Improving Patient Care by Improving Nurses' Work Environment

    • November 28, 2011

“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 Maja Djukic, PhD, RN. The projected nursing shortage and the grim economic climate are making it more difficult for hospitals and health care systems to increase nurse staffing. That reality led the Robert Wood Johnson Foundation (RWJF) RN Work Project researchers to investigate whether there are other factors in the work environment that RNs perceive as affecting the quality of patient care. The RN Work Project is a nationwide, 10-year longitudinal survey of RNs begun in 2006.

“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,” Djukic said.

Djukic, an assistant professor at the College of Nursing at New York University, is the lead author of the study, published in the November issue of Health Care Management Review. It revealed that RNs perceive several work environment factors to improve quality of care. In order of influence, they 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.

The RN Work Project is led by Christine Kovner, PhD, RN, FAAN, professor at the College of Nursing, New York University and Carol Brewer, PhD, RN, FAAN, professor at the School of Nursing, University at Buffalo.

The findings on work environment are based on a 98-question survey that the research team developed and administered to 1,226 RNs. They 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,” Kovner said. “They need to examine their resources and determine which changes are possible and which will have the most impact on improving patient care.”

The research team also included: Farida Fatehi, BDS, MS, junior research analyst at the College of Dentistry at New York University; and Daniel Cline, MSN, RN, CRNP, PhD candidate, and the John A. Hartford Foundation Building Academic Geriatric Nursing Capacity scholar at the College of Nursing at New York University.