Effects of work environments on nurse and patient outcomes

Aim To determine the relationship between nurses' perceptions of their work environment and quality/risk outcomes for patients and nurses in acute care settings. Background Nurses are leaving the profession as a result of high levels of job dissatisfaction arising from current working conditions. To gain organizational support for workplace improvements, evidence is needed to demonstrate the impact of the work environment on patient care. Method A multi-level design was used to collect data from nurses (n = 679) and patients (n = 1005) within 61 medical and surgical units in 21 hospitals in Canada. Results Using multilevel structural equation modelling, the hypothesized model fitted well with the data [chi(2) = 21.074, d.f. = 10, Comparative Fit Index (CFI) = 0.985, Tucker-Lewis Index (TLI) = 0.921, Root Mean Square Error of Approximation (RMSEA) = 0.041, Standardized Root Mean Square Residual (SRMR) 0.002 (within) and 0.054 (between)]. Empowering workplaces had positive effects on nurse-assessed quality of care and predicted fewer falls and nurse-assessed risks as mediated through group processes. These conditions positively impacted individual psychological empowerment which, in turn, had significant direct effects on empowered behaviour, job satisfaction and care quality. Conclusions Empowered workplaces support positive outcomes for both nurses and patients. Implications for nursing management Managers employing strategies to create more empowered workplaces have the potential to improve nursing teamwork that supports higher quality care, less patient risk and more satisfied nurses.