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Nurses around the world are among the least satisfied workers, and the problem is getting worse

American consumers' trust in hospitals is not as strong as it once was, nurses feel that they are under siege, and hospitals are having a hard time finding enough nurses willing to work under current hospital conditions. However, nurses in countries with distinctly different health care systems report similar burnout, shortcomings in their work environments, and concern about quality of hospital care.

This international problem suggests a fundamental flaw in the design of clinical care services and management of the hospital workforce. Resolving these issues is essential to preserving patient safety and quality of care, asserts Linda H. Aiken, Ph.D., R.N., of the University of Pennsylvania School of Nursing. In a study that was supported in part by the Agency for Healthcare Research and Quality, Dr. Aiken and her colleagues examined reports from 43,000 nurses from more than 700 hospitals in the United States, Canada, England, Scotland and Germany in 1998 and 1999.

The reports revealed that just under 30 percent to more than 40 percent of nurses in all countries except Germany had high burnout scores on a standard burnout scale. Also, more than 3 in 10 nurses in England and Scotland and more than 2 in 10 in the United States planned on leaving their jobs within the next year. Only 30 to 40 percent of nurses said that there were enough registered nurses to provide high-quality care and enough staff to get the work done. Fewer than half of the nurses in each country reported that management in their hospitals was responsive to their concerns, provided opportunities for nurses to participate in decisions, and acknowledged nurses' contributions to patient care.

Despite caring for sicker patients, U.S. and Canadian nurses said the number of patients assigned to them had increased in the past year. Also, in North America front-line nursing managers and support staff have been eliminated in a number of hospitals, with staff nurses taking up the slack at the expense of direct patient care. Not surprisingly, only one in nine nurses in Germany and one in three nurses in the remaining countries rated the quality of nursing care provided on their units as excellent. To retain a qualified nurse staff, hospitals need to develop personnel policies comparable to those in other lines of work, conclude the researchers.

See "Nurses' reports on hospital care in five countries," by Dr. Aiken, Sean P. Clarke, Douglas M. Sloane, Ph.D., and others, in the May 2001 Health Affairs 20(3), pp. 43-53.

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