Article

Effects of work environment on nurse and patient outcomes

Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada.
Journal of Nursing Management (Impact Factor: 1.14). 11/2010; 18(8):901-13. DOI: 10.1111/j.1365-2834.2010.01172.x
Source: PubMed

ABSTRACT To determine the relationship between nurses' perceptions of their work environment and quality/risk outcomes for patients and nurses in acute care settings.
Nurses are leaving the profession as a result of high levels of job dissatisfaction arising from current working conditions. To gain organizational support for workplace improvements, evidence is needed to demonstrate the impact of the work environment on patient care.
A multi-level design was used to collect data from nurses (n=679) and patients (n=1005) within 61 medical and surgical units in 21 hospitals in Canada.
Using multilevel structural equation modelling, the hypothesized model fitted well with the data [χ(2)=21.074, d.f.=10, Comparative Fit Index (CFI)=0.985, Tucker-Lewis Index (TLI)=0.921, Root Mean Square Error of Approximation (RMSEA)=0.041, Standardized Root Mean Square Residual (SRMR) 0.002 (within) and 0.054 (between)]. Empowering workplaces had positive effects on nurse-assessed quality of care and predicted fewer falls and nurse-assessed risks as mediated through group processes. These conditions positively impacted individual psychological empowerment which, in turn, had significant direct effects on empowered behaviour, job satisfaction and care quality.
Empowered workplaces support positive outcomes for both nurses and patients.
Managers employing strategies to create more empowered workplaces have the potential to improve nursing teamwork that supports higher quality care, less patient risk and more satisfied nurses.

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Available from: Nancy Purdy, Jul 29, 2015
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    • "A recent Canadian study by Laschinger and colleagues (2012) found that the authentic behaviour of nursing leaders with nurses' perceptions of structurally empowering work environment conditions, which positively influenced levels of emotional exhaustion and cynicism for graduate nurses as well as experienced acute-care nurses. Empowered work environments have been associated with feelings of autonomy among nurses, leading to improved job satisfaction and nurse perceived quality of care (Purdy et al., 2010). A systematic review of the literature has linked relational leadership style with supportive workplace environments, which influence staff retention (Cowden et al., 2011). "
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    • "The quality of care is certainly an aspect of performance and, in that sense, the results of this study correspond with earlier research. It has also been shown in previous studies in hospital settings and home-care services that group processes and climate are related to the quality of care (Hannan et al. 2001, Olsson & Ingvad 2001, Purdy et al. 2010). This link between social components at work and quality of care in home help services is interesting and merits further investigation. "
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    • "As an example of maintaining control, participants came to work early to prepare themselves for the shift. Consistent with the literature (Bowles & Candela 2005, Campbell et al. 2008, Morgan & Lynn 2009, Purdy et al. 2010), professional work practices such as being prepared and being seen to be prepared were highly valued by participants as was having the capacity to make informed decisions. Decision-making has the potential to build selfesteem and develop critical thinking skills and should be supported by broad guidelines (Benson & Dundis 2003). "
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