Linking Nursing Work Environment and Patient Outcomes

A cross-sectional secondary data analysis was conducted linking nursing work environment data from a 2004 survey of 633 nurses in 71 hospitals in North Carolina and Illinois to hospital-level patient outcomes data based on the Agency for Healthcare Research and Quality inpatient quality indicators and patient safety indicators. Nursing work environment was used as an umbrella term to include staffing, job demands, work schedule, and nursing practice environment. We found that pneumonia deaths were significantly more likely in hospitals where nurses reported increased psychological demands and more adverse work schedules. Postoperative pulmonary embolism/deep vein thrombosis was more likely in hospitals where nurses reported high psychological demands, controlling for staffing and other hospital characteristics. The nursing practice environment had a limited moderating impact on these relationships. Nurses' job demands and schedules are associated with selected patient outcomes and should be considered as modifiable working conditions, along with staffing, to improve patient care.