Os resultados desta investigação possibilitam concluir que, em geral, os profissionais de enfermagem avaliaram positivamente o ambiente da prática de enfermagem, apresentaram níveis baixos de burnout, estão satisfeitos com o trabalho atual e têm intenção de permanecer no emprego e na profissão.
Entre os hospitais participantes, foi possível observar que a instituição que possuía acreditação hospitalar no momento da coleta de dados apresentou resultados mais favoráveis, sugerindo que certificações de qualidade podem desempenhar um papel na percepção de profissionais de enfermagem em relação à percepção do desempenho organizacional, ambiente da prática, burnout, satisfação no trabalho e intenção de permanecer no emprego e na profissão. Enfermeiros e técnicos de enfermagem divergiram quanto à percepção em relação a adequação de recursos humanos para prestar assistência de enfermagem, sendo que os técnicos de enfermagem avaliaram ser inadequado o quantitativo de profissionais na equipe de enfermagem. Os enfermeiros apontaram menor interesse em permanecer no emprego e respondem por um número maior de pacientes que os técnicos de enfermagem.
Foi identificada correlação entre as variáveis do ambiente da prática, burnout, satisfação no trabalho e intenção de permanecer no emprego e na profissão sugerindo relação interdependente entre essas variáveis nos cenários de prestação de cuidados onde atuam enfermeiros e técnicos de enfermagem. O modelo teórico proposto demonstrou que intervenções para melhorar o ambiente da prática de enfermagem e reduzir os níveis de burnout podem aumentar a satisfação no trabalho.
Em conclusão, as hipóteses apresentadas inicialmente foram confirmadas pelos resultados. À vista disso, pode-se identificar que os profissionais de enfermagem que perceberam um ambiente de trabalho favorável à sua prática relataram menores níveis de
burnout, maior satisfação com o trabalho, e maior intenção de permanecer no emprego e na
profissão. Além disso, os profissionais de enfermagem que estão satisfeitos com o trabalho relataram menores níveis de burnout e maior intenção de permanecer no emprego e na profissão.
REFERÊNCIAS
1. Wiskow C, Albreht T, De Pietro C. How to create na attractive and supportive working environment for health professionals. Copenhagen; 2010. Report nº: Policy Brief 15.
2. Klopper HC, Coetzee SK, Pretorius R, Bester P. Practice environment, job satisfaction and burnout of critical care nurses in South Africa. J Nurs Manag. 2012;20(5):685–95.
3. McGlynn K, Griffin MQ, Donahue M, Fitzpatrick JJ. Registered nurse job satisfaction and satisfaction with the professional practice model. J Nurs Manag. 2012;20(2):260–5. 4. Erickson JI, Ditomassi M. Professional practice model: strategies for translating models into practice. Nurs Clin North Am. 2011;46(1):35–44.
5. Aiken LH, Patrician PA. Measuring organizational traits of hospitals: the Revised Nursing Work Index. Nurs Res. 2000;49(3):146–53.
6. Aiken LH, Clarke SP, Sloane DM, Sochalski JA, Busse R, Clarke H, et al. Nurses’ reports on hospital care in five countries. Health Aff (Millwood). 2001;20(3):43–53.
7. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Jama. 2002;288(16):1987–93.
8. Lake ET. Development of the practice environment scale of the Nursing Work Index. Res Nurs Health. 2002;25(3):176–88.
9. Stone PW, Larson EL, Mooney-Kane C, Smolowitz J, Lin SX, Dick AW. Organizational climate and intensive care unit nurses’ intention to leave. Crit Care Med. 2006;34(7):1907–12.
10. Aiken LH, Clarke SP, Sloane DM, Lake ET, Cheney T. Effects of hospital care environment on patient mortality and nurse outcomes. J Nurs Adm. 2008;38(5):223-29. 11. Boev C. The relationship between nurses’ perception of work environment and patient satisfaction in adult critical care. J Nurs Scholarsh. 2012;44(4):368–75.
12. Kutney-Lee A, Wu ES, Sloane DM, Aiken LH. Changes in hospital nurse work environments and nurse job outcomes: an analysis of panel data. Int J Nurs Stud. 2013;50(2):195–201.
13. Estabrooks CA, Tourangeau AE, Humphrey CK, Hesketh KL, Giovannetti P, Thomson D, et al. Measuring the hospital practice environment: a Canadian context. Res Nurs Health. 2002;25(4):256–68.
14. Leiter MP, Laschinger HKS. Relationships of work and practice environment to professional burnout: testing a causal model. Nurs Res. 2006;55(2):137–46.
15. Laschinger HKS, Leiter MP. The impact of nursing work environments on patient safety outcomes: The mediating role of burnout engagement. J Nurs Adm. 2006;36(5):259–67. 16. Li Y-F, Lake ET, Sales AE, Sharp ND, Greiner GT, Lowy E, et al. Measuring nurses’ practice environments with the revised nursing work index: evidence from registered nurses in the Veterans Health Administration. Res Nurs Health. 2007;30(1):31–44.
17. Budge C, Carryer J, Wood S. Health correlates of autonomy, control and professional relationships in the nursing work environment. J Adv Nurs. 2003;42(3):260–8.
18. Carryer J, Hansen C, Budge C. Public health nurses’ perceptions of the professional practice environment in New Zealand. Prim Health Care Res Dev. 2008;9(03):216–24. 19. Joyce-McCoach JT, Crookes PA. Developing a tool to measure’magnetism’in Australian nursing environments. Aust J Adv Nurs. 2007;25(1):17–23.
20. Duffield CM, Roche MA, Blay N, Stasa H. Nursing unit managers, staff retention and the work environment. J Clin Nurs. 2011;20(1‐2):23–33.
21. Kanai‐Pak M, Aiken LH, Sloane DM, Poghosyan L. Poor work environments and nurse inexperience are associated with burnout, job dissatisfaction and quality deficits in Japanese hospitals. J Clin Nurs. 2008;17(24):3324–9.
22. Van Bogaert P, Clarke S, Vermeyen K, Meulemans H, Van de Heyning P. Practice environments and their associations with nurse-reported outcomes in Belgian hospitals: Development and preliminary validation of a Dutch adaptation of the Revised Nursing Work Index. Int J Nurs Stud. 2009;46(1):55–65.
23. Van Bogaert P, Meulemans H, Clarke S, Vermeyen K, Van de Heyning P. Hospital nurse practice environment, burnout, job outcomes and quality of care: test of a structural equation model. J Adv Nurs. 2009;65(10):2175–85.
24. Gunnarsdóttir S, Clarke SP, Rafferty AM, Nutbeam D. Front-line management, staffing and nurse–doctor relationships as predictors of nurse and patient outcomes. A survey of Icelandic hospital nurses. Int J Nurs Stud. 2009;46(7):920–7.
25. Hinno S, Partanen P, Vehviläinen‐Julkunen K, Aaviksoo A. Nurses’ perceptions of the organizational attributes of their practice environment in acute care hospitals. J Nurs Manag. 2009;17(8):965–74.
26. Kwak C, Chung BY, Xu Y, Eun-Jung C. Relationship of job satisfaction with perceived organizational support and quality of care among South Korean nurses: A questionnaire survey. Int J Nurs Stud. 2010;47(10):1292–8.
27. El-Jardali F, Alameddine M, Dumit N, Dimassi H, Jamal D, Maalouf S. Nurses’ work environment and intent to leave in Lebanese hospitals: implications for policy and practice. Int J Nurs Stud. 2011;48(2):204–14.
28. Liu K, You L-M, Chen S-X, Hao Y-T, Zhu X-W, Zhang L-F, et al. The relationship between hospital work environment and nurse outcomes in Guangdong, China: a nurse questionnaire survey. J Clin Nurs. 2012;21(9‐10):1476–85.
29. Fuentelsaz-Gallego C, Moreno-Casbas MT, González-María E. Validation of the Spanish version of the questionnaire Practice Environment Scale of the Nursing Work Index. Int J Nurs Stud. 2013;50(2):274–80.
30. Kirwan M, Matthews A, Scott PA. The impact of the work environment of nurses on patient safety outcomes: a multi-level modelling approach. Int J Nurs Stud. 2013;50(2):253– 63.
31. Zander B, Blümel M, Busse R. Nurse migration in Europe—Can expectations really be met? Combining qualitative and quantitative data from Germany and eight of its destination and source countries. Int J Nurs Stud. 2013;50(2):210–8.
32. Mallidou AA, Cummings GG, Estabrooks CA, Giovannetti PB. Nurse specialty subcultures and patient outcomes in acute care hospitals: A multiple-group structural equation modeling. Int J Nurs Stud. 2011;48(1):81–93.
33. Heinen MM, van Achterberg T, Schwendimann R, Zander B, Matthews A, Kózka M, et al. Nurses’ intention to leave their profession: a cross sectional observational study in 10 European countries. Int J Nurs Stud. 2013;50(2):174–84.
34. McClure ML, Poulin MA, Sovie MD, Wandelt MA. Magnet hospitals: Attraction and recruitment of professional nurses. Washington, DC: American Nurses Association, 1983. 35. American Nurses Credentialing Center. ANCC Magnet Recognition Program®
[Internet]. ANCC; Silver Spring (MD): Available from:
http://www.nursecredentialing.org/magnet [2016 Nov 14].
36. American Nurses Credentialing Center. A new model for ANCC’s Magnet Recognition Program® [Internet]. ANCC; Silver Spring (MD): Available from: http://www.nursecredentialing.org/documents/magnet/newmodelbrochure.aspx [2016 Nov 16].
37. Stimpfel AW, Rosen JE, McHugh MD. Understanding the role of the professional practice environment on quality of care in Magnet® and non-Magnet hospitals. J Nurs Adm. 2014;44(1):10–6.
38. Salmond SW, Begley R, Brennan J, Saimbert MK. A comprehensive systematic review of evidence on determining the impact of Magnet designation on nursing and patient outcomes: is the investment worth it? JBI Database Syst Rev Implement Rep. 2009;6(12):1119–78. 39. Kelly LA, McHugh MD, Aiken LH. Nurse outcomes in Magnet® and non-Magnet hospitals. J Nurs Adm. 2011;41(10):428-33.
40. Kutney-lee A, Stimpfel AW, Sloane DM, Cimiotti JP, Quinn LW, Aiken LH. Changes in patient and nurse outcomes associated with magnet hospital recognition. Med Care. 2015;53(6):550–7.
41. McHugh MD, Kelly LA, Smith HL, Wu ES, Vanak JM, Aiken LH. Lower Mortality in Magnet Hospitals. Med Care. 2013;51(5):382–8.
42. Friese CR, Xia R, Ghaferi A, Birkmeyer JD, Banerjee M. Hospitals in “Magnet”program show better patient outcomes on mortality measures compared to non- “Magnet”hospitals. Health Aff (Millwood). 2015;34(6):986–92.
43. Evans T, Rittenhouse K, Horst M, Osler T, Rogers A, Miller JA, et al. Magnet hospitals are a magnet for higher survival rates at adult trauma centers. J Trauma Acute Care Surg. 2014;77(1):89–94.
44. Barnes H, Rearden J, McHugh MD. Magnet® Hospital Recognition Linked to Lower Central Line‐Associated Bloodstream Infection Rates. Res Nurs Health. 2016;39(2):96-104. 45. Lake ET, Shang J, Klaus S, Dunton NE. Patient falls: Association with hospital Magnet status and nursing unit staffing. Res Nurs Health. 2010;33(5):413–25.
46. Goode CJ, Blegen MA, Park SH, Vaughn T, Spetz J. Comparison of patient outcomes in Magnet® and non-Magnet hospitals. J Nurs Adm. 2011;41(12):517–23.
47. Lake ET, Staiger D, Horbar J, Cheung R, Kenny MJ, Patrick T, et al. Association between hospital recognition for nursing excellence and outcomes of very low-birth-weight infants. JAMA. 2012;307(16):1709–16.
48. Smith SA. Magnet hospitals: higher rates of patient satisfaction. Policy Polit Nurs Pract. 2014;15(1–2):30–41.
49. Jayawardhana J, Welton JM, Lindrooth RC. Is there a business case for Magnet hospitals? Estimates of the cost and revenue implications of becoming a Magnet. Med Care. 2014;52(5):400–6.
50. Lambrou P, Merkouris A, Middleton N, Papastavrou E. Nurses’ perceptions of their professional practice environment in relation to job satisfaction: a review of quantitative studies. Health Sci J. 2014;8(3):298-317.
51. Aiken LH, Cimiotti JP, Sloane DM, Smith HL, Flynn L, Neff DF. The effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Med Care. 2011;49(12):1047-53.
52. You L, Aiken LH, Sloane DM, Liu K, He G, Hu Y, et al. Hospital nursing, care quality, and patient satisfaction: cross-sectional surveys of nurses and patients in hospitals in China and Europe. Int J Nurs Stud. 2013;50(2):154–61.
53. Maslach C, Jackson SE. The measurement of experienced burnout. J Organ Behav. 1981;2(2):99–113.
54. Adriaenssens J, De Gucht V, Maes S. Determinants and prevalence of burnout in emergency nurses: a systematic review of 25 years of research. Int J Nurs Stud. 2015;52(2):649–61.
55. Grossi G, Perski A, Osika W, Savic I. Stress‐related exhaustion disorder–clinical manifestation of burnout? A review of assessment methods, sleep impairments, cognitive disturbances, and neuro‐biological and physiological changes in clinical burnout. Scand J Psychol. 2015;56(6):626–36.
56. Purvanova RK, Muros JP. Gender differences in burnout: A meta-analysis. J Vocat Behav. 2010;77(2):168–85.
57. Organização Mundial da Saúde. Ambientes de trabalho saudáveis: um modelo para ação: para empregadores, trabalhadores, formuladores de política e profissionais. Tradução do Serviço Social da Indústria. Brasília: SESI/DN, 2010.
58. Van Bogaert P, Clarke S, Roelant E, Meulemans H, Van de Heyning P. Impacts of unit‐ level nurse practice environment and burnout on nurse‐reported outcomes: a multilevel modelling approach. J Clin Nurs. 2010;19(11‐12):1664–74.
59. Sampieri RH, Collado DF, Lucio MPB. Definição do alcance da pesquisa a ser realizada: exploratória, descritiva, correlacional ou explicativa. In: Metodologia de pesquisa. 5ª ed. Porto Alegre: Penso, 2013. P.99-110.
60. Malachias I, Leles FAG, Pinto MAS. Plano Diretor de Regionalização da Saúde de Minas Gerais. Belo Horizonte: Secretaria de Estado de Saúde de Minas Gerais, 2011.
61. Cadastro Nacional de Estabelecimentos de Saúde - CnesWeb [homepage da internet]. Estabelecimento de Saúde do Município: JUIZ DE FORA [acesso em 29 jan 2013]. Disponível em:
http://cnes.datasus.gov.br/Lista_Es_Municipio.asp?VEstado=31&VCodMunicipio=313670& NomeEstado= .
62. Cohen J. Statistical power analysis for the behavioral sciences. 2ª ed. New Jersey: Lawrence Erlbaum Associates; 1988.
63. Ringle CM, Silva D, Bido D. Structural equation modeling with the SmartPLS. Brazilian Journal of Marketing - BJM. 2014;12(2):56-73.
64. Panunto MR. Ambiente da prática profissional da equipe de enfermagem em terapia intensiva. [Dissertação]. Campinas (SP): Universidade Estadual de Campinas; 2012.
65. Dorigan GH. Panorama do Ambiente da Prática: Percepção dos Enfermeiros do Estado de São Paulo. [Tese]. Campinas (SP): Universidade Estadual de Campinas; 2016.
66. Gasparino RC, Guirardello EB. Tradução e adaptação para a cultura brasileira do “Nursing Work index-Revised”. Acta Paul Enferm. 2009;22(3):281–7.
67. Gasparino RC, Guirardello EB, Aiken LH. Validation of the Brazilian version of the Nursing Work Index‐Revised (B‐NWI‐R). J Clin Nurs. 2011;20(23‐24):3494–501.
68. Marcelino CF, Alves DFS, Gasparino RC, Guirardello EB. Validação do Nursing Work Index-Revised entre auxiliares e técnicos de enfermagem. Acta Paul Enferm. 2014;27(4):305– 10.
69. Weston MJ. Defining control over nursing practice and autonomy. J Nurs Adm. 2008;38(9):404–8.
70. Schmalenberg C, Kramer M. Nurse-physician relationships in hospitals: 20 000 nurses tell their story. Crit Care Nurse. 2009;29(1):74–83.
71. Hinno S, Partanen P, Vehviläinen‐Julkunen K. The professional nursing practice environment and nurse‐reported job outcomes in two European countries: a survey of nurses in Finland and the Netherlands. Scand J Caring Sci. 2012;26(1):133–43.
72. Tamayo MR. Relação entre a síndrome do burnout e os valores organizacionais no pessoal de enfermagem de dois hospitais públicos [Dissertação]. Brasília (DF): Universidade de Brasília; 1997.
73. Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual. Mountain View, CA: CPP. Inc., and Davies-Black, 1996.
74. Lautert L. O desgaste profissional: estudo empírico com enfermeiras que trabalham em hospitais. Rev Gaúch Enferm. 1997;18(2):133–44.
75. Carvalho REFL. Adaptação transcultural do Safety Attitudes Questionnaire para o Brasil – Questionário de Atitudes de Segurança. [Dissertação]. Ribeirão Preto (SP): Universidade de São Paulo; 2011.
76. Carvalho REFL, Cassiani SHDB. Cross-cultural adaptation of the Safety Attitudes Questionnaire-Short Form 2006 for Brazil. Rev Lat Am Enfermagem. 2012;20(3):575–82.
77. Pagano M, Gauvreau K. Princípios de bioestatística. São Paulo: Cengage Learning, 2004.
78. Chan ZC, Tam WS, Lung MK, Wong WY, Chau CW. A systematic literature review of nurse shortage and the intention to leave. J Nurs Manag. 2013;21(4):605–13.
79. Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16(3):297–334.
80. Martins GA. Sobre confiabillidade e validade. Rev Bras Gest Neg. 2006;8(20):1–12. 81. Hair Jr JF, Hult GTM, Ringle C, Sarstedt M. A primer on partial least squares structural equation modeling (PLS-SEM). Sage Publications; 2014.
82. SmartPLS - Statistical Software For Structural Equation Modeling [Internet]. [citado 20 de dez de 2015]. Disponível em: https://www.smartpls.com/.
83. Hair JF, Anderson RE, Babin BJ, Tathan RL, Black WC. Análise multivariada de dados. 6ª ed. Porto Alegre: Bookman, 2009.
84. Fornell C, Larcker DF. Evaluating structural equation models with unobservable variables and measurement error. J Mark Res. 1981;39–50.
85. Conselho Nacional de Saúde (Brasil). Resolução n o 466, de 12 de dezembro de 2012. Brasília, 2012 [citado 11 de março de 2014]. Disponível em: http://www.conselho.saude.gov.br/web_comissoes/conep/index.html.
86. Panunto MR, Guirardello EB. Ambiente da prática profissional e exaustão emocional entre enfermeiros de terapia intensiva. Rev Lat Am Enfermagem. 2013;21(3):765–72.
87. Nantsupawat A, Srisuphan W, Kunaviktikul W, Wichaikhum O-A, Aungsuroch Y, Aiken LH. Impact of nurse work environment and staffing on hospital nurse and quality of care in Thailand. J Nurs Scholarsh. 2011;43(4):426–32.
88. Coetzee SK, Klopper HC, Ellis SM, Aiken LH. A tale of two systems—nurses practice environment, well being, perceived quality of care and patient safety in private and public hospitals in South Africa: A questionnaire survey. Int J Nurs Stud. 2013;50(2):162–73.
89. Aiken LH, Sermeus W, Van den Heede K, Sloane DM, Busse R, McKee M, et al. Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ. 2012;344:e1717.
90. AbuAlRub R, El-Jardali F, Jamal D, Al-Rub NA. Exploring the relationship between work environment, job satisfaction, and intent to stay of Jordanian nurses in underserved areas. Appl Nurs Res. 2016;31:19–23.
91. Machado MH, Aquiar Filho W, Lacerda WF, Oliveira E, Lemos W, Wermelinger M, et al. Características gerais da enfermagem: o perfil sociodemográfico. Enferm Foco Brasília. 2016;7(ESP):9–14.
92. Machado MH, Oliveira E, Lemos W, Lacerda WF, Aguiar Filho W, Wermelinger M, et al. Mercado de trabalho da enfermagem: aspectos gerais. Enferm Foco Brasília. 2016;7(ESP):35–62.
93. Cho E, Sloane DM, Kim E-Y, Kim S, Choi M, Yoo IY, et al. Effects of nurse staffing, work environments, and education on patient mortality: an observational study. Int J Nurs Stud. 2015;52(2):535–42.
94. Aiken LH, Sloane DM, Bruyneel L, Van den Heede K, Griffiths P, Busse R, et al. Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. The Lancet. 2014;383(9931):1824–30.
95. Blegen MA, Goode CJ, Park SH, Vaughn T, Spetz J. Baccalaureate education in nursing and patient outcomes. J Nurs Adm. 2013;43(2):89–94.
96. Schubert M, Clarke SP, Aiken LH, De Geest S. Associations between rationing of nursing care and inpatient mortality in Swiss hospitals. Int J Qual Health Care. 2012;24(3):230– 8.
97. Aiken LH, Sloane DM, Bruyneel L, Van den Heede K, Sermeus W, Consortium R. Nurses’ reports of working conditions and hospital quality of care in 12 countries in Europe. Int J Nurs Stud. 2013;50(2):143–53.
98. Conselho Federal de Enfermagem (Cofen). Resolução nº 527 de 03 de novembro de 2016. Atualiza e estabelece parâmetros para o Dimensionamento do Quadro de Profissionais de Enfermagem nos serviços/locais em que são realizadas atividades de enfermagem.Brasília, 2016. [citado 27 de abril de 2017]. Disponível em: http://www.cofen.gov.br/resolucao-cofen- no-05272016_46348.html.
99. Rochefort CM, Clarke SP. Nurses’ work environments, care rationing, job outcomes, and quality of care on neonatal units. J Adv Nurs. 2010;66(10):2213–24.
100. Alenius LS, Tishelman C, Runesdotter S, Lindqvist R. Staffing and resource adequacy strongly related to RNs’ assessment of patient safety: a national study of RNs working in acute- care hospitals in Sweden. BMJ Qual Saf. 2014;23(3):242–9.
101. Dill J, Erickson RJ, Diefendorff JM. Motivation in caring labor: Implications for the well-being and employment outcomes of nurses. Soc Sci Med. 2016;167:99–106.
102. Tourangeau AE, Cummings G, Cranley LA, Ferron EM, Harvey S. Determinants of hospital nurse intention to remain employed: broadening our understanding. J Adv Nurs. 2010;66(1):22–32.
103. Athey EK, Leslie MS, Briggs LA, Park J, Falk NL, Pericak A, et al. How important are autonomy and work setting to nurse practitioners’ job satisfaction? J Am Assoc Nurse Pract. 2016;6(28):320–6.
104. Alves DFS, Guirardello EB. Ambiente de trabalho da enfermagem, segurança do paciente e qualidade do cuidado em hospital pediátrico. Rev Gaúch Enferm. 2016;37(2):e58817.
105. Lorenz VR, Guirardello EB. The environment of professional practice and Burnout in nurses in primary healthcare. Rev Lat Am Enfermagem. 2014;22(6):926–33.
106. Montgomery A, Spânu F, Băban A, Panagopoulou E. Job demands, burnout, and engagement among nurses: a multi-level analysis of ORCAB data investigating the moderating effect of teamwork. Burn Res. 2015;2(2):71–9.
107. Leiter MP, Bakker AB, Maslach C. The contemporary context of job Burnout. In: Leiter MP, Bakker AB, Maslach C (org). Burnout at work: A psychological perspective. New York: Psychology Press, 2014. p.122-44.
108. Bai J, Zhang Q, Wang Y, Yu L-P, Pei X-B, Cheng L, et al. Work environment for Chinese nurses in different types of ICUs: a multisite cross‐sectional survey. J Nurs Manag. 2015;23(4):498–509.
109. Brubakk K, Vist GE, Bukholm G, Barach P, Tjomsland O. A systematic review of hospital accreditation: the challenges of measuring complex intervention effects. BMC Health Serv Res. 2015;15(1):280.
110. Bogh SB, Falstie-Jensen AM, Hollnagel E, Holst R, Braithwaite J, Johnsen SP. Improvement in quality of hospital care during accreditation: A nationwide stepped-wedge study. Int J Qual Health Care. 2016;28(6):715-20.
111. Smits H, Supachutikul A, Mate KS. Hospital accreditation: lessons from low-and middle-income countries. Glob Health. 2014;10(1):1–8.
112. Berssaneti FT, Saut AM, Barakat MF, Calarge FA. Is there any link between accreditation programs and the models of organizational excellence? Rev Esc Enferm USP. 2016;50(4):650–7.
113. Oliveira JL, Gabriel CS, Fertonani HP, Matsuda LM. Management changes resulting from hospital accreditation. Rev Lat Am Enfermagem. 2017;25:e2851.
114. Karino ME, Felli VEA, Sarquis LMM, Santana LL, Silva SR, Teixeira RC. Cargas de trabalho e desgastes dos trabalhadores de enfermagem de um hospital-escola. Ciênc Cuid Saúde. 2015;14(2):1011–8.
115. Santos JLG, Pestana AL, Guerrero P, Meirelles BSH, Erdmann AL. Nurses’ practices in the nursing and health care management: integrative review. Rev Bras Enferm. 2013;66(2):257–63.
116. Alves DFS, Silva D, Guirardello EB. Nursing practice environment, job outcomes and safety climate: a structural equation modelling analysis. J Nurs Manag. 2017;25:46-55. 117. Van Bogaert P, Timmermans O, Weeks SM, van Heusden D, Wouters K, Franck E. Nursing unit teams matter: Impact of unit-level nurse practice environment, nurse work characteristics, and burnout on nurse reported job outcomes, and quality of care, and patient adverse events—A cross-sectional survey. Int J Nurs Stud. 2014;51(8):1123–34.
118. Westermann C, Kozak A, Harling M, Nienhaus A. Burnout intervention studies for inpatient elderly care nursing staff: Systematic literature review. Int J Nurs Stud. 2014;51(1):63–71.
119. Jacobs LM, Nawaz MK, Hood JL, Bae S. Burnout among workers in a pediatric health care system. Workplace Health Saf. 2012;60(8):335–44.
120. Lartey S, Cummings G, Profetto‐McGrath J. Interventions that promote retention of experienced registered nurses in health care settings: a systematic review. J Nurs Manag.