Impact of the Work Environment on Nurse Outcomes: A Mediation Analysis

Abstract

Background: The nursing workforce remains in a vulnerable state post pandemic as working conditions are difficult and exacerbated by a global nursing shortage. Identifying factors leading to turnover intentions are thus critical for health care system recovery. Purpose: The purpose of this study was to examine the impact of nurses’ work environment and the pandemic on missed nursing care, scope of practice, emotional exhaustion, and intent to leave. Methods: This study was a cross-sectional, self-reporting online survey, sent to hospital-based nurses in a Canadian province (n = 419). Mediation analysis was used to examine both direct and indirect effects of work environment and COVID-19 impact on nurse outcomes (emotional exhaustion and intent to leave) through missed care and scope of practice. Results: The results showed that 73% of nurses were considering leaving the profession. Several direct and indirect pathways predicted emotional exhaustion and intent to leave. A better work environment was related to both decreased emotional exhaustion and intent to leave. Nurses’ scope of practice partially mediated the relationship between work environment and intent to leave. On the other hand, missed care did not mediate emotional exhaustion or intent to leave. Conclusions: While considering the global nursing shortage, it is imperative to implement strategies to promote nurses’ well-being and their retention within the health care system.