Study among first to describe work environments for nurses in Mexico
A study of nurses in Mexico identifies both positive and problematic areas of their work environments, with age, experience, and education level influencing nurses' perceptions of their workplaces.
The study, led by researchers at NYU Rory Meyers College of Nursing and published in the journal Hispanic Health Care International, is the among the first studies of Mexico's nursing workforce. It also adds Mexico to the list of more than 25 countries that have successfully used the Practice Environment Scale from the Nurses Work Index (PES-NWI) to measure nurses' work environments.
"Research from around the world shows that improving nursing workforce factors—such as adequate staffing, management, and education levels—can influence patient outcomes, including boosts in quality and patient satisfaction and reduced infections and readmissions," said Allison Squires, Ph.D., RN, FAAN, associate professor at NYU Rory Meyers College of Nursing and the study's lead author. "However, these studies have largely taken place in high-income countries with well-resourced health systems, and little research exists on the nursing work environment in low- and middle-income countries."
In this study, the researchers assessed the work environment for nurses in Mexico while also validating the PES-NWI for use in the Mexican healthcare context. Although an Iberian Spanish translation of the PES-NWI was available, it had not been tested in Mexico, and administrative or health system language does not always translate well when languages vary by country, as Spanish does.
The researchers surveyed 453 Mexican nurses from five sites using paper and online data collection techniques. Nurses ranged in age between 19 and 63 and had an average of 15 years of work experience. Seventy-two percent of nurses surveyed had a bachelor's degrees, with the majority of those having completed a technical or vocational nursing degree prior to their bachelor's degree.
Overall, most nurses had a positive perspective about their work environments. However, several workplace issues emerged focused on staffing levels, opportunities for career advancement, management, and nurse involvement in organizational policy making. Three-quarters of nurses indicated there were too few nurses to provide quality care, and 67 percent of those surveyed said they did not have sufficient support to complete their work during their shift. Approximately 64 percent of participants believed nurses had little input into hospital policies or decisions that affected their ability to do their jobs.
In addition, responses to certain topics—particularly related to management—varied based on a nurse's age, number of years worked in a hospital, and education level. Age and years of experience showed significant differences in how nurses perceived the extent to which quality of management influenced the workplace, including supervisor support of nurses and opportunities for continuing education. For example, nurses under 40 perceived management to be less accessible than older nurses. Nurses 41 and over, by contrast, perceived a greater sense of community in their workplace culture.
There were also significant differences in how supported nurses felt by their nurse managers when making clinical decisions, including when conflicts occur with physicians. Older and more experienced nurses felt less supported by managers when compared with younger and less experienced nurses.
Notably, nurses had significant concerns over the clinical competence of their peers. There were significant differences not only by age, but also based on years of experience and education level, with nurses with bachelor's degrees tending to perceive colleagues without a degree as less competent. Perceived opportunities for continuing education varied widely regardless of age, education, or experience, and seem specific to the geographic location of the nurse.
The researchers confirmed that the Mexican Spanish version of the PES-NWI is valid and offers an internationally reliable way for nurses in Mexico to report on their work environments, quality of care, and patient safety issues. They also stressed the importance of using such data to support nurses and improve working conditions.
"When data are generated for health system improvement, too often they are used for punitive purposes that affect staff. Managers' ability to learn from the data, understand what is 'normal' and what is out of the norm, and focus their efforts to address quality of care, work environment, and patient safety problems is critical for success," said Squires.