OBJECTIVE: The impact of interventions designed to improve the nursing work environment on patient and nurse outcomes was examined. BACKGROUND: Nursing work environments have been characterized as contributing to patient outcomes as a result of organizational management practices, workforce deployment, work design, and organizational culture. METHODS: This quasi-experimental study involved 16 unit managers, 1,137 patients, and 296 observations from registered nurses over time. RESULTS: After participation in the intervention, study nurses reported higher perceptions of their work and work environment. Demographic nurse, unit, and hospital characteristics also had an impact on the work environment and outcomes. CONCLUSIONS: Findings in this study highlight the importance of understanding factors in the work environment that influence patient and nurse outcomes.
Commentary by Dana Rutledge, RN, PhD, Nursing Research Facilitator
The intervention in this study was fairly complex in that individual units determined a workplace change to implement. For 6 months, change development and implementation was facilitated by a trained bachelor’s prepared nurse who devoted efforts solely to this project. Changes included things like enhancing documentation activities, increasing medication supplies, and implementation of a communication tool related to patient transfers. Changes before and 6 months after the workplace change were determined for system data (unit/hospital characteristics), nurse outcome data (surveys on satisfaction, work quality, etc.), and patient outcomes (ADLs, satisfaction, etc.). Analysis involved “nesting” outcomes for nurses within units. Patient outcomes were not nested since different patients were used at data collection points.
Hospitals studied all were in Ontario Canada. Nurses were mostly females (95%) prepared at diploma or certificate level (76%). Experience levels varied with 29% of nurses having less than 5 years and 20% having > 25 years. Most units (60%) used “total patient care delivery model,” which was not defined. Patients were 46% medical, 54% surgical.
Six-month findings indicated positive changes in nurse perceptions of the work and work environment. This is one of few studies that measure change over time with a work environment change (probably due to the complexity of such research designs). Researchers discussed the significant contributions of nurse and unit characteristics on outcomes. For example, RNs with baccalaureate degrees reported higher levels of job stress than those with diplomas… could the “added knowledge and understanding that comes with degree education and the greater sense of accountability” be active in these findings? Unit characteristics such as proportion of part-time nurses also impacted outcomes with units having more part-time nurses having higher average nurse ratings of job satisfaction. Finally, hospital and unit characteristics impacted patient outcomes… patients in teaching hospitals reported better perceptions of quality and increased independence than did community hospital patients.
Implications from this Canadian study are that fairly simple workplace changes can quickly (within 6 months) alter nurse and patient outcomes. Authors described issues with nurse generations, nurse experience, and patient-to-nurse ratios that deserve further study.