Quality of care increased by strong work environment

Survey of nurses shows positive workplace improves care

NEW YORK, NY – When nurses feel engaged and respected by their co-workers in a positive physical work environment, their perception of the quality of care given to their patients is much higher, according to a recent study that researched ways to improve nurses’ work environments without increasing nurse-to-patient ratios and overspending.

The study is based on a 98-question survey of 1,226 RNs, which is part of the RN Work Project, a nationwide, 10-year longitudinal survey of RNs begun in 2006, and supported by a grant from the Robert Wood Johnson Foundation. A third-wave of the survey asked the RNs about elements contributing to their perceived quality of care.

According to the survey, important factors included physical work environment, workgroup cohesion, nurse-physician relations, procedural justice and job satisfaction. Nurses’ quality ratings were also higher in hospitals that had earned Magnet designation.

“Staffing is important and we need to make sure there’s safe staffing levels, but at some point adding more people to this dysfunctional work environment will not yield the benefits for patients and nurses,” said Maja Djukic, RN, an author of the study and assistant professor at the College of Nursing, New York University. She said hospitals and other units would benefit by expanding their toolbox and beginning to pay attention to these other, less costly factors in improving quality.

“What we wanted to highlight for hospital administrators is that they can optimize the effectiveness of their available staff by focusing on work environment redesign,” said Djukic “Removing organizational barriers, insuring that nurses have the right equipment and supplies in the right place in the right time.”

Appropriate lighting, lower noise levels and a less-crowded workspace will all impact a nurse’s ability to perform the job at the highest potential, said Djukic. She also stressed the importance of worker cohesion, suggesting that co-workers take time outside of work to learn more about each other and ultimately interact in a friendlier and more gratifying manor that can be applied to hours spent on the job.

When considering work environment changes, it is essential for administrators to consider a projected nursing shortage for approximately 250,000 RNs over the next 15 years.

Nancy Fishman, a senior program officer in the Research and Evaluation Unit at the Robert Wood Johnson Foundation, said the work environment should be set up to honor and reap the benefits of having an experienced staff around.

“I think that we’re going to run into some problems when they do decide to retire once the economy improves,” said Fishman. “We have to continue to think of alternate ways to use experienced staff to help mentor new staff.”

She said hospitals and other units look for the types of ideas presented in these studies, and when given the opportunity, should implement the ones that best fit their practices.

“There are things that could be done now, and we have to make sure we get this message into the hands of hospital management and such that can help us implement some changes that don't have to wait until they can increase their staffing or educate their nurses,” she said.

While every healthcare facility is different, there is no single solution that will work for everyone.

“What our study offers is a road map on what factors they should be looking at,” Djukic said. “What they can all do is begin to assess their performance in these important measures.”