Research Paper|Articles in Press

Public health nurses’ views on quality measures: A cross-sectional study

Published:October 26, 2022DOI:



      The quality indicators program has intended and unintended consequences that may affect nurses’ professional performance and organisational outcomes.


      To explore public health nurses’ knowledge, attitudes, and perceptions of the nursing-sensitive quality indicators applied in mother–child health clinics and their associations with organisational quality outcomes: quality of care, burnout, and communication.


      A cross-sectional study with a convenience sample. In total, 177 public health nurses completed a self-administered questionnaire measuring their knowledge, attitudes, and perceptions of the quality indicators regarding their performance and organisational outcomes. A structural equation modelling analysis was performed to describe the associations between the variables and to identify the mediating variables.


      The structural equation modelling analysis revealed that the intended (positive) impact on the nurse's professional level was the mediating variable between the nurses’ knowledge and attitudes towards the National Health Quality Measure program, their seniority, and the unintended (negative) impact on the nurse's professional level, and the organisational outcomes.

      Discussion and conclusion

      Public health nurses perceive quality indicators as contributing to and improving their professional work, with a positive impact on organisational outcomes. Nursing leaders and policymakers may promote good organisational outcomes by developing methods that will emphasise the importance of quality indicators in nursing practice.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Collegian
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Aharon A.A.
        • Madjar B.
        • Kagan I.
        Organizational commitment and quality of life at work among public health nurses in Israel.
        Public Health Nursing. 2019; 36: 534-540
        • Algurén B.
        • Andersson-Gäre B.
        • Thor J.
        • Andersson A.-C.
        Quality indicators and their regular use in clinical practice: Results from a survey among users of two cardiovascular National Registries in Sweden.
        International Journal for Quality in Health Care. 2018; 30: 786-792
        • Al-Hammouri M.M.
        • Rababah J.A.
        • Ta'an W.F.
        Structural empowerment, formal and informal power, and job performance quality: A moderated mediation analysis.
        Journal of Nursing Management. 2021; 29: 159-1602
        • Anselmo-Witzel S.
        • Orshan S.A.
        • Heitner K.L.
        • Bachand J.
        Are generation Y nurses satisfied on the job? Understanding their lived experiences.
        The Journal of Nursing Administration. 2017; 47: 232-237
        • Bliss K.
        • Chambers M.
        • Rambur B.
        Building a culture of safety and quality: The paradox of measurement.
        Nursing economics. 2020; 38: 178-184
        • Blunch N.
        Introduction to structural equation modeling using IBM SPSS Statistics and AMOS., Ltd.
        SAGE Publications, 2013
        • Chassin M.R.
        • Loeb J.M.
        • Schmaltz S.P.
        • Wachter R.M.
        Accountability measures—Using measurement to promote quality improvement.
        The New England Journal of Medicine. 2010; 363: 683-688
        • Dreiher D.
        • Blagorazumnaya O.
        • Balicer R.
        • Dreiher J.
        National initiatives to promote quality of care and patient safety: Achievements to date and challenges ahead.
        Israel Journal of Health Policy Research. 2020; 9: 62
        • Eltaybani S.
        • Yamamoto-Mitani N.
        • Ninomiya A.
        • Igarashi A.
        The association between nurses’ burnout and objective care quality indicators: A cross-sectional survey in long-term care wards.
        BMC Nursing. 2021; 20: 34
        • Faul F.
        • Erdfelder E.
        • Lang A.-G.
        • Buchner A.
        G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences.
        Behavior Research Methods. 2007; 39: 175-191
        • Field A.
        Discovering statistics using IBM SPSS statistics.
        4th ed. SAGE Publications Ltd, London2013
        • Forster A.J.
        • van Walraven C.
        The use of quality indicators to promote accountability in health care: The good, the bad, and the ugly.
        Open Medicine: A Peer-Reviewed, Independent, Open-Access Journal. 2012; 6: e75-e79
        • García-Altés A.
        • Subirana-Casacuberta M.
        • Llorens D.
        • Bullich I.
        • Brugués A.
        • Teixidor M.
        • et al.
        The experience of Catalonia measuring nurse-sensitive indicators: Trends study 2012-2018.
        Journal of Nursing Management. 2021;
        • Giesbers A.P.M.S.
        • Schouteten R.L.J.
        • Poutsma E.
        • van der Heijden B.I.J.M.
        • van Achterberg T.
        Nurses’ perceptions of feedback to nursing teams on quality measurements: An embedded case study design.
        International Journal of Nursing Studies. 2016; 64: 120-129
        • Giltenane M.
        • Sheridan A.
        • Kroll T.
        • Frazer K.
        Identifying the role of public health nurses during first postnatal visits: Experiences of mothers and public health nurses in Ireland.
        International Journal of Nursing Studies Advances. 2021; 3100017
        • Giltenane M.
        • Sheridan A.
        • Kroll T.
        • Frazer K.
        Identification of quality indicators of public health nursing practice: “Modified Delphi” approach.
        Public Health Nursing. 2022; 39: 214-228
        • Kagan I.
        • Shachaf S.
        • Rapaport Z.
        • Livne T.
        • Madjar B.
        Public health nurses in Israel: A case study on a quality improvement project of nurse's work life.
        Public Health Nursing. 2017; 34: 78-86
        • Koch D.
        • Kutz A.
        • Conca A.
        • Wenke J.
        • Schuetz P.
        • Mueller B.
        The relevance, feasibility and benchmarking of nursing quality indicators: A Delphi study.
        Journal of Advanced Nursing. 2020; 76: 3483-3494
        • Kuhn M.
        • Siciliani L.
        Performance indicators for quality with costly falsification.
        Journal of Economics & Management Strategy. 2009; 18: 1137-1154
        • López-López I.M.
        • Gómez-Urquiza J.L.
        • Cañadas G.R.
        • De la Fuente E.I.
        • Albendín-García L.
        • Cañadas-De la Fuente G.A.
        Prevalence of burnout in mental health nurses and related factors: A systematic review and meta-analysis.
        International Journal of Mental Health Nursing. 2019; 28: 1032-1041
        • McCance T.
        • Dickson C.A.W.
        • Daly L.
        • Boomer C.A.
        • Brown D.
        • Lynch B.
        • et al.
        Implementing person-centred key performance indicators to strengthen leadership in community nursing: A feasibility study.
        Journal of Nursing Management. 2020;
        • Nancarrow S.A.
        • Booth A.
        • Ariss S.
        • Smith T.
        • Enderby P.
        • Roots A.
        Ten principles of good interdisciplinary team work.
        Human Resources for Health. 2013; 11: 19
        • Nissanholtz-Gannot R.
        • Goldman D.
        • Rosen B.
        • Kay C.
        • Wilf-Miron R.
        How do primary care physicians perceive the role of nurses in quality measurement and improvement? The Israeli story.
        Frontiers in Public Health. 2016; 4: 124
      1. Nive, Y. (2020). The national quality measurement for TIPAT-CHALAV in Israel (in Hebrow) (No. 01-2020-505). Quality Assistance Division.

        • OʼHara M.A.
        • Burke D.
        • Ditomassi M.
        • Palan Lopez R.
        Assessment of millennial nurses’ job satisfaction and professional practice environment.
        The Journal of Nursing Administration. 2019; 49: 411-417
        • Oner B.
        • Zengul F.D.
        • Oner N.
        • Ivankova N.V.
        • Karadag A.
        • Patrician P.A.
        Nursing-sensitive indicators for nursing care: A systematic review (1997-2017).
        Nursing open. 2021; 8: 1005-1022
        • Powell A.A.
        • White K.M.
        • Partin M.R.
        • Halek K.
        • Christianson J.B.
        • Neil B.
        • et al.
        Unintended consequences of implementing a national performance measurement system into local practice.
        Journal of General Internal Medicine. 2012; 27: 405-412
      2. Rozen, B., & Nisholtz-Ganot, R. (2012). Quality measurements in primary clinics (in Hebrew) Jerusalem, Israel. Retrieved from

        • Rubin L.
        • Belmaker I.
        • Somekh E.
        • Urkin J.
        • Rudolf M.
        • Honovich M.
        • et al.
        Maternal and child health in Israel: Building lives.
        The Lancet. 2017; 389: 2514-2530
        • Steel M.
        • Seaton P.
        • Christie D.
        • Dallas J.
        • Absalom I.
        Nurse perspectives of nurse-sensitive indicators for positive patient outcomes: A Delphi study.
        Collegian (Royal College of Nursing, Australia). 2021; 28: 145-156
        • Stoddart K.
        • Bugge C.
        • Shepherd A.
        • Farquharson B.
        The new clinical leadership role of senior charge nurses: A mixed methods study of their views and experience.
        Journal of Nursing Management. 2014; 22: 49-59
        • Tabachnick B.
        • Fidell L.
        Using multivariate statistics.
        6th ed. PWARSON, Edinburg, England2014
        • Vainieri M.
        • Seghieri C.
        • Barchielli C.
        Influences over Italian nurses’ job satisfaction and willingness to recommend their workplace. Health services management research: An official journal of the Association of University Programs in Health Administration /HSMC.
        AUPHA. 2021; 34: 62-69