A Meta-Analysis of the Associations Between the Nurse Work Environment in Hospitals and 4 Sets of Outcomes

• Published in: Medical care Vol. 57; no. 5; pp. 353 - 361
• Main Authors: Lake, Eileen T, Sanders, Jordan, Duan, Rui, Riman, Kathryn A, Schoenauer, Kathryn M, Chen, Yong
• Format: Journal Article
• Language: English
• Published: United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-05-2019; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Clinical outcomes; Confidence intervals; Environments; Health care; Health promotion; Hospitals; Humans; Job Satisfaction; Medical personnel; Meta-analysis; Nurses; Nursing; Nursing care; Nursing Staff, Hospital - psychology; Occupational safety; Outcome Assessment, Health Care; Patient Safety; Patient Satisfaction; Patients; Performance standards; Quality; Quality of Health Care; Ratings; Regression analysis; Regression models; Research design; Safety; Statistical analysis; Work environment; Working conditions; Workplace
• ISSN: 0025-7079; 1537-1948; 1537-1948
• DOI: 10.1097/MLR.0000000000001109

BACKGROUND:The nurse work environment is theorized to influence the quality of nursing care, nurse job outcomes, and patient outcomes.
OBJECTIVE:The aim of this meta-analysis was to evaluate quantitatively the association of the work environment with job and health outcomes.
RESEARCH DESIGN:Relevant studies published through September 2018 were identified. Inclusion criteria were use of a nationally endorsed work environment measure and reporting of odds ratios (ORs) and 95% confidence intervals from regression models of 4 outcome classesnurse job outcomes, safety and quality ratings, patient outcomes, and patient satisfaction. Pooled ORs and confidence intervals were estimated for each outcome using fixed or random effects models.
SUBJECTS:Of 308 articles reviewed, 40 met inclusion criteria. After excluding 23 due to sample overlap or too few observations to meta-analyze, a set of 17 articles, comprising 21 independent samples, was analyzed. Cumulatively, these articles reported data from 2677 hospitals, 141 nursing units, 165,024 nurses, and 1,368,420 patients, in 22 countries.
MEASURES:Practice Environment Scale of the Nursing Work Index, a National Quality Forum nursing care performance standard.
RESULTS:Consistent, significant associations between the work environment and all outcome classes were identified. Better work environments were associated with lower odds of negative nurse outcomes (average OR of 0.71), poor safety or quality ratings (average OR of 0.65), and negative patient outcomes (average OR of 0.93), but higher odds of patient satisfaction (OR of 1.16).
CONCLUSIONS:The nurse work environment warrants attention to promote health care quality, safety, and patient and clinician well-being.