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Aim: To detect possible changes in perception of the nurse work environment, job satisfaction and burnout between the years 2009 and 2014 among nurses working in the Spanish National Health System., Background: The global economic crisis has had a great impact on nurses in the Spanish National Health Service: tougher working conditions, lower pay and a reduction in social benefits. It is not known whether these changes affect the nurses' work environment, job satisfaction and burnout., Method: Comparative, cross-sectional study performed in seven hospitals in the Spanish National Health System between 2009 and 2014, through 1,454 surveys of nurses working in internal medicine, surgery and intensive care., Results: Nurses participating in the second period (2012-2014) were more satisfied with their current job (p = 0.001), perceived their work environment to be more favourable (p < 0.001) and had lower levels of burnout (p < 0.01). Professional factors as 'autonomy at work,' 'opportunities for advancement,' 'professional status' and 'nursing foundations for quality care,' as well as 'collegial nurse-physician relations' and 'nurse participation in hospital affairs' were the most important variables associated with these topics., Conclusions: Professional factors may influence these changes more than labour conditions and remuneration aspects., Implications for Nursing Management: In times of economic recession, encouraging interpersonal relationships, autonomy and participation in decision-making may improve the work environment, satisfaction and burnout of nurses., (© 2019 John Wiley & Sons Ltd.)

Aim: The purpose of the present study is to describe the economic context in Spain and its impact on the health care sector and in nursing schools., Background: The global economic crisis is affecting nursing in Spain. This study analyses and compares indicators related to health care and nursing schools among European countries. Some new strategies to cope with the challenges arising from the health care crisis are suggested., Key Issues: Health care costs are increasing as a result of the ageing of the Spanish population, immigration, chronicity of health problems and new medical technology. Nursing education has changed in 2010 from a 3-year diploma programme to a 4-year University degree in Nursing. This change requires new resources involving staff, facilities and equipment, all of which are lacking because of the economic crisis in Spain., Conclusions: The worldwide economic crisis has affected Spain more than it has other European Union (EU) countries. This global crisis has an impact on the health care sector as well on nursing schools., Implications for Nursing Management: It is essential for nursing management to develop creative approaches to maintain cost effective patient care. New programmes and technology must be carefully evaluated in terms of cost effectiveness before being implemented. All health care professionals should be well informed and have a solid understanding of this situation.

Aim: The purpose of the present study was to discuss some of effects of the downturn in the Irish economy and to demonstrate that in the face of economic difficulties innovation in health care is still occurring., Background: Staff that are managing and delivering healthcare need to know the challenges facing them and have an awareness of the importance of maintaining interest in innovative practice in turbulent times., Evaluation: Information obtained from several sources including government papers, the nursing regulatory board and quality authority documents and current best practice articles. Information was evaluated based on the study's aim., Key Issues: Issues emerging were that current challenges facing Irish health care delivery relate mainly to economic, clinical management, education and information technology factors and further reductions in the cost base of health care delivery remains focused on value for money., Conclusions: In the face of the economic downturn Ireland is achieving health targets and is now sitting in 13th place on the European health index, down from number 28 in 2008. This improvement in position has resulted from several new innovative work practices., Implications for Nursing Management: As a result of cost reduction measures in place nurse managers will face greater challenges than ever before in meeting the objectives of the healthcare transformation programme.

Aim: The purpose of this short paper is to identify some of the implications and opportunities nurse managers in England face as a result of the current global economic recession., Background: Government borrowing and poor global economic conditions have combined to create a pound175 billion budget deficit in the UK. The National Health Service in England will be required to make substantial savings in order to help offset this shortfall., Key Issues: This is a brief critical commentary which examines some of the challenges and opportunities for nurse managers in England. It draws on a number of sources to identify key issues concerning nursing management arising from the financial pressures facing health care., Conclusion: The next few years are going to be very difficult for nurses and their managers, however, the current situation also presents opportunities to advance the contribution and influence of nursing and nursing management., Implications for Nursing Management: What nurse managers do next will be crucial in shaping the NHS response to the financial storm and the future nature of health care in England.

Aims: Three levels of impact are reported and discussed in this commentary: the 'macro' level, which corresponds to policy(ies); the 'meso' level, which corresponds to nursing services and nursing education; and the 'micro' level, which deals with clinical practice and education, where interactions between patients and nurses and/or students take place., Background: The Italian economy is showing some signs of recovery after the worst economic crisis of past decades. However, these signs are still quite weak and insufficient to declare that the country is finally coming out of it., Key Issues: Several negative impacts of the economic crisis on nursing services and nursing education are documented. Reports have started to document initial signs of the economical crisis impact on patients too. Present and future issues related to nursing services, education and clinical practice are commented both from national data and from nurses' daily perceptions., Implications for Nursing Management: The Italian economic crisis will leave a heavy burden on the shoulders of future generations. Nurses' leaders are coping with these challenges, innovating the nursing system and preparing a sustainable future for generations of patients and nurses.