The nursing practice environment and nurse job outcomes: A path analysis of survey data

Aims and objectives To assess the nursing practice environments and nurse job-related outcomes in two types of hospitals in Saudi Arabia. Background The nursing shortage is a challenging problem in Saudi hospitals. Studies have shown that poor practice environments and high patient-to-nurse ratios are associated with poor nurse job outcomes (i.e. job dissatisfaction, burnout and intention to leave) and that can lead to nurse turnover and compound the nursing shortage. However, little research has been conducted on this topic in Saudi Arabia. Design A cross-sectional design. A model that links the nursing practice environment and patient-to-nurse ratio to nurse job outcomes was tested through a path analysis of survey data. Methods A sample of 404 nurses from public and military hospitals in Saudi Arabia completed a survey that included the Practice Environment Scale of the Nursing Work Index, the Maslach Burnout Inventory and questions related to job dissatisfaction and intention to leave the job. A model of nurse turnover was used to test the relationships among study variables. This study was carried out in accordance with the STROBE checklist for cross-sectional studies. Results The nursing practice environment and nurse job outcomes were better in military hospital compared with public hospital. Overall, 53% of participants had high burnout, 39% were dissatisfied, and 26% intended to leave their jobs. The path analysis showed that the nursing practice environment and patient-to-nurse ratio were predictors of burnout and job dissatisfaction, which in turn lead to intention to leave. The tested model had good fit and explained the direct and indirect effects of study variables. Conclusion Poor nursing practice environments and high patient-to-nurse ratios contribute to poor nurse job outcomes in Saudi hospitals. Relevance to clinical practice Nurse leaders can focus on enhancing practice environments and reducing patient-to-nurse ratios as retention strategies to improve nurse job outcomes.