Everyday descriptions of Norwegian hospitals. Results following a national survey of nurses in 2009
Personnel is the most important input factor in the hospitals, and forecasts suggest that there will be a challenge to balance supply and demand in the years to come.
Personnel is the most important input factor in the hospitals, and forecasts suggest that there will be a challenge to balance supply and demand in the years to come. The need for good human resource management will increase, regarding delivery of high quality and safe health care and efficient utilization of community resources.
“RN4CAST: Nurse forecasting in Europe” is an international, EU-funded project that aims at developing knowledge in this area by studying nursing in general hospitals in Norway and eleven other European countries.
The project is a multinational cross-sectional survey conducted in autumn 2009 to collect information of several types: Hospital profile (e.g. number of beds and length of stay), patient results and survey data from nurses. All countries followed the same procedure and used the same survey instruments, such as The Nursing Work Index (NWI), with items describing different aspects of nurses’ work environment, and selected questions from the Hospital Survey on Patient Safety Culture (HSOPSC).
This paper presents descriptive statistics based on results from the nurse survey in Norway. Nurses' description of their work environment, quality and patient safety, staffing and their education and experience were collected using questionnaires.
The data are also used in studies with the aim of scientific publications.
9548 questionnaires were distributed to nurses at 302 units in 35 hospitals. The response rate in the survey as a whole was 57 and the respondents worked in intensive care/monitoring units (n = 1703) and surgical or medical wards (n = 3752).
- In Norway as a whole, 79% of the nurses were moderately or very satisfied with their current job. This varied among hospitals from 93 to 51%.
- 71% of all the nurses described their work environment in general as good or excellent. This varied among hospitals from 90 to 37%.
- In the country as a whole, 25% of the respondents answered that they would like to leave their job, varying between hospitals from 65 to 12%.
- The quality of nursing care on their units was characterized as good or excellent by 88% of the nurses, varying from 96 to 61% between the hospitals.
- 16% said that the care quality had improved during the past year, 57% that the quality was unchanged, and 27% that it had deteriorated, varying from 88 to 7% between the hospitals.
- Just over 5% rated overall patient safety in their department as poor or failing, this varied among hospitals from 31 to 0%.
- By their answers to the NWI survey, nurses described the clinical, daily collaboration activities positively and the organizational conditions for the profession as less good.
- Regarding questions about patient safety aspects, the nurses' descriptions were most positive about local conditions and more critical to matters at higher organizational levels.
- A number of questions about "your most recent shift" returned answers with variation between hospitals in terms of organization and the activities that were performed.
- Compared to the other countries, the Norwegian results were good.
The results show that there are large differences among Norwegian hospital in terms of how nurses describe the organizations they work in and the quality of work being performed. A central idea within quality improvement is that where there is quality variations between units, some units have potential to improve.
The large scope of this study is a strength since one can study many hospitals, departments and units described in the same way and simultaneously. The study’s international character necessitated some methodological compromises and the survey method has known weaknesses in itself. On the other hand, obtaining data from other sources than the nurses themselves was demanding or not possible.
Personnel is the most important input factor in the hospital regarding cost, and probably also for clinical outcomes and patient safety. Paradoxically, the introduction or phasing of interventions and drugs requires thorough and transparent documentation of the efficacy and cost, while decisions relating to human resource management are largely based on tradition and assumptions. The knowledge in the field, valid in a Norwegian context, is insufficient, and there is a need for method development. This study will hopefully be a valuable contribution in this respect.