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Cited by 424Nursing education and managementHealthcare Education and Workforce IssuesHealthcare Quality and Management

A meta-analysis of the associations between the nurse work environment in hospitals and 4 sets of outcomes

Open access
Lake, Eileen T., Sanders, Jordan, Duan, Rui, Riman, Kathryn A., Schoenauer, Kathryn M., Chen, Yong·2019·Medical Care
DOI 10.1097/mlr.0000000000001109PMC PMC6615025
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Abstract

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 classes: nurse 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.

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  • Previous research has shown that improving work environments can reduce job dissatisfaction, burnout, and turnover intentions.

    “Previous research has shown that improving work environments can reduce job dissatisfaction, burnout, and turnover intentions [40].”

    From Factors Associated With Health-promoting Behaviors Among Nurses in South Korea: Systematic Review and Meta-analysis Based on Pender's Health Promotion Model. (2024) · cites this paper as [40]

    The Discussion reports that nurses in better work environments had 28%–32% lower odds of job dissatisfaction, burnout, or intention to leave. But it also says the study relied on cross-sectional data that do not support causal inference. The claim’s suggestion that improving environments can reduce those outcomes goes beyond the association established here. (LLM, conf=0.90)

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Research works printed but not linked: 3

  1. [1]Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001. 25057539
  2. [9]National Database of Nursing Quality Indicators. New!: RN Survey With the Practice Environment Scale, Vol. 7 Nursing Quality News. Kansas City, KS; 2006.
  3. [38]Press Ganey. Nursing special report: the influence of nurse work environment on patient, payment, and nurse outcomes in acute care settings. 2015 Available at: http://healthcare.pressganey.com/2015-NursingSR_Influence_Work_Environment. Accessed March 10, 2019.

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Authors
Lake, E. T., Sanders, J., Duan, R., Riman, K. A., Schoenauer, K. M., & Chen, Y.
Affiliations
  • University of Pennsylvania (US)
  • University of Vermont Medical Center (US)
  • Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA
Corresponding author
  • Lake, Eileen T.
  • Schoenauer, Kathryn M.
ORCID
Venue
Medical Care
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2019-05
Volume
57
Issue
5
Pages
353-361
ISSN
0025-7079 (ISSN-L)
DOI
10.1097/mlr.0000000000001109
PMC
PMC6615025
OpenAlex
W2924828281
Cited by
424
References
38
Citations by year
2026: 80 · 2025: 68 · 2024: 69 · 2023: 65 · 2022: 58 · 2021: 52 · 2020: 24 · 2019: 6
FWCI
7.33
Type
journal article
Language
en
Open access
Locations
  • Medical Care (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Nursing Research (T32NR007104)
  • National Institute of Allergy and Infectious Diseases (R01AI130460)
  • U.S. National Library of Medicine (R01LM012607)
Topics
  • Health Sciences › Nursing › Research and Theory › Nursing education and management
  • Health Sciences › Nursing › Leadership and Management › Healthcare Education and Workforce Issues
  • Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
Keywords
nursing work environment, nursing care quality, patient safety, patient outcomes, patient satisfaction, nurse well-being, hospital nursing units, Nursing Work Index, quality of care
MeSH terms
Humans, Job Satisfaction, Nursing Staff, Hospital, Quality of Health Care, Patient Satisfaction, Outcome Assessment, Health Care, Workplace, Patient Safety

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