Background
Methods
Sample
Patients (n) | Employees total (n) | Employees ≤ 20% & leave (n) | Employees > 20% invited (n) | Respondents (n) | Response rate (%) | |
---|---|---|---|---|---|---|
Nursing home 1 | 46 | 80 | 26 | 54 | 39 | 72.2 |
Nursing home 2 | 38 | 65 | 17 | 48 | 29 | 60.4 |
Nursing home 3 | 92 | 201 | 51 | 150 | 95 | 63.3 |
Nursing home 4 | 101 | 215 | 92 | 123 | 70 | 56.9 |
Nursing home 5 | 89 | 204 | 116 | 88 | 55 | 62.5 |
Total | 366 | 765 | 302 | 463 | 288 | 62.2 |
Number | Percent | ||
---|---|---|---|
Profession | Registered nurse | 78 | 30 |
Nursing assistant | 124 | 47 | |
Health worker | 41 | 16 | |
Kitchen personnel | 7 | 3 | |
Laundry personnel | 3 | 1 | |
Secretary | 1 | 0.4 | |
Other personnel | 9 | 3 | |
Missing | 25 | ||
Gender | Female | 241 | 94 |
Male | 16 | 6 | |
Missing | 31 | ||
Age | ≤ 30 years | 47 | 18 |
31–40 years | 44 | 17 | |
41–50 years | 65 | 25 | |
51–60 years | 78 | 30 | |
≥ 61 years | 30 | 11 | |
Missing | 24 | ||
Work experience in total | ≤ 5 years | 44 | 17 |
6–10 years | 29 | 11 | |
11–20 years | 60 | 23 | |
21–30 years | 68 | 26 | |
31–40 years | 56 | 21 | |
≥ 41 years | 9 | 3 | |
Missing | 22 | ||
Work experience in nursing home | ≤ 2 years | 59 | 22 |
3–5 years | 60 | 22 | |
6–10 years | 56 | 21 | |
11–20 years | 57 | 21 | |
21–30 years | 30 | 11 | |
≥ 31 years | 6 | 2 | |
Missing | 20 | ||
Position job | 21–40% | 30 | 12 |
41–60% | 42 | 16 | |
61–80% | 78 | 30 | |
≥ 81% | 107 | 42 | |
Missing | 31 | ||
Norwegian native speaker | Yes | 226 | 83 |
No | 47 | 17 | |
Missing | 15 |
Translation procedures
Scoring
Hypothesized factor structure
Teamwork climate | Nurse input is well received in this office |
In this office, it is difficult to speak up if I perceive a problem with patient care. | |
Disagreements in this office are resolved appropriately (i.e., not who is right but what is best for the patient). | |
I have the support I need from other personnel to care for patients. | |
It is easy for personnel in this office to ask questions when there is something that they do not understand. | |
The physicians and nurses here work together as a well-coordinated team. | |
Safety climate | I would feel safe being treated here as a patient. |
Medical errors are handled appropriately in this office. | |
I receive appropriate feedback about my performance. | |
In this office, it is difficult to discuss errors. | |
I am encouraged by my colleagues to report any patient safety concerns I may have. | |
The culture in this office makes it easy to learn from the errors of others. | |
I know the proper channels to direct questions regarding patient safety in this office. | |
Working conditions | This office does a good job of training new personnel. |
All the necessary information for diagnostic and therapeutic decisions is routinely available to me. | |
This office deals constructively with problem personnel. | |
Trainees in my discipline are adequately supervised. | |
Job satisfaction | I like my job. |
Working in this office is like being part of a large family. | |
This office is a good place to work. | |
I am proud to work at this office. | |
Morale in this office is high. | |
Perceptions of management | The management of this office supports my daily efforts. |
Office management does not knowingly compromise the safety of patients. | |
The levels of staffing in this office are sufficient to handle the number of patients. | |
I am provided with adequate, timely information about events in the office that might affect my work. | |
Stress recognition | When my workload becomes excessive, my performance is impaired. |
I am less effective at work when fatigued. | |
I am more likely to make errors in tense or hostile situations. | |
Fatigue impairs my performance during emergency situations (e.g. code or cardiac arrest). |
Data collection
Statistical analysis
Ethical considerations
Results
Statement | Missing/NAa n (%) | Median scoreb (range) | Mean scoreb (SDc) |
---|---|---|---|
1. High levels of workload are common in this nursing home ward. | 13 (4.5) | 5 (1–5) | 4.5 (0.9) |
2. I like my job.
|
3 (1.0)
|
5 (1–5)
|
4.7 (0.7)
|
3. Input from personnel is well received in this nursing home ward.
|
11 (3.8)
|
4 (1–5)
|
3.9 (1.0)
|
4. I would feel safe being treated here as a patient.
|
9 (3.1)
|
4 (1–5)
|
4.1 (1.0)
|
5. Medical errors are handled appropriately in this nursing home ward.
|
30 (10.4)
|
4 (1–5)
|
4.0 (1.1)
|
6. This nursing home ward does a good job of training new personnel.
|
11 (3.8)
|
4 (1–5)
|
3.9 (1.1)
|
7. All the necessary information for diagnostic and therapeutic decisions is routinely available to me.
|
26 (9.1)
|
4 (1–5)
|
3.8 (1.1)
|
8. Working in this nursing home ward is like being part of a large family.
|
16 (5.5)
|
4 (1–5)
|
3.7 (1.3)
|
9. Senior management of this nursing home ward is doing a good job.
|
16 (5.6)
|
4 (1–5)
|
3.8 (1.1)
|
10. The management of this nursing home ward supports my daily efforts.
|
14 (4.8)
|
4 (1–5)
|
3.9 (1.1)
|
11. I receive appropriate feedback about my performance.
|
7 (2.4)
|
4 (1–5)
|
3.7 (1.2)
|
12
d
. In this nursing home ward, it is difficult to discuss errors.
|
15 (5.2)
|
3 (1–5)
|
3.2 (1.3)
|
13. Briefing other personnel before a procedure (e.g., wound care) is important for patient safety. | 18 (6.3) | 5 (1–5) | 4.6 (0.8) |
14. Briefings are common in this nursing home ward. | 18 (6.2) | 4 (1–5) | 3.7 (1.1) |
15. This nursing home ward is a good place to work.
|
11 (3.8)
|
5 (1–5)
|
4.3 (0.9)
|
16. Communication breakdowns which lead to delays in delivery of care are common. | 32 (11.2) | 3 (1–5) | 2.8 (1.3) |
17. The nursing home ward management does not knowingly compromise the safety of patients. | 40 (13.9) | 4 (1–5) | 3.7 (1.3) |
18. The levels of staffing in this nursing home ward are sufficient to handle the number of patients. | 20 (6.9) | 4 (1–5) | 2.6 (1.3) |
19. Decision making in this nursing home ward utilizes input from relevant personnel. | 25 (8.7) | 4 (1–5) | 3.8 (1.0) |
20. I am encouraged by my colleagues to report any patient safety concerns I may have.
|
29 (10.1)
|
4 (1–5)
|
4.0 (1.1)
|
21. The culture in this nursing home ward makes it easy to learn from the errors of others.
|
15 (5.2)
|
4 (1–5)
|
3.8 (1.1)
|
22. This nursing home ward deals constructively with problem personnel.
|
16 (5.6)
|
4 (1–5)
|
3.5 (1.2)
|
23. The medical equipment in this nursing home ward is adequate. | 26 (9.0) | 4 (1–5) | 3.4 (1.1) |
24
d
. In this nursing home ward, it is difficult to speak up if I perceive a problem with patient care.
|
23 (8.0)
|
4 (1–5)
|
3.4 (1.3)
|
25. When my workload becomes excessive, my performance is impaired.
|
10 (3.4)
|
4 (1–5)
|
4.0 (1.2)
|
26. I am provided with adequate, timely information about events in the nursing home ward that might affect my work.
|
17 (5.9)
|
4 (1–5)
|
3.8 (1.1)
|
27. I have seen others make errors that had the potential to harm patients. | 23 (8.0) | 3 (1–5) | 2.7 (1.5) |
28. I know the proper channels to direct questions regarding patient safety in this nursing home ward.
|
19 (6.6)
|
5 (1–5)
|
4.1 (1.2)
|
29. I am proud to work at this nursing home ward.
|
8 (2.8)
|
5 (1–5)
|
4.3 (0.9)
|
30. Disagreements in this nursing home ward are resolved appropriately (i.e., not who is right but what is best for the patient). |
16 (5.6)
|
4 (1–5)
|
4.0 (1.1)
|
31. I am less effective at work when fatigued.
|
10 (3.5)
|
4 (1–5)
|
4.0 (1.2)
|
32. I am more likely to make errors in tense or hostile situations.
|
15 (5.2)
|
4 (1–5)
|
3.8 (1.3)
|
33. Stress from personal problems adversely affects my performance.
|
24 (8.3)
|
4 (1–5)
|
3.3 (1.4)
|
34. I have the support I need from other personnel to care for patients.
|
16 (5.6)
|
5 (1–5)
|
4.3 (1.0)
|
35. It is easy for personnel in this nursing home ward to ask questions when there is something that they do not understand. | 23 (8.0) | 5 (1–5) | 4.3 (1.0) |
36. Disruptions in the continuity of care can be detrimental to patient safety. | 27 (9.4) | 5 (1–5) | 4.3 (1.0) |
37. During emergencies, I can predict what other personnel are going to do next. | 27 (9.4) | 4 (1–5) | 3.7 (1.0) |
38. The physicians and nurses here work together as a well-coordinated team. | 42 (14.6) | 4 (1–5) | 4.0 (1.0) |
39. I am frequently unable to express disagreement with staff physicians in this nursing home ward. | 92 (31.9) | 3 (1–5) | 2.5 (1.3) |
40. Truly professional personnel can leave personal problems behind when working. | 23 (8.0) | 5 (1–5) | 4.2 (1.1) |
41. Morale in this nursing home ward is high.
|
10 (3.5)
|
5 (1–5)
|
4.3 (1.0)
|
42. Trainees in my discipline are adequately supervised.
|
25 (8.7)
|
4 (1–5)
|
4.1 (1.0)
|
43. I know the first and last names of all the personnel I worked with during my last shift. | 19 (6.6) | 4 (1–5) | 3.9 (1.4) |
44. I have made errors that had the potential to harm patients. | 28 (9.7) | 1 (1–5) | 1.9 (1.3) |
45. Attending health care providers in this nursing home ward are doing a good job. | 23 (8.0) | 5 (1–5) | 4.5 (0.9) |
46. All the personnel in this nursing home ward take responsibility for patient safety. | 23 (8.0) | 5 (1–5) | 4.2 (1.0) |
47. I feel fatigued when I have to get up in the morning and face another day on the job. | 28 (9.7) | 2 (1–5) | 2.3 (1.4) |
48. Patient safety is constantly reinforced as the priority in this nursing home ward. | 22 (7.7) | 4 (1–5) | 4.0 (1.0) |
49. I feel burned out from my work. | 26 (9.1) | 1 (1–5) | 2.0 (1.3) |
50. Important issues are well communicated at shift changes. | 20 (6.9) | 4 (1–5) | 3.9 (1.2) |
51. There is widespread adherence to clinical guidelines and evidence-based criteria in this nursing home ward. | 35 (12.1) | 4 (1–5) | 4.1 (0.9) |
52. I feel frustrated by my job. | 23 (8.0) | 2 (1–5) | 2.4 (1.4) |
53. I feel I am working too hard on my job. | 23 (8.0) | 3 (1–5) | 2.9 (1.4) |
54. Information obtained through incident reports is used to make patient care safer in this nursing home ward. | 31 (10.8) | 4 (1–5) | 3.5 (1.3) |
55. Personnel frequently disregard rules or guidelines (e.g., handwashing, wound care, etc.) that are established for this nursing home ward. | 19 (6.6) | 2 (1–5) | 2.2 (1.4) |
56. Fatigue impairs my performance during emergency situations. | 31 (10.8) | 2 (1–5) | 2.5 (1.5) |
57. Fatigue impairs my performance during routine care. | 36 (12.6) | 2 (1–5) | 2.5 (1.5) |
58. I am satisfied with the current referral process in this nursing home ward. | 51 (17.7) | 4 (2–5) | 3.8 (1.0) |
59. There is adequate and timely transfer of patient information between the nursing home physician and the general practitioner. | 127 (44.1) | 3 (1–5) | 3.5 (1.1) |
60. Medications are refilled in a timely manner. | 78 (27.1) | 4 (1–5) | 4.1 (1.1) |
61. Medications are refilled correctly. | 88 (30.6) | 4 (1–5) | 4.1 (1.1) |
62. Abnormal test results are frequently lost or overlooked. | 80 (27.8) | 1 (1–5) | 1.9 (1.1) |
χ2/d.f. | P | RMSEA | Pclose | Hoelter 0.05 | CFI | |
---|---|---|---|---|---|---|
Entire model | 618.3/335 = 1.846 | <.001 | .054 | .144 | 176 | .891 |
Total model: Cronbach’s alpha: 0.886 | ||
---|---|---|
Teamwork climate: Cronbach’s alpha: 0.655 | Mean (SDb) | CI-OFCc |
3. Input from personnel is well received in this nursing home ward. | 3.92 (1.01) | 0.54 |
24d. In this nursing home ward, it is difficult to speak up if I perceive a problem with patient care. | 3.50 (1.32) | 0.33 |
30. Disagreements in this nursing home ward are resolved appropriately (i.e., not who is right but what is best for the patient). | 4.00 (1.08) | 0.55 |
34. I have the support I need from other personnel to care for patients. | 4.30 (0.98) | 0.37 |
Safety climate: Cronbach’s alpha: 0.738 | Mean (SDb) | CI-OFCc |
4. I would feel safe being treated here as a patient. | 4.05 (1.03) | 0.51 |
5. Medical errors are handled appropriately in this nursing home ward. | 4.02 (1.05) | 0.49 |
11. I receive appropriate feedback about my performance. | 3.69 (1.22) | 0.52 |
12d. In this nursing home ward, it is difficult to discuss errors. | 3.10 (1.31) | 0.36 |
20. I am encouraged by my colleagues to report any patient safety concerns I may have. | 4.08 (1.05) | 0.43 |
21. The culture in this nursing home ward makes it easy to learn from the errors of others. | 3.79 (1.09) | 0.57 |
28. I know the proper channels to direct questions regarding patient safety in this nursing home ward. | 4.10 (1.17) | 0.31 |
Job satisfaction: Cronbach’s alpha: 0.786 | Mean (SDb) | CI-OFCc |
2. I like my job. | 4.70 (0.71) | 0.78 |
8. Working in this nursing home ward is like being part of a large family. | 3.67 (1.27) | 0.77 |
15. This nursing home ward is a good place to work. | 4.31 (0.89) | 0.71 |
29. I am proud to work at this nursing home ward. | 4.32 (0.93) | 0.75 |
41. Morale in this nursing home ward is high. | 4.24 (1.01) | 0.79 |
Perceptions of management: Cronbach’s alpha: 0.713 | Mean (SDb) | CI-OFCc |
9. Senior management of this nursing home ward is doing a good job. | 3.76 (1.13) | 0.63 |
10. The management of this nursing home ward supports my daily efforts. | 3.68 (1.09) | 0.64 |
26. I am provided with adequate, timely information about events in the nursing home ward that might affect my work. | 3.41 (1.08) | 0.35 |
Working conditions: Cronbach’s alpha: 0.686 | Mean (SDb) | CI-OFCc |
6. This nursing home ward does a good job of training new personnel. | 3.89 (1.10) | 0.61 |
7. All the necessary information for diagnostic and therapeutic decisions is routinely available to me. | 3.82 (1.07) | 0.63 |
18. The levels of staffing in this nursing home ward are sufficient to handle the number of patients. | 2.61 (1.31) | 0.73 |
22. This nursing home ward deals constructively with problem personnel. | 3.44 (1.22) | 0.59 |
42. Trainees in my discipline are adequately supervised. | 4.14 (0.98) | 0.61 |
Stress recognition: Cronbach’s alpha: 0.694 | Mean (SDb) | CI-OFCc |
25. When my workload becomes excessive, my performance is impaired. | 3.98 (1.24) | 0.73 |
31. I am less effective at work when fatigued. | 4.01 (1.21) | 0.56 |
32. I am more likely to make errors in tense or hostile situations. | 3.86 (1.24) | 0.60 |
33. Stress from personal problems adversely affects my performance. | 3.37 (1.43) | 0.45 |
Cumulative variance explained | Communalities | |
---|---|---|
Teamwork climate | 50.2% | |
3. Input from personnel is well received in this nursing home ward. | .653 | |
24. In this nursing home ward, it is difficult to speak up if I perceive a problem with patient care. | .322 | |
30. Disagreements in this nursing home ward are resolved appropriately (i.e., not who is right but what is best for the patient). | .622 | |
34. I have the support I need from other personnel to care for patients. | .400 | |
Safety climate | 43.4% | |
4. I would feel safe being treated here as a patient. | .512 | |
5. Medical errors are handled appropriately in this nursing home ward. | .443 | |
11. I receive appropriate feedback about my performance. | .444 | |
12. In this nursing home ward, it is difficult to discuss errors. | .254 | |
20. I am encouraged by my colleagues to report any patient safety concerns I may have. | .363 | |
21. The culture in this nursing home ward makes it easy to learn from the errors of others. | .553 | |
28. I know the proper channels to direct questions regarding patient safety in this nursing home ward. | .471 | |
Job satisfaction | 55.6% | |
2. I like my job. | .407 | |
8. Working in this nursing home ward is like being part of a large family. | .502 | |
15. This nursing home ward is a good place to work. | .687 | |
29. I am proud to work at this nursing home ward. | .682 | |
41. Morale in this nursing home ward is high. | .504 | |
Perceptions of management | 64.3% | |
9. Senior management of this nursing home ward is doing a good job. | .769 | |
10. The management of this nursing home ward supports my daily efforts. | .778 | |
26. I am provided with adequate, timely information about events in the nursing home ward that might affect my work. | .382 | |
Working conditions | 46.6% | |
6. This nursing home ward does a good job of training new personnel. | .587 | |
7. All the necessary information for diagnostic and therapeutic decisions is routinely available to me. | .479 | |
18. The levels of staffing in this nursing home ward are sufficient to handle the number of patients. | .169 | |
22. This nursing home ward deals constructively with problem personnel. | .535 | |
42. Trainees in my discipline are adequately supervised. | .559 | |
Stress recognition | 53.3% | |
25. When my workload becomes excessive, my performance is impaired. | .280 | |
31. I am less effective at work when fatigued. | .670 | |
32. I am more likely to make errors in tense or hostile situations. | .679 | |
33. Stress from personal problems adversely affects my performance. | .504 |