The state of the science of nurse work environments in the United States: A systematic review.
Holly Wei, Kerry A Sewell, Gina Woody and 1 others
PMID 31406839WHAT IT FOUND
Hospitals with healthier nurse work environments and Magnet designation see lower patient mortality, fewer pressure ulcers, and better cardiac arrest survival.
Staffing ratios and leadership quality are critical drivers of these patient safety outcomes.
Key findings
01Patients in hospitals with poor work environments had a 16% lower chance of surviving in-hospital cardiac arrests compared to those in hospitals with respectable environments.
02Units within Magnet-designated hospitals had a 21% lower likelihood of developing hospital-acquired pressure ulcers than units in non-Magnet hospitals.
03In hospitals with the best nurse staffing, healthier environments decreased the odds of patient deaths and failure-to-rescue by 12% and 14% respectively.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review is restricted to studies conducted in the United States, which may not apply to healthcare systems in other countries. Most included studies were descriptive or correlational, meaning they show associations but cannot prove that improving the work environment directly causes better patient outcomes. The definition of 'healthy work environment' varied across the 54 studies, using different instruments and conceptual models.
Declared interests
The authors declared no potential conflicts of interest. The research did not receive specific grant funding from public, commercial, or not-for-profit sectors.
The easy way to misread this
Do not assume that changing the work environment alone will fix patient outcomes. The data shows that staffing ratios and work environment quality interact; improving staffing had no effect in hospitals with poor work environments, and the greatest benefit was seen only when both were optimized.