Work Environment Trumps Staffing Levels for Nurses

A survey has found that one way to improve patient care is to improve the work environment for nurses.

Staffing levels are also important, but this survey indicated that even just a single incremental increase in how nurses rated their physical work environment resulted in a nearly five times greater chance that nurses would rate their patient care as being high quality.

“Similarly, one incremental increase in [nurses’] rating of organizational constraints decreased the odds of reporting their patients received high-quality care by 44%,” they [Maja Djukic, PhD, RN, of the New York University College of Nursing in New York City, and colleagues] wrote online in Health Care Management Review.

Djukic and colleagues examined the association between the nurses’ ratings of patient care quality and several work environment factors, adjusting for the effects of two staffing variables: reported patient-to-nurse ratios and ratings of staffing adequacy.

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“The impact of [nurse] staffing on patient care quality has been extensively studied,” wrote the authors. “Identifying additional modifiable work environment factors linked to patient care quality is critical as the projected shortage of approximately 250,000 [nurses] over the next 15 years limits institution’s ability to rely on staffing alone to ensure high-quality care.”

Limitations included the use of a cross-sectional data set that precluded inference to causal relationships. They used nurse ratings of quality of care that were not backed up by measurements of actual outcomes. In addition, the respondents were relatively new nurses so their opinions may have differed from their more experienced peers.

“Our evidence demonstrates the importance of considering [nurse] work environment factors other than staffing when planning improvements that may effect patient care,” the authors wrote. “These are consequential for health managers, because these are the factors that they have the ability to improve on.”

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