Staff engagement as a target for managing work environments in psychiatric hospitals: implications for workforce stability and quality of care

J Clin Nurs. 2013 Jun;22(11-12):1717-28. doi: 10.1111/j.1365-2702.2012.04341.x. Epub 2012 Dec 7.


Aims and objectives: To examine relationships between practice environment ratings, workload, work engagement, job outcomes and assessments of quality of care in nursing personnel in psychiatric hospitals.

Design: Cross-sectional survey.

Background: A broad base of research studies in health care reveals important links between work environment factors, staff burnout and organisational outcomes that merit examination in inpatient mental healthcare settings. Work engagement, a positively framed parallel construct for burnout, may offer an additional insight into the impacts of work on staff.

Methods: A sample of 357 registered nurses (65·5%), licensed practical nurses (23·5%) and non-registered caregiver (10·6%) of two Belgian psychiatric hospitals were surveyed. A causal model was tested using structural equation modelling, whereby it was proposed that work engagement would be influenced by work environment factors and itself impact perceived quality of care and staff job outcomes such as job satisfaction and turnover intentions.

Results: An adjusted model was confirmed. Practice environment features influenced staff vigour and dedication and demonstrated positive effects on job satisfaction, turnover intentions and perceived quality of care through their effects on absorption.

Conclusion: The findings of this study suggest that work engagement is a likely direct consequence of practice environments that may ultimately have impacts on both staff and patient outcomes.

Relevance to clinical practice: Leaders, nurse managers, clinicians as well as nurses themselves should be aware of the importance of work environments in mental healthcare facilities that favour engagement. Future efforts should focus on developing and sustaining practice environments that engage mental healthcare workers within interdisciplinary teams with the goal of creating a stable workforce possessing optimal possible knowledge, skills and abilities for delivering care.

MeSH terms

  • Adult
  • Female
  • Hospitals, Psychiatric / organization & administration*
  • Humans
  • Male
  • Middle Aged
  • Personnel, Hospital / psychology*
  • Quality of Health Care*
  • Workplace*