The relationship between the nursing practice environment and five nursing-sensitive patient outcomes in acute care hospitals: A systematic review.
Tamer Al-Ghraiybah, Jenny Sim, Luise Lago
PMID 33665965WHAT IT FOUND
A better nursing work environment is linked to lower patient mortality, but evidence for other outcomes like falls, medication errors, and infections is inconsistent or missing.
Cross-sectional data cannot prove that improving the environment causes these patient outcomes to change.
Key findings
01Seven studies found an association between a favourable nursing practice environment and reduced patient mortality, though the magnitude of the effect varied widely.
02Evidence for other nursing-sensitive outcomes was inconsistent: no studies examined falls, medication error findings were conflicting, and pressure injury and infection results were mixed.
03All included studies used a cross-sectional design, which prevents drawing causal conclusions about the impact of the work environment on patient outcomes.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
All included studies were cross-sectional, so causation cannot be inferred. Definitions of outcomes (especially mortality and NPE) varied widely across studies, preventing meta-analysis. Only 10 studies were included, and none examined patient falls. The search was limited to English-language studies and administrative data, potentially missing evidence from studies using nurse perceptions. Most studies were conducted in the USA, limiting generalizability to other healthcare systems.
Declared interests
The authors report no conflict of interest.
The easy way to misread this
Do not interpret the association between a favourable nursing work environment and lower mortality as proof that improving the environment will directly cause mortality to drop. The studies are cross-sectional and cannot establish causation.