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Work Environment Strongly Influences Nurse and Patient Outcomes

Analysis  |  By Jennifer Thew RN  
   November 29, 2016

Workplace safety and nurse surveillance capacity can boost quality ratings and lower pressure ulcer rates, Press Ganey analysis finds.

Workplace safety and nurse surveillance capacity are significantly associated with healthcare organizations' performance on nurse, patient, patient experience, and pay-for-performance outcomes, according to analysis by Press Ganey.

The South Bend, IN-based company reached these conclusions after analyzing data from its patient and caregiver surveys, its National Database of Nursing Quality Indicators, and the CMS Hospital Compare website.

The analysis found that when compared to hospitals in the bottom quartile of perceived nursing workplace safety, hospitals in top quartile of perceived nursing workplace safety had:

  • A rate of RN-perceived missed care that is approximately 52% lower
  • RN job enjoyment that is 27% higher
  • A 22% higher CMS Overall Hospital Quality star rating
  • Average "likelihood to recommend" scores that are 3% higher

Press Ganey published its findings in a report titled "The Role of Workplace Safety and Surveillance Capacity in Driving Nurse and Patient Outcomes."

Christy Dempsey, RN, MSN, MBA, CNOR, CENP, FAAN, Chief Nursing Officer at Press Ganey, assessed the findings in relation to Maslow's hierarchy of needs, a concept familiar to most nurses. "Safety is at the bottom of the pyramid. The only thing more important is physiological needs," Dempsey says.


"As a nurse, if I don't perceive that my work environment is safe, then I'm not going to be able to continue up the pyramid to self-actualization—the 90th percentile—or any other improvement effort that you want me to do."

To assess the components of a safe work environment, researchers created an RN Safety Composite measure that included survey items related to safe patient handling and mobility practices, RN-to-RN interaction, appropriateness of patient care assignments, meal-break practices, and shift duration.

The analysis also found the work environment significantly influences nurse surveillance capacity—the degree to which nurses are able to observe, monitor, collect, interpret, and synthesize patient information to make informed decisions regarding their course of care.

Compared to hospitals in the bottom quartile of perceived nursing surveillance capacity, those in the top quartile had:

  • 26% fewer hospital-acquired pressure ulcers
  • A 5% higher CMS Overall Hospital Quality star rating
  • 3% higher average "likelihood to recommend" scores
  • 13% lower rate of RN-perceived missed care

To measure nurse surveillance capacity, the researchers adapted a composite measure that included subscales of the Practice Environment Scale of the Nursing Work Index linked to surveillance capacity, according to the report.


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"Staffing, resource adequacy, nurse manager ability and leadership, the percent of nurses with certification, and the nurses' participation in hospital affairs—those are the things that drive the ability to surveil your environment," Dempsey explains.

The surveillance composite also included RN characteristics such as education, clinical competence, and years of experience.


Of the two work environment components, workplace safety had a stronger influence on outcomes than perceived surveillance capacity.

"It was interesting that workplace safety was a more significant driver than the surveillance capacity," Dempsey says. "I think that goes back to the whole fundamental basic need that before you can move to anything else you have to feel safe."

One the many takeaways from the analysis, says Dempsey, is the need for frontline nurse managers to have the skills to create safe work environments that foster nurse surveillance capacity.

Nurse leaders need to be "making sure that frontline leadership has the resources and training that they need to actually make a difference in that role," she says. "Not just training on the budget and on scheduling but on coaching and leading and mentoring."

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.


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