion: RN4CAST is the first project focused on the hospital and contextual determinants of its operation, which compares Polish results with those from other European states, thanks to a single international study procedure.
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Wpływ struktury zatrudnienia personelu i wybranych czynników organizacyjnych szpitala na wskaźnik zgonów pacjentów hospitalizowanych w szpitalach polskich uczestniczących w projekcie RN4CAST

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Gajda K., Kózka M., Brzyski P., Gabryś T., Przewoźniak L., Cisek M., Ogarek M., Ksykiewicz-Dorota A., Brzostek T.
Zdrowie Publiczne i Zarządzanie
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2012
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vol. 10
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issue 4
297–305
EN
Introduction. Adequate hospital staff employment and assorted organisational circumstances influence outcomes of hospitalised patients. Aim. To analyse influence of hospital staff employment structure and selected organisational circumstances on the death rate of patients hospitalised in acute hospitals. Material and method. Anonymous data of hospitalised patients (fragment of the NHF* report) and of hospital organisational questionnaire were used. The hospital death rate (proportion of hospital deaths to patient admissions) was defined as the dependent variable. The study included 25 hospitals, which provided all the required data. Statistical analysis was conducted in IBM SPSS Statistics 20, using rho Spearman’s rank correlation coefficient for quantitative variables and eta correlation ratio for qualitative variables. Results. The death rate value was adversely correlated with the number of employed physicians, nurses and other not-nursing staff who provided direct patient care. The global number of hospital intensive care units and allocation of separate medical and surgical intensive care units positively influenced the hospital death rate. Conclusions. The number of employed personnel (physician, nurses, and other staff) involved in direct patient care and organization of intensive care in a hospital structure influence the death rate of patients treated in Polish acute hospitals.
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Wybrane czynniki determinujące ocenę jakości opieki pielęgniarskiej w szpitalach pełniących stały dyżur. Wyniki projektu RN4CAST

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Kózka M., Gabryś T., Brzyski P., Ogarek M., Cisek M., Przewoźniak L., Ksykiewicz-Dorota, A., Gajda K., Brzostek T.
Zdrowie Publiczne i Zarządzanie
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2012
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vol. 10
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issue 4
278–288
XX
Introduction. The essence of nursing care is to improve treatment results, patient satisfaction, and decrease treatment costs. Aim. Presenting the factors determining the assessment of nursing care quality in acute hospitals. Material and method. The study included 2605 nurses working in 30 hospitals in Poland. The Work Environment Scale and an opinion questionnaire were used to collect the data. The analysis based on logistic regression model, generalised estimating equations, χ² test, and Mann-Whitney test. Results. Three in every four respondents evaluated the quality of nursing care as good. The assessment depended on the conditions of work, autonomy in providing care, patient information flow, patient safety, occurrence of adverse events, discussion of mistakes, nurse workload, potential for education, and flexible working time. Conclusion. The factors significantly influencing the assessment of nursing care quality are the working environment, care monitoring and management.
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Czynniki wpływające na rekomendację szpitala jako miejsca pracy w opinii pielęgniarek zatrudnionych w polskich szpitalach

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Gabryś T., Kózka M., Brzyski P., Ogarek M., Cisek M., Przewoźniak L., Ksykiewicz-Dorota A., Gajda K., Brzostek T.
Zdrowie Publiczne i Zarządzanie
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2012
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vol. 10
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issue 4
289–296
EN
Introduction. European states observe an increased demand for healthcare services and diminishing numbers of nurses working in the healthcare system. A divergence that may result in future shortages of hospital nursing staff. Aim. Definition of factors that influence readiness to recommend the hospital as place of employment by nurses employed in Polish hospitals. Material and method. Polish part of the RN4CAST protocol, the study uses logistic regression model on data from 2605 questioners from nurses working in 30 Polish hospitals. Results. About half of the responders declared readiness to recommend employment in their hospital. The recommendation depended on working conditions, quality of care, patient safety, and manager interest in professional development of personnel. Higher level of emotional burnout reduced the probability of recommendation. Conclusions. Working conditions, quality of care, patient safety, and potential of professional development are the main factors deciding about the eagerness to recommend employment in one’s hospital.
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