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Download PDF: Complete Report, Executive Summary, Report, Appendices, Supplementary Materials
Results of this systematic review suggest approaches that health care administrators and nursing leadership may pursue to create supportive nursing work environments that foster quality care and patient safety. Changing just 1 element of the work environment is likely not sufficient to create robust impacts on quality and safety outcomes, as evidenced by our mixed findings and generally small associations across individual work environment factors. These review findings support that multidimensional measures of the nurse work environment are associated with significant and positive effects of moderate magnitude.
The nursing workforce is a key component of health care systems and an important factor in assuring high-quality care and patient safety. Multiple studies have reported a significant association between objective measures of health care quality and nurse-reported perceptions of quality of care. Many factors contribute to nursing-perceived quality and safety of care; the environment in which nurses perform their work is one such factor. The purpose of this review is to synthesize the literature exploring the relationship between nurse work environment factors, nurse-perceived health care quality, and nurse-perceived patient safety.
Global measures of nurse work environment demonstrated a moderate and significant association with nurse-rated health care quality and safety. However, measures of individual factors of the nurse work environment (eg, innovation, leadership, organizational culture, staffing adequacy, and teamwork) demonstrated smaller associations with mixed significance. Qualitative exploration of nurses' perceptions of the work environment showed that communication skills, shared team processes, and positive relationships and cohesion among team members, leadership support and trust, as well as staffing features (ie, nurse experience, patient-to-nurse ratios, patient acuity, use of overtime, staffing mix during shift) are integral to perceptions of quality or safety. Mapping of the interventional literature for improving nurse work environments showed that the median number of workplace factors targeted was 3 (range = 2-6). Future research in this area may benefit from a multifaceted approach across multiple, likely interconnected, workplace factors.
