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Objective The purpose of this study was to examine the relationships between hospital context, nursing unit structure, and patient characteristics and patients’ satisfaction with nursing care in hospitals. Background Although patient satisfaction has been widely researched, our understanding of the relationship between hospital context and nursing unit structure and their impact on patient satisfaction is limited. Methods The data source for this study was the Outcomes Research in Nursing Administration Project, a multi-site organizational study to investigate relationships among nurse staffing, organizational context and structure and patient outcomes. The sample for this study was 2720 patients and 3718 RNs in 286 medical-surgical units in 146 hospitals. Results Greater availability of nursing unit support services and higher levels of work engagement were associated with higher levels of patient satisfaction. Older age, better health status and better symptom management were also associated with higher levels of patient satisfaction. Conclusions Organizational factors in hospitals and nursing units, particularly support services on the nursing unit and mechanisms that foster nurses’ work engagement and effective symptom management, are important influences on patient satisfaction.

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