Article Critique

Christina L. Vidrich
University of St. Marys

Abstract
The purpose of this paper is to study the relationship between work environments and nurse
outcomes in hospitals in Guangdong Province, China. 21 hospitals were surveyed; these surveys
were conducted by all staff nurses at level 2 hospitals that had 300-500 beds and level 3 hospitals
that had less than 500 beds. The China Hospital Nurse Survey, Practice Environment Scale of the
Nursing Work Index, and Maslach Burnout Inventory were measures used to collect data from
nurses. The findings concluded that the nursing shortage is prevalent in China and working with
the shortage has decreased job satisfaction among nurses. Improving the work environment is a
stratagem to improve satisfaction and assistance with retention.

The relationship between hospital work environment and nurse outcomes in

Guangdong, China: A nurse questionnaire survey.
This study aims to examine the relationship between work environments and nurse
outcomes in hospitals in Guangdong Province, China with the goal of identifying promising
strategies for addressing their nursing shortage. The research design was Cross Sectional Study
as it involved data collected at a defined time and involved censuses among the nurses. Survey
data was collected from 1104 bedside nurses in 89 medical, surgical, and intensive care units in
21 hospitals across the Guangdong Province. The hypothesis is clearly stated and answers the
research question of improving work environments from poor to better holds promise for
reducing nurses job dissatisfaction and burnout. Action by management in hospitals to create
positive work environments may be essential to reduce high nurse burnout and job
dissatisfaction.
The variables in this study include: Independent variables which are defined as what you
(or nature) manipulate; in this article, they include work environment, nursing shortage, job
dissatisfaction, and retention. Dependent variables describe what are affected by the independent
variable such as age, females, and China (Groves, 2007).
Stratified convenience sampling was used to select hospitals, and systematic sampling
was used to select units. All staff nurses working on participating units were surveyed. The China
Hospital Nurse Survey, including the Practice Environment Scale of the Nursing Work Index and
Maslach Burnout Inventory, was employed to collect data from nurses. Statistical significance
level was set at 005(Lou, 2012).
Inferential Statistics showed in the study, 21 hospitals were surveyed; the stratified
sampling provided a representative sample of hospitals in Guangdong Province, and systematic

sampling of units and cluster sampling of nurses decreased the sampling bias among units.
Nurses (54%) in the sample reported dissatisfaction with their job, as compared with 174410%
in other studies. Descriptive statistics concluded the high rate of burnout reported by nurses in
Guangdong Province was comparable to those in other studies, except Japan. Here, 60% of
nurses reported being dissatisfied with their jobs and 56% of nurses demonstrated high burnout
(Lou, 2012).
The study population consisted of nurses that held the minimum qualifications for
practice in China, which was a secondary diploma or had further educational qualifications in
nursing and provided bed side care in hospitals. The target population of the survey was nurses
working on adult general, specialty medical, and ICU units. It was conducted in Guangdong
Province by all staff nurses with the nurse managers omitted. The level 2 hospitals had 300-500
beds and the level 3 hospitals had less than 500 beds (Lou, 2012).
This study is not generalized specifically to China as other studies conducted in Western
countries, have indicated that hospital work environments were associated with nurse and patient
outcomes and thus could be a solution for the nursing shortage and improved care quality
(Lou,2012). The nursing shortage is the common element leading to high nurse burnout and job
dissatisfaction. The study identified nurses in Canadian hospitals who rated their interactions
with physicians as the lowest subscale but nurses in the China were more satisfied with nurse
physician relations than with other aspects of the work environment (Lou, 2012).
The findings concluded that the nursing shortage is prevalent in China and working with
the shortage has decreased job satisfaction among nurses. Improving the work environment is a
stratagem to improve satisfaction and assistance with retention. Thirty-seven per cent of the
nurses experienced high burnout, and 54% were dissatisfied with their jobs. Improving nurses'

work environments from poor to better was associated with a 50% decrease in job dissatisfaction
and a 33% decrease in job-related burnout among nurses (Lou, 2012).
The study was logically related to the hypotheses but limited smaller hospitals, not
survived were nurses in units such as emergency, outpatient and pediatrics; Limitations of the
study using the chi-square test, examined differences in work environments among hospitals with
different characteristics, such as, hospital level, technology complexity, and locations. Also
identified included gender, age, marital status, education, employment status, and having young
children. Factors were controlled when predicting the relationship between work environments
and nurse outcomes (LOU, 2012).
These results are valid and usable. Nurse burnout and efforts to retain nursing staff has
been a problem worldwide. Healthcare is becoming attentive to the demands on the nursing staff
and has to be open to the idea to improve quality and care. These findings can help petition to the
leaders of healthcare in China to implement change.
Conclusion
In conclusion, the study did find that the nursing shortage in China hospitals contributed
to a dissatisfaction among staff. It concluded improvements in work environments would
increase nurse satisfaction and decrease nurse turnover. The study aimed to lobby management in
hospitals to create positive work environments to facilitate retention and satisfaction among
nurses.

References
Liu, K., You, LM., Chen, SX., Hao, YT., Zhu, XW., Zhang, LF., & Aiken, L.H. (2012). The
relationship between hospital work environment and nurse outcomes in Guangdong,
China: A nurse questionnaire survey. Journal of Clinical Nursing, 21, 1476-1485.

Groves, (2007).Statistics for Health Care Research, A Practical Workbook, Saunders, Elsevier.