Impacts of unit-level nurse practice environment, workload and burnout on nurse-reported outcomes in psychiatric hospitals: a multilevel modelling approach

Int J Nurs Stud. 2013 Mar;50(3):357-65. doi: 10.1016/j.ijnurstu.2012.05.006. Epub 2012 Jun 12.


Aim: To investigate impacts of practice environment factors, nurse perceptions of workload and self-reported burnout at the unit-level on job outcomes and nurse-assessed quality of care in psychiatric hospitals.

Background: Associations between practice environments and nurse and patient outcomes have been widely described in acute care hospitals in nursing research examining variables primarily at the respondent level. Research on this topic in psychiatric hospitals is sparse.

Design: A cross-sectional design with a survey.

Method: Samples of registered nurses, licenced practical nurses and non-registered caregivers from 32 clinical units in two psychiatric hospitals were surveyed. Validated instruments were used to measure work environment, workload, burnout, job outcomes and nurse-perceived quality of care. Unit-level associations were examined using multilevel modelling techniques.

Results: Multiple multilevel models identified depersonalization and nurse-physician relations as predictors of turnover intentions and quality of care of the interdisciplinary team. Ratings of nursing management at the unit level were predictors of all of the quality of care variables. Emotional exhaustion was predictive of quality of care at the unit level. While workload was correlated with burnout, it was not predictive of any of the outcomes examined in multiple multilevel models.

Conclusion: While relatively low levels of burnout and fairly favourable job and quality of care outcomes were reported by the mental health personnel surveyed, differences across units in ratings of practice environment factors such as nurse-physician relations and nurse management as well as levels of depersonalization were predictive of outcomes. While most findings are consistent with those from other studies of acute care settings, some (slight) differences were also identified.

MeSH terms

  • Analysis of Variance
  • Burnout, Professional*
  • Cross-Sectional Studies
  • Hospitals, Psychiatric / organization & administration*
  • Humans
  • Job Satisfaction
  • Models, Organizational*
  • Nursing Staff, Hospital / psychology*
  • Workload*