A cross-sectional study of more than 95,000 nurses finds that direct care nurses in hospitals and nursing homes, who are often considered the first line of defense in patient care, are significantly more likely to be dissatisfied with their jobs (24% and 27% in hospitals and nursing homes, respectively) and to describe themselves as burned out (34% and 37%, respectively) than nurses in nonnursing jobs or jobs not involving direct care (of whom 13% are dissatisfied and 22% burned out).

Although frequently cited factors like work schedule and a lack of autonomy do contribute to dissatisfaction in direct care hospital and nursing home nurses, the two groups report that they're far more dissatisfied with health care benefits (41% and 51%, respectively) and retirement benefits (nearly 50% and 60%)-with complaints about salary (37% and 42%) and a lack of opportunities to advance (31% and 38%) not far behind.

The study by McHugh and colleagues, which combined data from a survey of nurses, data on the hospitals, and a patient-satisfaction survey, also found that patients are more likely to be dissatisfied with care at workplaces that have higher percentages of dissatisfied nurses, a finding with possible implications for quality of care.

Work environments were rated using scales related to such factors as "nursing leadership capacity, nurses' participation in hospital affairs, nursing standards for quality patient care, and nurse-physician relationships."

The authors predict that as the need for nurses rises sharply in coming years, job dissatisfaction will only worsen already-low rates of nurse retention and lead to further labor unrest, work stoppages, emotional and intellectual disengagement, and other consequences likely to adversely affect outcomes in patients.-Jacob Molyneux, senior editor

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