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      The Impact of Organizational Support on Practice Outcomes in Nurse Practitioners in Taiwan

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          ABSTRACT

          Background

          Nurse practitioners (NPs) in Taiwan have practiced mainly in acute care hospitals since 2006. Although organizational support and level of support have been associated with the successful integration of NP roles and effective practice outcomes, organizational support in the context of NPs in inpatient settings is an area that has been rarely explored in the literature.

          Purpose

          The purpose of this study was to investigate the relationship between organizational support and the practice outcomes of job satisfaction, care effectiveness, and intention to leave in NPs.

          Methods

          A national survey of 512 NPs was conducted that included a demographic characteristics datasheet, the Nurse Practitioner Primary Care Organizational Climate Questionnaire, the Misener Nurse Practitioner Job Satisfaction Scale, and the Nurse Practitioner Care Effectiveness Scale. Multiple regression analysis was applied to explore the specific factors associated with job satisfaction. The statistical significance level was set at .05 with a two-tailed test. All statistical analyses were conducted using SPSS Statistics Version 22.0 software.

          Results

          More than half of the participants were found to be dissatisfied with their hospital managers (54.8%) and with each dimension of organizational support. Overall, 82.1% of the participants were satisfied with their current practice. A multiple regression analysis showed that the participants who perceived higher levels of organizational support in the workplace (β = .53, p < .001), expressed satisfaction with working with their managers (β = .25, p < .001), or perceived better care outcomes (β = .10, p < .001) reported higher job satisfaction. In addition, the participants who expressed intention to leave within 1 year (β = −.09, p < .001) and those with higher patient loads (β = −.09, p < .001) reported lower job satisfaction. Organizational support was found to explain 50% of the variance in job satisfaction.

          Conclusions/Implications for Practice

          The results of this study highlight organizational support as the most important factor affecting job satisfaction in NPs. Therefore, administrators work to promote organizational support and improve the work environment to enhance the job satisfaction, increase the clinical practice retention, and improve the care outcomes of NPs.

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          Most cited references35

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          Perceived organizational support.

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            Perceived organizational support: A review of the literature.

            The authors reviewed more than 70 studies concerning employees' general belief that their work organization values their contribution and cares about their well-being (perceived organizational support; POS). A meta-analysis indicated that 3 major categories of beneficial treatment received by employees (i.e., fairness, supervisor support, and organizational rewards and favorable job conditions) were associated with POS. POS, in turn, was related to outcomes favorable to employees (e.g., job satisfaction, positive mood) and the organization (e.g., affective commitment, performance, and lessened withdrawal behavior). These relationships depended on processes assumed by organizational support theory: employees' belief that the organization's actions were discretionary, feeling of obligation to aid the organization, fulfillment of socioemotional needs, and performance-reward expectancies.
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              Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States

              Objective To determine whether hospitals with a good organisation of care (such as improved nurse staffing and work environments) can affect patient care and nurse workforce stability in European countries. Design Cross sectional surveys of patients and nurses. Setting Nurses were surveyed in general acute care hospitals (488 in 12 European countries; 617 in the United States); patients were surveyed in 210 European hospitals and 430 US hospitals. Participants 33 659 nurses and 11 318 patients in Europe; 27 509 nurses and more than 120 000 patients in the US. Main outcome measures Nurse outcomes (hospital staffing, work environments, burnout, dissatisfaction, intention to leave job in the next year, patient safety, quality of care), patient outcomes (satisfaction overall and with nursing care, willingness to recommend hospitals). Results The percentage of nurses reporting poor or fair quality of patient care varied substantially by country (from 11% (Ireland) to 47% (Greece)), as did rates for nurses who gave their hospital a poor or failing safety grade (4% (Switzerland) to 18% (Poland)). We found high rates of nurse burnout (10% (Netherlands) to 78% (Greece)), job dissatisfaction (11% (Netherlands) to 56% (Greece)), and intention to leave (14% (US) to 49% (Finland, Greece)). Patients’ high ratings of their hospitals also varied considerably (35% (Spain) to 61% (Finland, Ireland)), as did rates of patients willing to recommend their hospital (53% (Greece) to 78% (Switzerland)). Improved work environments and reduced ratios of patients to nurses were associated with increased care quality and patient satisfaction. In European hospitals, after adjusting for hospital and nurse characteristics, nurses with better work environments were half as likely to report poor or fair care quality (adjusted odds ratio 0.56, 95% confidence interval 0.51 to 0.61) and give their hospitals poor or failing grades on patient safety (0.50, 0.44 to 0.56). Each additional patient per nurse increased the odds of nurses reporting poor or fair quality care (1.11, 1.07 to 1.15) and poor or failing safety grades (1.10, 1.05 to 1.16). Patients in hospitals with better work environments were more likely to rate their hospital highly (1.16, 1.03 to 1.32) and recommend their hospitals (1.20, 1.05 to 1.37), whereas those with higher ratios of patients to nurses were less likely to rate them highly (0.94, 0.91 to 0.97) or recommend them (0.95, 0.91 to 0.98). Results were similar in the US. Nurses and patients agreed on which hospitals provided good care and could be recommended. Conclusions Deficits in hospital care quality were common in all countries. Improvement of hospital work environments might be a relatively low cost strategy to improve safety and quality in hospital care and to increase patient satisfaction.
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                Author and article information

                Contributors
                Journal
                J Nurs Res
                J Nurs Res
                JNR
                The Journal of Nursing Research
                Lippincott Williams & Wilkins
                1682-3141
                1948-965X
                June 2021
                19 March 2021
                : 29
                : 3
                : e148
                Affiliations
                [1 ]MS, RN, NP, Department of Neurosurgery, China Medical Hospital, Taiwan, Republic of China
                [2 ]PhD, RN, Director, Department of Nursing, Chunghwa Christian Hospital, and Adjunct Assistant Professor, College of Nursing and Health Sciences, Da-Yeh University, Taiwan, Republic of China
                [3 ]MA, Lecturer, Academic Writing Education Center, National Taiwan University, Taiwan, Republic of China
                [4 ]MS, RN, NP, Emergency Room, Department of Nursing, Chunghwa Christian Hospital, Taiwan, Republic of China
                [5 ]PhD, Assistant Professor, College of Nursing and Health Sciences, Da-Yeh University, Taiwan, Republic of China
                [6 ]PhD, RN, Assistant Professor, Department of Nursing, Da-Yeh University, Taiwan, Republic of China
                [7 ]PhD, RN, NP, Professor, College of Nursing and Health Sciences, Da-Yeh University, Taiwan, Republic of China.
                Author notes
                [*]Address correspondence to: Shiow-Luan TSAY, PhD, RN, NP, No.168, University Rd., Dacun, Changhua County 751591, Taiwan, ROC. Tel: +886-4-8511888 ext. 7200; E-mail: sltsay0308@ 123456gmail.com
                Article
                JNR_200007 00002
                10.1097/JNR.0000000000000425
                8126501
                33756519
                18f19af1-ece4-46fc-a327-b994afed3b46
                Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 17 September 2020
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                organizational support,job satisfaction,care outcomes,intent to leave,nurse practitioners

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