The Effects of Nursing Satisfaction and Turnover Cognitions on Patient Attitudes and Outcomes: A Three‐Level Multisource Study

Abstract

Objective: To explore antecedents and outcomes of nurse self‐reported job satisfaction and dissatisfaction‐based turnover cognitions, theorizing (using Self‐Determination Theory) that leaders can foster work conditions that help fulfill innate needs, thereby fostering satisfaction of nurses and patients, and reducing adverse events. Data Sources/Study Setting: Primary and secondary data were collected within a 4‐month period in 2015, from 2,596 nurses in 110 Army treatment facilities (hospitals and clinics) across 35 health care systems. Data Collection/Extraction: We collected individual nurse responses to the Practice Environment Scale‐Nursing Work Index, in addition to aggregated archival data from the same timeframe, including both facility‐level patient satisfaction records (the Army Provider Level Satisfaction Survey) and health care system‐level adverse events records (provided by the Army Programming, Analysis, and Evaluation office). Principal Findings: Five predictors of nurse satisfaction and turnover cognitions emerged—supportive leadership, staffing levels, nurse–physician teamwork, adoption of nursing care practice, and advancement opportunities. Aggregated nurse satisfaction was the most consistent predictor of both patient satisfaction and adverse events. Conclusion: These findings provide evidence of the importance of nurse attitudes in improving perceived and actual performance across facilities and health care systems; in addition to practical steps, managers can take to improve satisfaction and retention.