Through careful manipulation of the hospital environment, both structural and psychological empowerment can be increased, resulting in greater job and patient satisfaction and, ultimately, improved patient outcomes.

Background Adverse events and serious errors are common in critical care. Although factors in the work environment are important predictors of adverse outcomes for patients, communication between nurses and physicians may be the most significant factor associated with excess hospital mortality in critical care settings. Objectives To examine the relationships between nurses’ perceptions of their practice environment, nurse-physician communication, and selected patients’ outcomes. Methods A nonexperimental, descriptive design was used, and all nurses (N=866) working in 25 intensive care units in southeastern Michigan were surveyed. The Conditions for Work Effectiveness Questionnaire-II and the Practice Environment Scale of the Nursing Work Index were used to measure characteristics of the work environment; the ICU Nurse-Physician Questionnaire was used to measure nurse-physician communication. Nurses self-rated the frequency of ventilator-associated pneumonia, catheter-related sepsis, and medication errors in patients under their care. Results A total of 462 nurses (53%) responded. According to multilevel modeling, both practice environment scales accounted for 47% of the variance in nurse-physician communication scores (P=.001). Nurse-physician communication was predictive of nurse-assessed medication errors only (R2=0.11). Neither environment scale was predictive of any of the patient outcomes. Conclusions Healthy work environments are important for nurse-physician communication. In intensive care units, characteristics of the work environment did not vary enough to be significantly predictive of outcomes, suggesting that even in various types of critical care units, characteristics of the work environment may be more similar than different.

Purpose: The purpose of this study was to examine associations among the nursing work environment, nurse job satisfaction, and intent to stay for nurses who practice in hospitals in Jordan. Design: A quantitative descriptive cross-sectional survey design was used. Methods: Data were collected through survey questionnaires distributed to 650 registered nurses (RNs) who worked in three hospitals in Jordan. The selfreport questionnaire consisted of three instruments and demographic questions. The instruments were the Practice Environment

Factors in the practice environment contributed both directly to nursing job satisfaction and also indirectly through RN-MD communication. Study findings showed that a practice environment favorable to nurses improved both nurses' perceptions of their communications with physicians and their job satisfaction.

We provide the first, to our knowledge, systematic differential diagnosis of barriers to ABCDE delivery, moving beyond the conventional focus on patient-level factors. Our analysis offers a differential diagnosis checklist for clinicians planning ABCDE implementation to improve patient care and outcomes.

Aims  We tested a modification of Leiter and Laschinger's Nursing Worklife Model by examining the impact of structural empowerment on professional work environment factors that lead to nursing job satisfaction. Background  The original model explains how five magnet hospital practice domains described by Lake (2002) interact to influence nurses’ work lives by either contributing to or mitigating burnout. Methods  A non‐experimental design was used. Five hundred randomly selected nurses in Michigan were surveyed (response rate 66%, n = 332). Instruments included the Conditions for Work Effectiveness Questionnaire‐II, the Practice Environment Scale of the Nursing Work Index, and the Index of Work Satisfaction. Path analysis was used to test the model. Results  The final model fit the data well (χ2 = 96.4, d.f. = 10, NFI: 0.90, CFI: 0.43, RMSEA: 0.18), supporting both hypotheses. Conclusions  The expanded Nursing Worklife Model demonstrates the role of empowerment in creating positive practice conditions that contribute to job satisfaction.

Background Various factors in hospitals can adversely affect patients' outcomes, including faulty communication between nurses and physicians. Whether specific communication elements (timeliness, accuracy, openness, understanding) can influence adverse outcomes is unknown. Objectives To determine the relationships between patients' outcomes and (1) nurses' perceptions of elements of communication between nurses and physicians and (2) characteristics of the practice environment. Methods A cross-sectional survey design was used. Information on ventilator-associated pneumonia, bloodstream infection associated with a central catheter, and pressure ulcers was collected from 25 intensive care units in southeastern Michigan. Simultaneously, 462 nurses in those units (response rate, 53.3%) were anonymously surveyed. The Conditions for Work Effectiveness Questionnaire-II and the Practice Environment Scale of the Nursing Work Index were used to measure characteristics of the practice environment. The Intensive Care Unit Nurse-Physician Questionnaire was used to measure communication between nurses and physicians. Statistical tests included correlation and multiple regression. Analyses were conducted at the unit level. Results Unit response rates varied from 6% to 100%. Together, variability in understanding communication and capacity utilization were predictive of 27% of the variance in ventilator-associated pneumonia. Timeliness of communication was inversely related to pressure ulcers (r = -0.38; P = .06), and workplace empowerment and scores on the Acute Physiology and Chronic Health Evaluation III were positive predictors of ventilator-associated pneumonia (R 2 = 0.36; P = .005). Conclusions Not all elements of communication were related to the selected adverse outcomes. The connection between characteristics of the practice environment at the unit level and adverse outcomes remains elusive.

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