Understanding the Link Between Nurses' Practice Environment, Emotional Exhaustion, Compassion Satisfaction, and Adverse Events

Nurses are essential to effective patient care, the operational success of hospital units, and the broader healthcare system. Their sustained, optimal functioning is crucial for healthcare. The study investigated how the nurse practice environment affects nurses' functioning at work (emotional exhaustion and compassion satisfaction) and how these factors impact the occurrence of adverse events in South African hospitals. A quantitative, cross-sectional survey design was employed, involving 4533 nurses from all nine provinces in South Africa. Data were collected using the Practice Environment Scale of the Nursing Work Index, the Maslach Burnout Inventory and the Compassion Practice Instrument, along with single items measuring adverse events. Confirmatory factor analysis (CFA), bifactor exploratory structural equation modeling (bifactor-ESEM) and CFA-within-ESEM, was used to evaluate the measurement and structural models. The bifactor-ESEM model provided the best fit for the multidimensional PES-NWI. A supportive nurse practice environment was associated with lower emotional exhaustion and higher compassion satisfaction. Emotional exhaustion was negatively associated with compassion satisfaction and increased adverse events. Compassion satisfaction decreased adverse events.