Figure 1 displays the expanded Nursing Worklife
Model tested in this study. The model describes the
mediating role of burnout between worklife factors and patient safety outcomes. Moving from left to right in Figure 1, the pattern of relationships
among Lake’s 5 qualities of professional nursing
work environments is defined according to Leiter
and Laschinger’s previous results.4 Leadership is
the starting point, with direct paths to staffing
adequacy and policy involvement as well as nurse/
physician relationships. Both policy involvement
and nurse/physician relationships are hypothesized
to predict the prevalence of a nursing model of care
(in contrast to a medical model). Use of a nursing
model of care is projected as enhancing leadership’s
prediction of staffing. Staffing adequacy has a
direct path to exhaustion which mediates that
relationship with depersonalization. Nursing
model also has a direct path to personal accomplishment.
The burnout mediation quality of the
model is captured in the channeling of all relationships
of the work environment variables with
adverse events through the 3 qualities of burnout.
This pattern signifies that qualities of the work
environment influence adverse events to the extent
that they contribute to feelings of exhaustion,
depersonalization, and personal accomplishment.