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How the Nursing Work Environment Affects Patient Outcomes

"As a key player on the front lines of health care delivery, nurses play a critical role in ... enabling patients to achieve optimal outcomes."

By Jacqueline DiChiara

- Nurses play a significant role in advancing favorable patient and nurse outcomes, says a recent report and accompanying press release from Press Ganey.

 nursing care delivery patient experience

“As a key player on the front lines of health care delivery, nurses play a critical role in preventing adverse events, coordinating care and enabling patients to achieve optimal outcomes,” Press Ganey states.

“[It] is essential that health system leaders and nurse managers understand the various internal and external factors influencing the nurses’ work environment and the quality of the nursing practice,” maintains Press Ganey.

Key finding: nurses vital to top-notch care delivery

According to results from “rigorous” statistical analysis, including pay-for-performance data findings, Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) scores across all patient experience domains respond highly to quality work environments. Such is not dependent on staffing composite scores, says Press Ganey.

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The higher the quality of a nursing work environment, the higher perceptions of care quality from both nurses and patients, Press Ganey maintains. The Hospital Value-Based Purchasing Program’s (VBP) performance regarding patient experience scores go up according to work environment improvements made, says Press Ganey.

“Nurses are vital to ensuring delivery of safe, effective and compassionate care across every sector of health care,” states Christy Dempsey, Press Ganey Chief Nursing Officer.

“These findings clearly demonstrate that the quality of the nursing work environment significantly influences nurses’ ability to reduce suffering for patients and caregivers alike,” Dempsey adds.

Achieving high-quality nursing care far from simple

Although such findings are perhaps nothing particularly innovative, the fact of the matter is achieving top-notch nursing care does not involve a one-minded or simplistic execution. The nursing/patient outcome connection is allegedly stunningly diverse, complicated, and starkly multi-faceted in nature.

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Says Press Ganey, “High-quality nursing care depends on multiple underlying structure and process factors, such as nurses’ skills and education, the availability of sufficient supplies and equipment, staff training, facilities, reliable use of demonstrated nursing best practices, inter-professional relationships, nurse engagement and job satisfaction — all of which influence outcomes."

Indeed, a nurse stressed over his or her job security, for instance, with limited supplies available throughout a shift and inadequate educational training will generally not exactly have a leg up on a nurse who feels valued at work, has more than sufficient education to fall back upon, and feels wholly engaged and generally happy within the day-to-day work environment.

Says Press Ganey, if nurses' burn-out rates and general intentions of leaving are low and RN staffing shortage needs are met or exceeded, patient outcomes are higher. Additionally, 30-day readmission rates notably drop for Medicare patients with heart failure, myocardial infarction, and pneumonia, Press Ganey says.

Nurse turnover rates alone, merely one facet of the above, are perhaps proving to be an alleged monster to tackle in and of itself. Nurse turnover rates, says Press Ganey, are not only a multi-million dollar dilemma but represent “one of the most disruptive problems facing health care systems and organizations.”

According to leading labor statistic projections, the RN workforce will likely increase from over 2.7 million in 2012 to over 3.2 million in 2022, representing a 15% spike – an increase of over 526,000.

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“Understanding the factors that contribute to relevant nurse outcomes as defined by intention to stay on the job, job enjoyment and turnover is a critical step in the development of workforce strategies to improve the value of care for patients and care providers,” Press Ganey states.

Nonetheless, more isolated techniques reportedly improve nursing care delivery and in turn enhance patient experience and nurse satisfaction outcomes, says Press Ganey, such as increases in hourly nurse rounds and bedside shift reporting.

“[Patient] clinical, safety and experience outcomes are influenced by the number and skill mix of nurses, the degree to which nurses are doing the right things to meet patients’ needs and the nature of the environment in which they are working,” Press Ganey maintains.

“Because patient and nurse perceptions of care quality show similar patterns and are both enhanced by higher-quality nurse work environments and favorable staffing, hospital decision makers should make sure that direct-care nurses are involved in decision-making and that quality of care concerns are taken seriously,” says Press Ganey.

Press Ganey’s highlighted suggestions for improvement include:

  • Nurses should practice at the highest level regarding education and training
  • Nurses should strive to receive more education and training via an improved education system that values academic growth
  • Nurses, physicians, and health care professionals should consider themselves as full partners working to redesign the greater industry
  • Efforts should be put firmly in place to strengthen RN autonomy and allow for greater levels of RN control over practice and resources
  • Greater focus on maintaining strong interprofessional relationships, consistent leadership support
  • Maintenance of consistent, adequate staffing and skill mix


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