Penn Nursing Study Links Nurse Work Environments and Outcomes

Newswise — PHILADELPHIA (March 26, 2019) – Nurses play critical roles in patient safety and are often the last line of defense against medical errors and unsafe practices. Considerable research has explored the relationship between the nurse work environment and a variety of patient and nurse quality and safety outcomes. But until now, no synthesis of this body of research has been made to clearly articulate the association between nurse work environments and health care quality, safety and patient and clinician well-being.  The nurse work environment refers to organizational elements that influence nursing care quality, such as nurse-physician collaboration, nurse manager support, and nurse involvement in decisions affecting clinical care.

A new meta-analysis from Penn Nursing’s Center for Health Outcomes & Policy Research (CHOPR) has synthesized 16 years of studies to show the association between the nurse work environment and four sets of outcomes: nurse job outcomes, nurse assessments of quality and safety, patient health outcomes, and patient satisfaction.  The article, “A Meta-Analysis of the Associations Between the Nurse Work Environment in Hospitals and 4 Sets of Outcomes,” is set for publication in an upcoming issue of the journal Medical Care, but is available online first here.

“Our quantitative synthesis of the results of many studies revealed that better work environments were associated with lower odds of negative outcomes ranging from patient and nurse job dissatisfaction to patient mortality,” said lead-investigator Eileen T. Lake, PhD, MSN, FAAN, the Jessie M. Scott Endowed Term Chair in Nursing and Health Policy.

The researchers did a systematic review of studies from around the world that reported empirical research using the Practice Environment Scale of the Nursing Work Index. Those studies reported data from more than 2,600 hospitals, 165,000 nurses and 1.3 million patients about the practice environment, nurse job outcomes, safety and quality ratings, patient outcomes, and patient satisfaction.

“Our results support the unique status of the nurse work environment as a foundation for both patient and provider well-being that warrants the resources and attention of health care administrators,” says Lake.

 Co-authors of the article include University of Pennsylvania alumna Jordan Sanders, of the University of Vermont Medical Center; Rui Duan, MS, and Yong Chen, PhD, both of the Perelman School of Medicine, University of Pennsylvania; and Kathryn A. Riman, BSN, BSPH, RN, and Kathryn M. Schoenauer, both of CHOPR. The study was supported in part by NIH grants 1R01LM012607 and 1R01AI130460 and a research grant from Penn Nursing’s Office of Nursing Research. 


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