The NHS watchdog has found that half of all employees feel overstretched and about a third do not feel valued, but cleanliness and work-related stress has improved.
A survey by the Healthcare Commission recieved responses from 160,000 workers at all 390 trusts last year and found there were "real lessons to be learned".
Figures show that last year, 31% of staff did not feel valued by their trust, compared with 36% in 2007. Meanwhile, 21% of staff said managers did not communicate clearly.
A total of 47% of employees who responded also said there were not enough workers to "do the job properly", compared with 51% in 2007. A further 35% of staff said they had seen an incident in the previous month that "could have hurt staff or patients", up from 31% in 2007.
However, the survey did find that cleanliness had improved since 2007, with 71% of staff saying that hand-washing materials were available when needed, up from 61%, and work-related stress had also dropped from 33% in 2007 to 28%.
Anna Walker, chief executive of the commission, said: "There are real lessons to be learned from this survey about leadership, management and team work.
"Staff feel informed but not involved in the decisions that affect their working life and do not feel valued by their trust."