Structural characteristics of hospitals and nurse-reported care quality, work environment, burnout and leaving intentions

J Nurs Manag. 2015 Mar;23(2):263-74. doi: 10.1111/jonm.12123. Epub 2013 Sep 19.


Aim: To investigate whether hospital characteristics not readily susceptible to change (i.e. hospital size, university status, and geographic location) are associated with specific self-reported nurse outcomes.

Background: Research often focuses on factors within hospitals (e.g. work environment), which are susceptible to change, rather than on structural factors in their own right. However, numerous assumptions exist about the role of structural factors that may lead to a sense of pessimism and undermine efforts at constructive change.

Method: Data was derived from survey questions on assessments of work environment and satisfaction, intention to leave, quality of care and burnout (measured by the Maslach Burnout Inventory), from a population-based sample of 11 000 registered nurses in Sweden. Mixed model regressions were used for analysis.

Result: Registered nurses in small hospitals were slightly more likely to rank their working environment and quality of nursing care better than others. For example 23% of staff in small hospitals were very satisfied with the work environment compared with 20% in medium-sized hospitals and 21% in large hospitals. Registered nurses in urban areas, who intended to leave their job, were more likely to seek work in another hospital (38% vs. 32%).

Conclusion: While some structural factors were related to nurse-reported outcomes in this large sample, the associations were small or of questionable importance.

Implications for nursing management: The influence of structural factors such as hospital size on nurse-reported outcomes is small and unlikely to negate efforts to improve work environment.

Keywords: burnout; hospitals; nursing; work environment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Burnout, Professional / etiology*
  • Burnout, Professional / psychology
  • Female
  • Hospital Design and Construction / standards*
  • Humans
  • Job Satisfaction*
  • Male
  • Nurses / psychology*
  • Nursing Staff, Hospital / psychology
  • Quality of Health Care*
  • Surveys and Questionnaires
  • Sweden
  • Workplace / psychology
  • Workplace / standards