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Background: It is indicated that healthcare personnel's perceptions of the work environment may reflect the clinical outcomes for the patients they care for. However, the body of evidence is inconsistent when it comes to the association between work environment and surgical site infection., Objectives: The aim of this study is to examine the associations between nurse-reported characteristics of the work environment and incidence of surgical site infections after total hip arthroplasty., Design and Settings: This is a cross-sectional multicentre study conducted in 16 Norwegian hospitals., Participants: Clinical outcomes for 2885 patients >18years that underwent total hip arthroplasty are combined with work environment descriptions from 320 nurses., Materials and Methods: We combine data about surgical site infections from The Norwegian Surveillance System for Antibiotic Consumption and Healthcare-Associated Infections and hospital characteristics such as overall survival probability (from administrative patient data) and nurses' reports of characteristics of the work environment (from a multicentre survey among nurses in Norwegian hospitals). Stepwise mixed-effects logistic regression model was performed to examine the associations between characteristics of the work environment and surgical site infections., Results: The incidence of surgical site infection among 2885 patients undergoing total hip arthroplasty in 16 Norwegian hospitals was 2.6%. Older age, elective procedures and high scores for staffing adequacy were associated with risk for surgical site infection. The association between high scores for adequate staffing and low risk for surgical site infections was present for patients that were admitted for an elective procedure, but not for patients admitted for a non-elective procedure., Conclusion: Our results show that the risk of surgical site infections after elective total hip arthroplasty was lower in hospitals where nurses assessed staffing as adequate. Our findings add to the existing literature that examines the linkage between work environment and clinical outcomes., (Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Health care systems in Finland, Norway and Sweden share many similarities, e.g. full-coverage and tax-financed, with predominately public sector hospitals. Despite similarities, there are differences in the working situations for RNs within these Nordic countries. The aim of this study was to analyze associations between RNs' patient workload and level of involvement in direct patient care, their job satisfaction and intention to leave in these countries., Methods: A workforce survey was conducted through RN4CAST, an EU 7th framework project. The survey included 118 items derived from validated instruments or tested in prior research. Responses from 1133 RNs at 32 Finnish hospitals, 3752 RNs at 35 Norwegian hospitals, and 11 015 RNs at 71 Swedish hospitals comprise the database, which was analyzed using logistic and odds ratio regressions analyses., Results: We found statistically significant differences in RNs' level of involvement in direct patient care (p < 0.001, Sweden compared to Norway and Finland), in patient workload and in number of patients needing ADL assistance and surveillance. A U-formed relationship was found between level of involvement in direct patient care and intention to leave in Sweden, and more satisfaction among RNs in roles with more direct patient care (OR = 1.16, 1.02 ≤ CI95% ≤ 1.32). Nearly half the Finnish sample report intention to leave, with significantly lower levels in Norway and Sweden (p < 0.001). Patient workload is associated with job satisfaction and intention to leave to some degree in all countries, i.e. greater patient workload, less job satisfaction and greater intention to leave., Conclusions: This study suggests that more attention paid to patient mix, workload and role of RNs in patient care might potentially diminish intention to leave and increase job satisfaction in these Nordic countries.

Background: There is a growing body of evidence for associations between the work environment and patient outcomes. A good work environment may maximise healthcare workers' efforts to avoid failures and to facilitate quality care that is focused on patient safety. Several studies use nurse-reported quality measures, but it is uncertain whether these outcomes are correlated with clinical outcomes. The aim of this study was to determine the correlations between hospital-aggregated, nurse-assessed quality and safety, and estimated probabilities for 30-day survival in and out of hospital., Methods: In a multicentre study involving almost all Norwegian hospitals with more than 85 beds (sample size=30, information about nurses' perceptions of organisational characteristics were collected. Subscales from this survey were used to describe properties of the organisations: quality system, patient safety management, nurse-physician relationship, staffing adequacy, quality of nursing and patient safety. The average scores for these organisational characteristics were aggregated to hospital level, and merged with estimated probabilities for 30-day survival in and out of hospital (survival probabilities) from a national database. In this observational, ecological study, the relationships between the organisational characteristics (independent variables) and clinical outcomes (survival probabilities) were examined., Results: Survival probabilities were correlated with nurse-assessed quality of nursing. Furthermore, the subjective perception of staffing adequacy was correlated with overall survival., Conclusions: This study showed that perceived staffing adequacy and nurses' assessments of quality of nursing were correlated with survival probabilities. It is suggested that the way nurses characterise the microsystems they belong to, also reflects the general performance of hospitals., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Objectives: The purpose of this study was to identify organisational processes and structures that are associated with nurse-reported patient safety and quality of nursing., Design: This is an observational cross-sectional study using survey methods., Setting: Respondents from 31 Norwegian hospitals with more than 85 beds were included in the survey., Participants: All registered nurses working in direct patient care in a position of 20% or more were invited to answer the survey. In this study, 3618 nurses from surgical and medical wards responded (response rate 58.9). Nurses' practice environment was defined as organisational processes and measured by the Nursing Work Index Revised and items from Hospital Survey on Patient Safety Culture., Outcome Measures: Nurses' assessments of patient safety, quality of nursing, confidence in how their patients manage after discharge and frequency of adverse events were used as outcome measures., Results: Quality system, nurse-physician relation, patient safety management and staff adequacy were process measures associated with nurse-reported work-related and patient-related outcomes, but we found no associations with nurse participation, education and career and ward leadership. Most organisational structures were non-significant in the multilevel model except for nurses' affiliations to medical department and hospital type., Conclusions: Organisational structures may have minor impact on how nurses perceive work-related and patient-related outcomes, but the findings in this study indicate that there is a considerable potential to address organisational design in improvement of patient safety and quality of care.