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: 1.5). 11/2010; 18(8):901-13. DOI: 10.1111/j.1365-2834.2010.01172.x
Source: PubMed


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, Oct 08, 2015
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    • "An organization which fosters a culture of poor attendance at CPD shows contempt for the process of identifying, acknowledging and responding to patient safety in health care. A large crosssectional study by Purdy et al. (2010) suggests positive patient outcomes are achieved when the clinical environment has knowledgeable nurses. A sense of competence and confidence occurs through ongoing education. "
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    ABSTRACT: To identify the best evidence on the impact of healthcare organizations' supply of nurses and nursing workload on the continuing professional development opportunities of Registered Nurses in the acute care hospital. To maintain registration and professional competence nurses are expected to participate in continuing professional development. One challenge of recruitment and retention is the Registered Nurse's ability to participate in continuing professional development opportunities. The integrative review method was used to present Registered Nurses perspectives on this area of professional concern. The review was conducted for the period of 2001-February 2015. Keywords were: nurs*, continuing professional development, continuing education, professional development, supply, shortage, staffing, workload, nurse: patient ratio, barrier and deterrent. The integrative review used a structured approach for literature search and data evaluation, analysis and presentation. Eleven international studies met the inclusion criteria. Nurses are reluctant or prevented from leaving clinical settings to attend continuing professional development due to lack of relief cover, obtaining paid or unpaid study leave, use of personal time to undertake mandatory training and organizational culture and leadership issues constraining the implementation of learning to benefit patients. Culture, leadership and workload issues impact nurses' ability to attend continuing professional development. The consequences affect competence to practice, the provision of safe, quality patient care, maintenance of professional registration, job satisfaction, recruitment and retention. Organizational leadership plays an important role in supporting attendance at continuing professional development as an investment for the future. © 2015 John Wiley & Sons Ltd.
    Journal of Advanced Nursing 07/2015; DOI:10.1111/jan.12724 · 1.74 Impact Factor
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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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    ABSTRACT: Study aim: To test a model derived from the Nursing Worklife Model linking elements of supportive practice environments to nurses' turnover intentions and behaviours in Canada and Australia. Background: With the worldwide shortage of nurses, retaining nurses within fiscally challenged health care systems is critical to sustaining the future of the nursing workforce and ultimately safe patient care. The Nursing Worklife Model describes a pattern of relationships amongst environmental factors that support nursing practice and link to nurse turnover. This model has been tested in north American settings but not in other countries. Methods: A secondary analysis of data collected in two cross-sectional studies in Canadian and Australian hospitals (N=4816) was conducted to test our theoretical model. Multigroup structural equation modelling techniques were used to determine the validity of our model in both countries and to identify differences between countries. Results: The hypothesized model relationships were supported in both countries with few differences between groups. Components of supportive professional practice work environments, particularly resources, were significantly linked to nurses' turnover intentions and active search for new jobs. Leadership played a critical role in shaping the pattern of relationships to other components of supportive practice environments and ultimately turnover behaviours. Conclusion: The Nursing Worklife Model was shown to be valid in both countries, suggesting that management efforts to ensure that features of supportive practice environments are in place to promote the retention of valuable nursing resources.
    International Journal of Nursing Studies 11/2014; 52(2). DOI:10.1016/j.ijnurstu.2014.10.016 · 2.90 Impact Factor
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    • "Processes may be defined and operationalised as the care delivered (clinical process measures) or as organisational processes measures that describe the work environemnt.3 12 13 It has been suggested that the impact of safety culture vary with the work environment,14 and several studies have shown that nursing work environments are associated with clinical and nurse-reported quality.5 15 16 17 18 Improvements in nurses’ perceptions of organisational process measures in their work environment are likely to have an impact on nurse-reported quality. Two studies have shown that nurse-reported quality was associated with clinical outcomes such as hospital standardised mortality rates (HSMR), 30-day mortality, failure to rescue and patient satisfaction.19 "
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    ABSTRACT: There is a growing body of evidence for associations between the work environment and patient outcomes. A good work environment may maximise healthcare workers' efforts to avoid failures and to facilitate quality care that is focused on patient safety. Several studies use nurse-reported quality measures, but it is uncertain whether these outcomes are correlated with clinical outcomes. The aim of this study was to determine the correlations between hospital-aggregated, nurse-assessed quality and safety, and estimated probabilities for 30-day survival in and out of hospital. In a multicentre study involving almost all Norwegian hospitals with more than 85 beds (sample size=30, information about nurses' perceptions of organisational characteristics were collected. Subscales from this survey were used to describe properties of the organisations: quality system, patient safety management, nurse-physician relationship, staffing adequacy, quality of nursing and patient safety. The average scores for these organisational characteristics were aggregated to hospital level, and merged with estimated probabilities for 30-day survival in and out of hospital (survival probabilities) from a national database. In this observational, ecological study, the relationships between the organisational characteristics (independent variables) and clinical outcomes (survival probabilities) were examined. Survival probabilities were correlated with nurse-assessed quality of nursing. Furthermore, the subjective perception of staffing adequacy was correlated with overall survival. This study showed that perceived staffing adequacy and nurses' assessments of quality of nursing were correlated with survival probabilities. It is suggested that the way nurses characterise the microsystems they belong to, also reflects the general performance of hospitals.
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