New nurses' practice environment, job stress, and patient safety attitudes: a cross-sectional study based on the job demands-resources model

Abstract

Background: Patient safety is paramount for all healthcare agencies. Health professionals' lack of patient safety competencies threaten patients' lives, and increase patients, families, hospitals, and social burdens. The new nurse-related patient safety issues have particularly attracted much attention. The aim of this study was to examine the impacts of practice environment and job stress on new nurses' patient safety attitudes by employing the job demands-resources model.

Methods: The study used a cross-sectional structural equation modeling (SEM). A convenience sample of 370 new nurses was recruited from seven tertiary hospitals in Anhui province, China, from April 2022 to August 2022. Data were collected using self-report questionnaires including the Chinese version of the Nurse Job Stressors Scale, the Practice Environment Scale, and the Safety Attitudes Questionnaire.

Results: New nurses' patient safety attitudes scores were moderate (126.99 ± 14.39). Practice environment had a significant direct effect on job stress (β = -0.337, t = 6.120), patient safety attitudes (β = 0.604, t = 13.766), practice environment had an indirect effect on patient safety attitudes through job stress (β = 0.066, t = 3.690), and the indirect effect accounted for 9.9% of the total effect. This model was able to explain 48.3% of patient safety attitudes with moderate prediction accuracy.

Conclusions: This study emphasizes the importance of improving new nurses' attitudes toward patient safety. Hospital administrators should develop policies and strategies to address job characteristics, and establish a favorable work environment to reduce new nurses' job stress as well as to improve patient safety.

Keywords: Job demands–resources; Job stress; New nurses; Patient safety attitudes; Practice environment.

Fig. 1

Job demands-resources model

Fig. 2

Correlations between practice environment, job stress, and patient safety attitudes. Note: blue, positive correlation; red, negative correlation; dark color, high correlation; upper half, color plots; lower half, numerical plots; × , p > 0.05; PE, practice environment; NPHA, nurse participation in hospital affairs; NFQC, nursing foundations for quality of care; NMALSN, nurse manager ability, leadership, and support of nurses; SRA, staffing and resource adequacy; CNPR, collegial nurse-physician relations; JS, job stress; NPW, nurse profession and work; WTA, workload and time allocation; WER, work environment and resources; PC, patient care; MD, management and dressing; PSA, patient safety attitudes; TC, teamwork climate; SC, safety climate; PM, perceptions of management; JS_2, job satisfaction; WC, working conditions; SR, stress recognition

Fig. 3

Structural equation modeling of practice environment, job stress and patient safety attitudes