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The Relationship between the Nurses' Work Environment and Patient and Nurse Outcomes

  • Author(s): Blake, Nancy
  • Advisor(s): Leach, Linda S
  • et al.
Abstract

Medical errors cost the United States over $50 billion annually. Healthy work environments (HWE) can reduce medical errors and decrease Registered Nurse (RN) turnover. Three of the variables that impact the work environments are communication, collaboration and leadership. The Joint Commission stated that communication failures are the leading cause of harm to patients in hospitals today. With an estimated shortage of 260,000 nurses identified in the year 2025, nurse leaders need to be creative and do what they can to improve the work environment. The purpose of this research study was to determine the relationship between HWEs, patient outcomes and nurse turnover in the pediatric intensive care unit (PICU), specifically around communication, collaboration and leadership and risk adjusted patient mortality, risk adjusted length of stay, central line infections, ventilator associated pneumonia and nurse turnover in the PICU. This type of study has never been done in the PICU. Donabedian's model of Structure, Process and Outcomes was used as the conceptual framework. The study design was exploratory. Nurses completed the Practice Environment Scale of the Nursing Work Index Revised (PES-NWIR), which is a 31 items instrument used the measure the practice environment. Participants also completed questions from the ICU Nurse-Physician Questionnaire regarding communication and a demographic questionnaire. In addition to the nurses completing the questionnaire, data was obtained from the hospitals regarding nurse turnover, central line infections, ventilator associated pneumonia, risk adjusted length of stay and risk adjusted mortality as well as information about the unit's nursing and medical structure. Statistical analysis was done using SPSS 17.0. Pearson correlations were conducted to examine the relationships of healthy work environments and the outcome measures. Multiple regression, t-tests (two-tailed) and one way analysis of variance (ANOVA) were completed. This significance level was set at .05 for this study. A sample of 415 RNs completed the survey from ten hospitals. RN's were mostly female (94%), Caucasian (95%), has a bachelor's degree (75 %), and 1-10 years as a PICU RN (70%). There was an inverse relationship between CLBSI and collaboration and communication (p<.01) but no association between communication, collaboration, or leadership and VAP. Risk adjusted mortality was inversely related to collaboration and communication (p<.05). Risk adjusted LOS was inversely related to collaboration and communication (p<.05). There was a statistically significant relationship between leadership and the outcome ITL (p<.05), but not any of the other predictor variables. Communication and collaboration in the PICU between RNs and between RNs and MDs are vital for patient safety, preventing complications and increased risk of death and to reduce hospital costs at the unit level. Findings from this study also indicate that effective nursing leadership is important to PICU RNs and significantly influences their decisions about staying in their current job.

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