Research has shown that hospitals with better nurse staffing and work environments have better nurse outcomes—less burnout, job dissatisfaction, and intention to leave the job. Many studies, however, have not accounted for wage effects, which may confound findings. By using a secondary analysis with cross-sectional administrative data and a four-state survey of nurses, we investigated how wage, work environment, and staffing were associated with nurse outcomes. Logistic regression models, with and without wage, were used to estimate the effects of work environment and staffing on burnout, job dissatisfaction, and intent to leave. We discovered that wage was associated with job dissatisfaction and intent to leave but had little influence on burnout, while work environment and average patient-to-nurse ratio still have considerable effects on nurse outcomes. Wage is important for good nurse outcomes, but it does not diminish the significant influence of work environment and staffing on nurse outcomes.
AikenL. H.CimiottiJ. P.SloaneD. M.SmithH. L.FlynnL.NeffD. F. (2011) Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Medical Care49(12): 1047–1053.
2.
AikenL. H.ClarkeS. P.SloaneD. M.LakeE. T.CheneyT. (2008) Effects of hospital care environment on patient mortality and nurse outcomes. Journal of Nursing Administration38(5): 223–229.
3.
AikenL. H.ClarkeS. P.SloaneD. M.SochalskiJ.SilberJ. H. (2002) Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA288(16): 1987–1993.
4.
AikenL. H.PatricianP. A. (2000) Measuring organizational traits of hospitals: The Revised Nursing Work Index. Nursing Research49(3): 146–153.
5.
AntonazzoE.ScottA.SkatunD.ElliottR. (2003) The labour market for nursing: A review of the labour supply literature. Health Economics12(6): 465–478.
6.
AshM.SeagoJ. A. (2004) The effect of registered nurses’ unions on heart-attack mortality. Industrial & Labor Relations Review57(3): 422–442.
7.
BlauD. M. (1991) Search for nonwage job characteristics: A test of the reservation wage hypothesis. Journal of Labor Economics9(2): 186–205.
8.
BuerhausP. I. (1991) Economic determinants of annual hours worked by registered nurses. Medical Care29(12): 1181–1195.
9.
BuerhausP. I. (2008) The potential imposition of wage controls on nurses: A threat to nurses, patients, and hospitals. Nursing Economics26(4): 276–279.
10.
BuerhausP. I.DesRochesC.DonelanK.HessR. (2009) Still making progress to improve the hospital workplace environment? Results from the 2008 National Survey of Registered Nurses. Nursing Economics27(5): 289–301.
11.
ChihaY. A.LinkC. R. (2003) The shortage of registered nurses and some new estimates of the effects of wages on registered nurses labor supply: A look at the past and a preview of the 21st century. Health Policy64(3): 349–375.
12.
DallT. M.ChenY. J.SeifertR. F.MaddoxP. J.HoganP. F. (2009) The economic value of professional nursing. Medical Care47(1): 97–104.
13.
DeBacaV.JonesK.TornabeniJ. (1993) A cost-benefit analysis of shared governance. Journal of Nursing Administration23(7–8): 50–57.
14.
EhrenbergR.SmithR. (2008) Modern labor economics: Theory and public policy, 10th ed. Reading, MA: Addison-Wesley.
15.
FochsenG.SjogrenK.JosephsonM.LagerstromM. (2005) Factors contributing to the decision to leave nursing care: A study among Swedish nursing personnel. Journal of Nursing Management13(4): 338–344.
16.
GarcíaI.MolinaJ. A. (1999) How do workers decide their jobs? The influence of income, wage and job characteristics. Managerial and Decision Economics20(4): 189–204.
17.
GlickW. H. (1985) Conceptualizing and measuring organizational and psychological climate: Pitfalls in multilevel research. Academy of Management Review10(3): 601–616.
18.
GreippM. E. (2003) Salary compression: Its effect on nurse recruitment and retention. Journal of Nursing Administration33(6): 321–323.
19.
HareJ.SkinnerD. A. (1990) The relationship between work environment and burnout in nursing home employees. Journal of Long Term Care Administration18(3): 9–12.
20.
HayesL. J.O’Brien-PallasL.DuffieldC.ShamianJ.BuchanJ.HughesF.StoneP. W. (2006) Nurse turnover: A literature review. International Journal of Nursing Studies43(2): 237–263.
21.
JonesC. B. (2004) The costs of nurse turnover: Part 1: An economic perspective. Journal of Nursing Administration34(12): 562–570.
22.
KellyL. A.McHughM. D.AikenL. H. (2011) Nurse outcomes in Magnet® and non-Magnet hospitals. Journal of Nursing Administration41(10): 428–433.
23.
KlopperH. C.CoetzeeS. K.PretoriusR.BesterP. (2012) Practice environment, job satisfaction and burnout of critical care nurses in South Africa. Journal of Nursing Management20(5): 685–695.
24.
KovnerC. T.BrewerC.WuY.-W.ChengY.SuzukiM. (2006) Factors associated with work satisfaction of registered nurses. Journal of Nursing Scholarship38(1): 71–79.
25.
KovnerC. T.BrewerC. S.GreeneW.FairchildS. (2009) Understanding new registered nurses’ intent to stay at their jobs. Nursing Economics27(2): 81–98.
26.
Kutney-LeeA.McHughM. D.SloaneD. M.CimiottiJ. P.FlynnL.NeffD. F.AikenL. H. (2009) Nursing: A key to patient satisfaction. Health Affairs (Millwood)28(4): w669–w677.
27.
Kutney-LeeA.WuE. S.SloaneD. M.AikenL. H. (2013) Changes in hospital nurse work environments on nurse job outcomes: An analysis of panel data. International Journal of Nursing Studies50(2): 195–201.
28.
LakeE. T. (2002) Development of the practice environment scale of the Nursing Work Index. Research in Nursing & Health25(3): 176–188.
29.
LakeE. T.ShangJ.KlausS.DuntonN. E. (2010) Patient falls: Association with hospital Magnet status and nursing unit staffing. Research in Nursing and Health33(5): 413–425.
30.
LakeE. T.StaigerD.HorbarJ.CheungR.KennyM. J.PatrickT.RogowskiJ. A. (2012) Association between hospital recognition for nursing excellence and outcomes of very low-birth-weight infants. Journal of the American Medical Association307(16): 1709–1716.
31.
Larrabee, J. H., Janney, M. A., Ostrow, C. L., Withrow, M. L., Hobbs, G. R., Jr., & Burant, C. (2003). Predicting registered nurse job satisfaction and intent to leave. Journal of Nursing Administration, 33(5), 271–283.
32.
MarkB.HarlessD. W.SpetzJ. (2009) California’s minimum-nurse-staffing legislation and nurses’ wages. Health Affairs (Millwood)28(2): w326–w334.
33.
MarkB. A.LindleyL.JonesC. B. (2009) Nurse working conditions and nursing unit costs. Policy, Politics, and Nursing Practice10(2): 120–128.
34.
MaslachC.JacksonS. E. (1982) Burnout in health professions: A social psychologists analysis. In: SaundersG.SulsJ. (eds) Social psychology of health and illness, Hillsdale, NJ: Lawrence Erlbaum Association, pp. 227–251.
MaslachC.SchaufeliW. B.LeiterM. P. (2001) Job burnout. Annual Review of Psychology52(1): 397–422.
37.
MayJ. H.BazzoliG. J.GerlandA. M. (2006) Hospitals’ responses to nurse staffing shortages. Health Affairs25(4): W316–W323.
38.
McCloskeyJ. (1974) Influence of rewards and incentives on staff nurse turnover rate. Nursing Research23(3): 239–247.
39.
McHughM. D.KellyL. A.SmithH. L.WuE. S.VanakJ.AikenL. H. (2013) Lower mortality in Magnet hospitals. Medical Care51(5): 382–388.
40.
McHughM. D.Kutney-LeeA.CimiottiJ. P.SloaneD. M.AikenL. H. (2011) Nurses’ widespread job dissatisfaction, burnout and frustration with health benefits signal problems for patient care. Health Affairs (Millwood)30(2): 202–210.
41.
NeedlemanJ.HassmillerS. (2009) The role of nurses in improving hospital quality and efficiency: Real-world results. Health Affairs28(4): w625–w633.
42.
Palmer, S. P. (2014). Nurse retention and satisfaction in Ecuador: Implications for nursing administration. Journal of Nursing Management, 22(1), 89–96.
43.
RothbergM. B.AbrahamI.LindenauerP. K.RoseD. N. (2005) Improving nurse-to-patient staffing ratios as a cost-effective safety intervention. Medical Care43(8): 785–791.
44.
ShieldsM. A. (2004) Addressing nurse shortages: What can policy makers learn from the econometric evidence on nurse labour supply?The Economic Journal114(499): F464–F498.
45.
ShieldsM. A.WardM. (2001) Improving nurse retention in the National Health Service in England: The impact of job satisfaction on intentions to quit. Journal of Health Economics20(5): 677–701.
46.
Smith, H. L. (2009). A double sample to minimize bias due to non-response in a mail survey (Population Studies Center Working Paper Series, No. 09-05). Philadelphia: University of Pennsylvania, Population Studies Center.
47.
SpetzJ.AdamsS. (2006) How can employment-based benefits help the nurse shortage?Health Affairs25(1): 212–218.
48.
SpetzJ.GivenR. (2003) The future of the nurse shortage: Will wage increases close the gap?Health Affairs22(6): 199–206.
49.
StaigerD. O.AuerbachD. I.BuerhausP. I. (2012) Registered nurse labor supply and the recession—Are we in a bubble?New England Journal of Medicine366(16): 1463–1465.
50.
StaigerD. O.SpetzJ.PhibbsC. S. (2010) Is there monopsony in the labor market? Evidence from a natural experiment. Journal of Labor Economics28(2): 211–236.
51.
StoneP. W.Mooney-KaneC.LarsonE. L.PastorD. K.ZwanzigerJ.DickA. W. (2007) Nurse working conditions, organizational climate, and intent to leave in ICUs: An instrumental variable approach. Health Services Research42(3 Pt. 1): 1085–1104.
52.
UlrichC.O’DonnellP.TaylorC.FarrarA.DanisM.GradyC. (2007) Ethical climate, ethics stress, and the job satisfaction of nurses and social workers in the United States. Social Science & Medicine65(8): 1708–1719.
53.
VaheyD. C.AikenL. H.SloaneD. M.ClarkeS. P.VargasD. (2004) Nurse burnout and patient satisfaction. Medical Care42(2 Suppl): II57–II66.
54.
WhiteH. (1980) A heteroskedasticity-consistent covariance matrix estimator and a direct test for heteroskedasticity. Econometrica48(4): 817–838.
55.
WilliamsR. L. (2000) A note on robust variance estimation for cluster-correlated data. Biometrics56(2): 645–646.
56.
WoodburyS. A. (1983) Substitution between wage and nonwage benefits. The American Economic Review73(1): 166–182.
57.
ZelauskasB.HowesD. G. (1992) The effects of implementing a professional practice model. Journal of Nursing Administration22(7/8): 18–23.
