Work Environment Factors Other Than Staffing Associated with Nurses' Ratings of Patient Care Quality

According to a survey of registered nurses (RNs) early in their careers, some work environment factors beyond staffing are associated with nurses’ ratings of the quality of care received by patients, suggesting managers should consider these specific issues to improve care quality.

With the U.S. facing a shortage of 250,000 RNs over the next 15 years and hospitals under increasing financial pressure, institutions must maximize the effectiveness of nursing resources. This study extends prior research into the impact of the nursing workplace on patient care quality, and measures the independent effects of specific factors. Findings are based on responses to a 2007 written survey by a nationally-representative sample of 1,439 RNs (n=2,007; response rate = 68%), initially licensed in 2004 and 2005 and employed in 60 hospitals across the country.

Key Findings:

  • Despite responses indicating there are often an insufficient number of nurses and that RNs are working “very hard and very fast,” 69.5 percent of respondents believe patients are “very likely” to receive high-quality care and another 28.4 percent said that such care is “somewhat likely.”
  • Specific factors were found to be associated with nurses’ ratings of care quality to varying degrees. For example, a single incremental increase in how well nurses rated their physical work environment, made it almost five times more likely (4.99) they would rate their patients’ care as high-quality. Other notable relations were as follows: workgroup cohesion (1.69), nurse-physician relations (1.40), procedural justice (1.34), job satisfaction (1.26), and working at a hospital with Magnet recognition status (1.69.)
  • Some factors were associated negatively with ratings of patient care, including promotional opportunity (0.86), organizational constraints (0.56), and the patient-to-RN ratio (0.92).

The authors note the assessments of relative impact of workplace factors beyond staffing should help managers evaluate possible improvements since costs and opportunities for change vary greatly among the factors.