The current nursing shortage, high hospital-nurse job dissatisfaction, and reports of uneven quality of hospital care are not uniquely American phenomena. This article presents reports from 43,000 nurses at more than 700 hospitals in the United States, Canada, England, Scotland, and Germany during 1998 and 1999. Nurses in countries with distinctly different health care systems report similar shortcomings in their work environments and the quality of hospital care. Although nurse and physician competence and nurse-physician relationships appear satisfactory, core problems in work design and workforce management threaten care provision. Resolving these issues, which are amenable to managerial intervention, is essential to preserve patient safety and provide care of consistently high quality.
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