The relationship between patients' perceptions of care quality and three factors: nursing staff job satisfaction, organizational characteristics and patient age

Abstract

Background: The relationship between nurses' job satisfaction and their perceptions of quality of care has been examined in previous studies. There is little evidence, however, about relationships between the job satisfaction of nursing staff and quality of care perceived by the patients. The aim of this study was to analyze, how the job satisfaction of nursing staff, organizational characteristics (hospital and unit type), and patients' age relate to patients' perceptions of the quality of care.

Methods: The study was cross-sectional and descriptive, based on a secondary analysis of survey data acquired during the At Safe study in Finland. The study included 98 units at four acute care hospitals between autumn 2008 and spring 2009. The participants were 1909 patients and 929 nursing staff. Patients' perceptions of quality of care were measured using the 42-item RHCS questionnaire. Job satisfaction of nursing staff was measured with the 37-item KUHJSS scale. Statistical analyses included descriptive statistics, principal component analysis, t-tests, analysis of variance, linear regression, and multivariate analysis of variance.

Results: Patients' perceptions of overall quality of care were positively related to general job satisfaction of nursing staff. Adequate numbers of staff appeared to be the clearest aspect affecting quality of care. Older patients were more satisfied with staff number than younger patients. Patients cared for in outpatient departments felt more respected than patients in wards, whereas patients in wards reported better care of basic needs (e.g., hygiene, food) than outpatients.

Conclusions: The evaluation of resources by nursing staff is related to patients' perceptions of the adequacy of nursing staff levels in the unit. The results emphasize the importance of considering patients' perceptions of the quality of care and assessments by nurses of their job satisfaction at the hospital unit level when evaluating quality of care.

Figure 1

Relationship between patients’ perceptions of overall quality of care and nurses’ general job satisfaction. The overall quality of care refers to the mean value from the patient questionnaire; general job satisfaction refers to the mean value from the staff questionnaire per hospital unit (n = 98, indicated with black dots). The solid line represents a linear regression.

Figure 2

Effect of unit type (ward or outpatient department) on patients’ perceptions of mutual respect (patient survey component 1) and fulfilling the basic needs (patient survey component 3).

Figure 3

Relationships between patients’ perceptions of staffing adequacy (patient survey component 5) and nurses’ evaluations of staff resources (staff survey component 2, on the left) and patients’ ages (on the right).