Improving patient care by improving nurses' work environment

November 30, 2011

While nurse-to-patient ratios are widely recognized as an important factor in determining the quality of patient care, those ratios are not always easy to change without significant cost and investment of resources. What's more, the projected nursing shortage will make it even more difficult for hospitals to increase nurse staffing. A study published in the current issue of Health Care Management Review indicates that there are other aspects of registered nurses' (RNs) work environments that RNs perceive can also have a significant impact on the quality of care they deliver. In order of influence, those factors are: physical work environment, workgroup cohesion, nurse-physician relations, procedural justice and job satisfaction. Nurses' ratings of patient care quality were also higher in hospitals with Magnet® recognition programs, and lower in work settings with greater organizational constraints such as lack of equipment and supplies.

Maja Djukic, PhD, RN, assistant professor at the New York University College of Nursing (NYUCN); Christine Kovner, PhD, RN, FAAN, professor at NYUCN; Carol Brewer, PhD, RN, FAAN, professor at the School of Nursing, University at Buffalo; Farida Fatehi, BDS, MS, junior research analyst at the New York University College of Dentistry (NYUCD); and Daniel Cline, MSN, RN, CRNP, PhD candidate, and the John A. Hartford Foundation Building Academic Geriatric Nursing Capacity scholar, at NYUCN, were the investigators for the published study. The study is based on a 98-question survey of 1,226 RNs, which is part of RN Work Project, a nationwide, 10-year longitudinal survey of RNs begun in 2006 by Kovner and Brewer, and supported by a grant from the Robert Wood Johnson Foundation.

"There has been a great deal of research into the impact of staffing on patient care, but we know that increasing nurse-to-patient ratios isn't always possible," said Djukic. "What we found in our study is that administrators can improve a variety of work environment factors that are also likely to improve the quality of patient care, without having to change nurse-to-patient ratios. Improvements need to be strategic, because our work shows that the value of enhancing work environment varies across different factors."

For example, the researchers found that Magnet recognition has nearly the same impact on nurses' ratings of patient care quality as workgroup cohesion, but investing in workgroup cohesion is significantly less costly and complicated than applying for and earning Magnet recognition. Additionally, improvements in physical are likely to yield a greater benefit for quality of patient care, as perceived by RNs, than improvements in nurse-physician relations. Then again, implementing a team building program is likely to be less costly than remodeling a hospital unit. Nonetheless, if a hospital is planning to remodel, incorporating RNs' preferences into the physical environment design could result in changes that improve the quality of patient care.

"Health care managers need to think about how they can best redesign RNs' work environments to promote high quality patient care," said Kovner. "They need to examine their resources and determine which changes are possible and which will have the most impact on improving ."

Explore further: California nurse staffing

Related Stories

California nurse staffing

July 15, 2011
In a comprehensive analysis comparing nurse staffing in California hospitals to similar hospitals in the U.S. over nearly a decade, researchers at the University of Pennsylvania School of Nursing have found that controversial ...

RN staffing affects patient success after discharge

April 26, 2011
Higher non-overtime staffing levels of registered nurses lower the probability of patient readmissions to the hospital, a new study finds. However, higher levels of RN overtime increase the likelihood of unplanned visits ...

New study the first to look at nursing error disclosure in nursing homes

November 4, 2011
Nurses have an obligation to disclose an error when one occurs. While errors should be avoided as much as possible, the reality is the health care delivery system is not and will never be perfect; errors and adverse events ...

Hospital safety climate linked to both patient and nurse injuries: study

November 7, 2011
A safe working environment for nurses is also a safe environment for the patients in their care, according to a new study led by public health researchers at Drexel University. Researchers, led by Dr. Jennifer Taylor, an ...

Recommended for you

New shoe makes running 4 percent easier, 2-hour marathon possible, study shows

November 17, 2017
Eleven days after Boulder-born Shalane Flanagan won the New York City Marathon in new state-of-the-art racing flats known as "4%s," University of Colorado Boulder researchers have published the study that inspired the shoes' ...

Vaping while pregnant could cause craniofacial birth defects, study shows

November 16, 2017
Using e-cigarettes during pregnancy could cause birth defects of the oral cavity and face, according to a recent Virginia Commonwealth University study.

Study: For older women, every movement matters

November 16, 2017
Folding your laundry or doing the dishes might not be the most enjoyable parts of your day. But simple activities like these may help prolong your life, according to the findings of a new study in older women led by the University ...

When vegetables are closer in price to chips, people eat healthier, study finds

November 16, 2017
When healthier food, like vegetables and dairy products, is pricier compared to unhealthy items, like salty snacks and sugary sweets, Americans are significantly less likely to have a high-quality diet, a new Drexel University ...

Children's exposure to secondhand smoke may be vastly underestimated by parents

November 15, 2017
Four out of 10 children in the US are exposed to secondhand smoke, according to the American Heart Association. A new Tel Aviv University study suggests that parents who smoke mistakenly rely on their own physical senses ...

How pomegranate extract alters breast cancer stem cell properties

November 15, 2017
A University at Albany research team has found evidence suggesting that the same antioxidant that gives pomegranate fruit their vibrant red color can alter the characteristics of breast cancer stem cells, showing the superfood's ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.