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 nurse 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 hospital 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 work environment 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 patient care."
-end-
NYU College of Nursing is a global leader in nursing education, research, and practice. It offers a Bachelor of Science in Nursing, a Master of Arts and Post-Master's Certificate Programs, a Doctor of Philosophy in Research Theory and Development, and a Doctor of Nursing Practice degree. For more information, visit www.nyu.edu/nursing.

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measureable and timely change. For nearly 40 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. For more information, visit www.rwjf.org.

New York University

Related Nursing Articles from Brightsurf:

Dismantling structural racism in nursing
Confronting the uncomfortable reality of systemic racism - the system that creates and maintains racial inequality in every facet of life for people of color - is having a national heyday.

MU School of Nursing programs help nursing homes respond to COVID-19
As the coronavirus pandemic continues to put a strain on health care systems, nursing homes have become overburdened with the challenge of keeping both patients and staff safe and healthy.

Palliative nursing's role during COVID-19 and beyond
As a rapid influx of patients overwhelmed health systems during the coronavirus pandemic, palliative nurses played dual roles supporting patients, patient families, and colleagues.

Calling for nursing support amid COVID-19 pandemic
There are close to 28 million nurses around the world who comprise a global workforce that delivers about 90 percent of primary healthcare, including frontline response to the COVID-19 pandemic.

Nursing research informs response to COVID-19 pandemic
Nursing research has an important influence on evidence-based health care practice, care delivery, and policy.

Designing better nursing care with robots
Robots are becoming an increasingly important part of human care, according to researchers based in Japan.

A work patch for better nursing home care
A research team, including a Purdue University work-life balance expert, studied work schedules in nursing home facilities and found a patching approach could benefit patients and staff.

Nursing science could help reduce firearm violence and its impact
Firearm violence is a significant public health problem worldwide. In the United States, firearms are used to kill almost 100 people daily.

A nursing perspective on the opioid crisis
Addictions nursing specialists have a unique role to play in caring for patients, families, and communities affected by the crisis.

Nursing notes can help indicate whether ICU patients will survive
Researchers at the University of Waterloo have found that sentiments in the nursing notes of health care providers are good indicators of whether intensive care unit (ICU) patients will survive.

Read More: Nursing News and Nursing Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.