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Work Environment Strongly Influences Nurse and Patient Outcomes

By Jennifer Thew RN  
   November 29, 2016

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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