Abstract
BACKGROUND: Nurses play a vital role in patient care, and their perceptions of their work environment are crucial for healthcare quality. A supportive and well-resourced work environment enhances the quality of care and increases employee commitment. The physical environment directly influences nurses' well-being and efficiency, while a culture that fosters collaboration and communication is essential for improving patient outcomes and ensuring high-quality care. This study aimed to analyse nurses' assessments of the work environment, organisational culture and work organisation over three decades (1999, 2009 and 2021) to understand their connection to changes in nursing activities over time. Data were collected via a structured questionnaire. METHODS: A cross-sectional survey methodology was adopted. Descriptive statistical analysis, correlation analysis and logistic regression analysis were conducted via IBM SPSS. These analyses sought to track temporal changes, explore relationships between workforce resources and nursing activities, and investigate the determinants of the perceived nurse-to-patient ratio. RESULTS: In the work environment domain, the perceived quality of the physical work environment remained stable, although the nurse-to-patient ratio increased insufficiently. Changes in organisational culture yielded improvements in communication and the psychosocial work environment but reductions in the quality of collaboration. With respect to work organisation, a greater standardisation of nursing work emerged over time. The logistic regression analysis indicated that nurses working in regional hospitals and departments with more beds more frequently considered the nurse-to-patient ratio to be insufficient. CONCLUSIONS: The nurses' views showed that despite the increased health care workforce, the nurse-to-patient ratio was often seen as insufficient. Although the quality of the physical environment either remained stable or improved, organisational culture shifts indicated less group work and greater multiprofessional cooperation. This study underscores the necessity of a comprehensive approach for evaluating the nurse-to-patient ratio, integrating both quantitative and qualitative measures to effectively gauge and improve the nursing work environment. CLINICAL TRIAL NUMBER: Not applicable.