The present situation of the nursing practice environment and its influence on nursing quality in a post-epidemic era: a cross-sectional study

The results of this study showed that the average PPE score was (3.34 ± 0.40). Among them, the dimension of staff relationships with physicians had the highest score (3.53 ± 0.53), it shows that the medical cooperation in the COVID-19 ward is close and the harmonious relationship has been established. However, the teamwork dimension has the lowest average score(3.01 ± 0.68),and “This ward can not get the cooperation it needs from other wards” and “The lack of close cooperation with other departments of the hospital limits the effective development of work in this ward” had low scores, indicated the bad cooperation between the nurses in the ward. Good doctor-nurse relations but low scores for teamwork are consistent with a work environment for retired nurses in China [19]. In addition handling disagreement and conflict dimension score is also low, At the same time, “Everyone ignores or avoids disagreement between members” is the lowest, This indicates that the cooperation between nurses and the communication between nurses and other wards needs to be strengthened. On the one hand, faced with the risk of cross-infection during a pandemic, the COVID-19 ward is under closed management, there is a lack of effective communication between departments. Previous studies also have pointed out that physical barriers (i.e., personal protective equipment) and spatial barriers (i.e., social distance) implemented during the pandemic disrupted workflow and communication and affected teamwork [20, 21]. On the other hand, a study pointed out that health care workers in COVID-19 critical care were more likely to frequently work with each other than those in non–COVID-19 critical care [22]. 85.2% of the nurses (n = 92/108) in the ICU ward came from different hospitals in our study. Due to the different age, geography, and cultural level of nurses in each area, as well as the difficulty of establishing effective teamwork in a short period of time in a temporarily formed team, which leads to unsuccessful teamwork. Effective teamwork is facilitated by timely, frequent, accurate, problem-solving communication based on shared knowledge, common goals, and mutual respect [23]. Therefore, nursing managers should pay attention to the relationship between doctors and nurses, encourage the exchange of important clinical information between nurses and doctors, and strengthen the cohesion and teamwork of the whole team.

At the same time, we found that the internal work motivation dimension scores were at the top. Moreover, “I feel a high degree of personal responsibility for the work I do.” and “My discipline controls its own practice” also rank at the top, it indicated that the nurses thought that the working conditions of the COVID-19ward were better and the nurses had a high sense of responsibility, which made the nurses mobilize their own enthusiasm. Research shows that individual factors (e.g., emotional intelligence, self-reflectiveness, confidence, communication style), attitudinal factors mediated by the team (e.g., accountability, commitment, values or enthusiasm), and lastly socio-economic factors (e.g., education, culture) were all found to influence individual’s attitudes and behaveours vis-à-vis colleagues, impacting the work environment in which teamwork occurred [24]. Organizing teamwork training and clarifying team roles can improve team relationships [25], It is suggested that the manager should carry out team cooperation according to the situation of the ward, and make clear the nursing responsibility of each nurse, attach importance to the opinion of each nurse, and jointly create a harmonious and mutual help working environment.

According to the results of this study, the nursing quality of Chinese nurses during the COVID-19 period was relatively high, and the average score of nurses in the COVID-19 ward was (9.47 ± 0.81).Based on previous research [26], we believe that is related to higher standards, stringent ward environment in the COVID-19 ward and to the increased professional competence of nurses.

Nurse characteristics have relationship between high nursing quality and patient results [27]. A total of 88.4% female nurses participated in the study, 60.6% were between 26 and 35 years old, and 31.1% had worked for 6 to 10 years. The results showed that the front-line nurses were all experienced nurses, which enabled them to provide quality care. In addition, a shocking the nursing quality scores for associate degrees or below are higher than those for bachelor’s, which may be because of the It may have to do with the fact that highly educated nurses demand more from their own development. The more educated nurses are, the more demand for your own development, thus scoring lower on the self-assessed quality of care scores.

We showed that the highest score dimension was nursing operation technique (9.65 ± 0.77), which indicated that all nurses performed the operation according to the ward standard. And the dimension with the worst score is “doctor-nurse-patient cooperation” and “health education”. This may be due to the busy clinical work of nurses, long working hours, heavy tasks of epidemic prevention leading to insufficient attention and assessment to patients. Moreover, nurses may reduce direct contact with patients and doctors at work due to fear of infection, thus resulting in poor health education for patients and communication with doctors Meanwhile, patients felt anxious and reluctance to communicate with medical and nursing staff due to the disease. Therefore, hospitals should strengthen the knowledge related to 2019 coronavirus disease pneumonia training so that nurses can receive timely, accurate, precise and comprehensive education on health knowledge and disease assessment, and relieve patients’ tension and anxiety through humanistic care and health education so that they can actively cooperate with treatment and care.

The regression analysis showed that the nursing quality was influenced by the degree of education and the rank of Nursing Hospital, which is consistent with the study by Fitzpatrick et al [28]. This may be related to the fact that highly educated nurses have a more systematic knowledge of nursing and are more likely to work in higher-level hospitals, and that examinations are more frequent in level 3 hospitals than in level 2 and lower hospitals. In China, hospitals are classified into three levels from small to large based on their scale (staffing, hardware facilities, research capabilities, etc.) [29, 30]. Among them, the third-level hospitals are representative of the large comprehensive hospitals in our country, often possessing more advanced large medical equipment and medical technology, and are responsible for important tasks such as the treatment of critical illnesses and specialized diagnosis and treatment [29]. Nursing quality is an important indicator for evaluating the level of hospitals, so nurses in higher level hospitals tertiary hospitals tend to face high level of work requirements, which poses a higher challenge to the nurses’ own competence. Previous studies [31, 32] have shown that nurses in tertiary hospitals have stronger professional competencies such as information competency and emergency management competency than nurses in secondary and lower hospitals. This shows that it is necessary for nursing managers to focus on the cultivation of nursing professional skills, particularly for nurses at the secondary level and below hospital, which is ensures the quality and efficiency of nursing services. The results of this study show that education was a negative variable of nursing quality. This may be due to the fact that healthcare workers with higher academic qualifications may have a heavier workload, not only needing to complete clinical frontline medical and nursing care, but also different roles such as teaching, scientific research, management, and so on, which gives them a higher sense of responsibility for their patients, resulting in a greater work pressure [33], and thus impacting on the quality of their care. In addition, the number of nurses with Master degree or above in this study was only 11 (4.4%), so it is necessary to continue to expand the sample in the follow-up study for further in-depth analysis.

Numerous studies have demonstrated that a better professional nursing practice environment can lead to higher nursing quality [34‐36]. The results of correlation analysis showed that the nursing practice environment all other dimensions except teamwork, were positive related to nursing quality. We hypothesized that it may be due to the particularity of the setting of the COVID-19 ward. The better the nursing practice environment was, the higher level of nursing quality in the COVID-19 ward was. Zelauskas et al [37]showed that environment of professional nursing practice means that the nurse in nursing service, through authorized managers have more autonomy, and responsibility to work environment. A study of 69 hospitals in 217 Chinese provinces found that the longer nurses worked in COVID-19 ward, the worse the quality of care [38]. At the same time, Cheng et al [15] showed that COVID-19 had brought positive changes to the nursing practice environment. For example, nurses have a greater say in the organization and work more closely with doctors. However, there are also some problems, such as the difficulty of ward management and increased occupational risks, and the safety and comfort of the ward environment need to be improved. Therefore, it is suggested that managers should arrange shift patterns scientifically, optimize and rationally allocate personnel, provide adequate rest time, and reduce the workload of nurses, ward managers need to develop simple and standard management patterns, establish good ward facilities and rest environment.

This study has some limitations. First of all, this study aimed at the cross-sectional investigation in the post-epidemic period, is a specific environment. It is not applicable after the COVID-19 pandemic, provides reference for similar outbreaks of infectious diseases in the future. Second, the data in this study were the result of nurses’ self-report, so there may be bias. However, this study can provide a reference for nursing managers to improve the quality of nursing care from the perspective of improving the working environment during the outbreak of infectious diseases.

Our study participants were nurses in the COVID-19 ward of designated hospitals, our evidence and recommendations will contribute to improved care practices.

The results showed that the working environment of the nurses in the COVID-19.

ward was good, and the nursing practice environment was much improved compared with the previous studies, especially the leadership ability, autonomy and cultural sensitivity in the clinical practice. However, team cooperation is not good enough. COVID-19 wards require multidisciplinary teamwork, so we should focus on training nurses’ team cooperation ability to promote the friendly development of the ward. In addition, nurses’ clinical practice ability affects nursing outcomes. Among the seven dimensions of nursing quality, doctor-nurse-patient cooperation scored the lowest, which also indicates that doctor-nurse-patient communication needs to be improved. The quality of nursing is influenced by grade of original hospital, nursing education and nursing practice environment. Therefore, sending excellent nurses and training local nurses, promoting good cooperation between medical and nursing staff, and improving the working environment of nurses can effectively improve the quality of care.