In a healthcare system, improving the quality of care is an urgent priority, and nurses play a vital role in influencing the quality of health services . Nurse-perceived quality of care was defined as “nurses’ view of the degree of excellence on the standard nursing services they provided, expectations to meet patients’ satisfaction and needs” . Poor quality of care would significantly increase adverse patient outcomes, such as patient injury, medication error and failure to rescue, and even high mortality . According to the World Health Organization and nursing organizations, the relationship between nurses’ work-related fatigue and quality of care is a significant issue in the healthcare field [4–6].
During the past ten years, a series of studies indicated that quality of care was related to nurses’ work-related fatigue . Work-related fatigue is a common complaint encountered at the workplace [8, 9]. The elements affecting work-related fatigue are: long work hours, extended-duration work shifts, duration and intensity of work, sleep deprivation, adverse environmental conditions (noise, light), the type of work performed (psychological or physical burden), the lack of breaks for relaxing and excessive stress [8–10]. Work shifts, specifically night shifts and extended work shifts without sufficient inter-shift recovery, were linked to higher fatigue levels. Nurses’ high level of work-related fatigue may not only lead to their health deterioration, disease occurrence and may also provoke severe consequences for patients . Work-related fatigue has become a significant risk for nurses working in hospitals. It has consequently led to poor outcomes such as reduced mental acuity, degradation in performance, and errors (Canadian Centre for Occupational Health and Safety, 2017). Excessive and prolonged stress from work will lead to work-related fatigue-related declining quality of care [7, 11]. When each nurse undertakes a large number of non-nursing tasks, it may be concluded over workload, so nurses may not be able to properly carry out tasks that require professional skills, such as training. In other words, when the number of non-nursing tasks increases, adverse patient events may occur because nurses do not have time to provide necessary supervision for patients. When the hospital lacks adequate nursing staff, patients may not receive timely care, and adverse patient events such as medication errors, patient falls, bedsores, failure of cardiopulmonary resuscitation, and death may occur [12, 13]. For instance, fatigue nurses were more likely to make a mistake in clinical judgment that would adversely affect the quality of care . A study in Taiwan testing the relationship between nursing workloads and patients’ safety has revealed an association between overtime hours and patient safety indices . Therefore, the relationship between quality of care and work-related fatigue is worth researchers’ attention for sure.
Work-related fatigue has become a significant occupational health issue, particularly in East Asia [16–18]. The unprecedented growth of the Chinese economy in past years has been accompanied by a crazy increase in the hospital demand for medical care, especially the need for hospital service . Hospital service is determined by the need for psychological work, not just quantitative physical workloads. Chinese nurses are responsible for substantial work reports. Chinese nurses increased from 1.35 million in 2005 to 4.2 million in 2019 [16, 19]. However, more than 40% of outpatient visits in China occur in hospitals. Nurses still faced heavy workloads because of severe nurse shortages, characterized by long working hours, intensive repetitive work, high stress, etc. [20–22]. Although work-related fatigue of nurses and quality of care was acknowledged as critical factors in healthcare delivery, the research on the determinants of nurses’ work-related fatigue and quality of care in China has not been well documented [2, 23].
Up to now, although the relationships between work-related fatigue and QOC have been reported previously , the effect of job satisfaction between work-related fatigue and QOC for nurses has not been well documented. Nurse Work Environment, Nurse Staffing, and Outcome Model (NWE-NS-OM) is used internationally to guide the study of medical outcomes . It revealed that the work environment among nurses is related to work-related fatigue, severely impacted job satisfaction, burnout, and quality of care [25, 26]. Nurses’ job satisfaction is defined as: “Nurses' responses to working conditions support their desired needs as a result of their assessment of the value or fairness of their work experience” . Previous studies indicated that high satisfaction leads to better performance and increases service quality . Additionally, the causes of nurses’ dissatisfaction are correlated to work-related fatigue, which is related to the work environment , transformational leadership, and nurse staffing . Therefore, testing the role of job satisfaction as a mediator might provide insights into the direction and strength of the relationship between work-related fatigue (independent variable) and quality of care (outcome variable).
Based on previous findings, the purposes of the study are 1) work-related fatigue has a negative effect on QOC; 2) job satisfaction mediates the relationship between work-related fatigue and QOC.