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Background: A growing global nursing shortage has affected the quality of care (QOC) provision. Aim: To test the structure‐process‐outcome model for quality of nursing care in regional medical centres in Thailand. Methods: A cross‐sectional study with multi‐stage, proportional stratified random sampling. The sample comprised 136 units, 916 nurses and 943 patients from nine regional medical centres. Data were collected from six instruments in February–June 2016 and analysed with structural equation modelling. Results: The modified model fitted the empirical data. The nurse practice environment (NPE) had a negative direct effect on pressure ulcer prevalence and a positive direct effect on patient satisfaction, perceived QOC and interpersonal processes of care (IPC). Increasing the patient‐to‐nurse ratio had a positive direct effect on catheter‐associated urinary tract infections and pressure ulcer prevalence and had negative direct effects on patient satisfaction and perceived QOC. Skill mix had negative direct effects on the two former conditions but had a positive direct effect on patient satisfaction. The patient‐to‐nurse ratio and skill mix also had indirect effect on four outcomes via NPE. Limitations: The generalizability of findings may be limited to settings similar to this study. Conclusion: We empirically demonstrated that NPE, patient‐to‐nurse‐ ratio and skill mix had direct effects on unfinished nursing care and four outcomes. Also, the IPC had significant influence on patient satisfaction. Implications for nursing and health policy: The findings add to increasing international evidence that favourable nurse working conditions, low nurse‐to‐patient ratio and richer skill mix result in positive patient outcomes. Health systems can foster nurses to perform high‐quality care by improving work conditions, and providing sufficient nurses and resources. [ABSTRACT FROM AUTHOR]

Background: The nursing shortage is a critical issue in many countries. High turnover rates among nurses is contributing to the shortage, and job dissatisfaction, intention to leave, and burnout have been identified as some of the predictors of nurse turnover. A well‐established body of evidence demonstrates that the work environment for nurses influences nurse job dissatisfaction, intention to leave, and burnout, but there never has been a study undertaken in Thailand to investigate this relationship. Objectives: To investigate how work environment affects job dissatisfaction, burnout, and intention to leave among nurses in Thailand. Methods: The study used a cross‐sectional survey to collect data from 1351 nurses working in 43 inpatient units in five university hospitals across Thailand. The participants completed the Practice Environment Scale of the Nursing Work Index, the Maslach Burnout Inventory, and measures of job dissatisfaction and intention to leave. Logistical regression models assessed the association between work environment and nurse‐reported job dissatisfaction, burnout, and intent to leave. Results: Nurses working in university hospitals with better work environments had significantly less job dissatisfaction, intention to leave, and burnout. Conclusion: The nurse work environment is a significant feature contributing to nurse retention in Thai university hospitals. Implications for nursing and health policy: Improving the work environment for nurses may lead to lower levels of job dissatisfaction, intention to leave, and burnout. Focusing on these nurse outcomes can be used as a strategy to retain nurses in the healthcare system. Addressing the challenges of poor work environments requires coordinated action from policymakers and health managers. [ABSTRACT FROM AUTHOR]