Pupil symmetry was impressive in the entire cohort.

This study examines two important aspects that are both relevant and important to clinical nursing. The first aspect is the healthy work environment. Multiple studies have linked the nursing work environment to patient outcomes and this is an area that deserves further attention. The second aspect, patient satisfaction, is now associated with hospital reimbursement. The relationship between the nursing work environment and patient satisfaction highlights an important link to improving patient care.

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BACKGROUND Nurse-physician collaboration may be related to outcomes in health care–associated infections. OBJECTIVE To examine the relationship between nurse-physician collaboration and health care–associated infections in critically ill adults. METHODS A secondary analysis was done of 5 years of nurses’ perception data from 671 surveys from 4 intensive care units. Ventilator-associated pneumonia and central catheter–associated bloodstream infections were examined. Multilevel modeling was used to examine relationships between nurse-physician collaboration and the 2 infections. RESULTS Nurse-physician collaboration was significantly related to both infections. For every 0.5 unit increase in collaboration, the rate of the bloodstream infections decreased by 2.98 (P= .005) and that of pneumonia by 1.13 (P= .005). Intensive care units with a higher proportion of certified nurses were associated with a 0.43 lower incidence of bloodstream infections (P= .02) and a 0.17 lower rate of the pneumonia (P= .01). With nursing hours per patient day as a covariate, units with more nursing hours per patient day were associated with a 0.42 decrease in the rate of bloodstream infections (P= .05). CONCLUSION Nurse-physician collaboration was significantly related to health care–associated infections

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