Background Nurse engagement is a modifiable element of the work environment and has shown promise as a potential safety intervention. Purpose Our study examined the relationship between the level of engagement, staffing, and assessments of patient safety among nurses working in hospital settings. Methods A secondary analysis of linked cross-sectional data was conducted using survey data of 26,960 nurses across 599 hospitals in 4 states. Logistic regression models were used to examine the association between nurse engagement, staffing, and nurse assessments of patient safety. Results Thirty-two percent of nurses gave their hospital a poor or failing patient safety grade. In 25% of hospitals, nurses fell in the “least” or only “somewhat” engaged categories. A 1-unit increase in engagement lowered the odds of an unfavorable safety grade by 29% (p <.001). Hospitals where nurses reported higher levels of engagement were 19% (p<.001) less likely to report that mistakes were held against them. Nurses in poorly staffed hospitals were 6% more likely to report that important information about patients “fell through the cracks” when transferring patients across units (p<.001). Conclusions Interventions to improve nurse engagement and adequate staffing serve as strategies to improve patient safety.

Aims and objectives To explore the experiences of nurses caring for socially at‐risk patients and gain an understanding of the challenges nurses face when providing care. Background Nurses play a pivotal role in caring for hospitalised patients with social risk factors and preparing them for discharge. Few studies have explored whether acute care nurses are adequately supported in their practice environments to address the unique needs of socially at‐risk patients as they transition back into community settings. Design A qualitative descriptive study of nurses working in a large urban academic medical centre. Methods We conducted six semi‐structured focus groups of nurses (n = 21). Thematic content analysis was performed to analyse the transcripts from the focus groups. We adhered to COREQ guidelines for reporting this qualitative study. Results Six key themes emerged: (a) nurses’ assessments of social risk factors, (b) experiences providing care, (c) barriers to care, (d) fear of “labelling” socially at‐risk patients, (e) unmet social care needs and (f) recommendations to improve care. Conclusions Our findings suggest that nurses are able to identify social risk factors. However, prioritisation of medical needs during acute care hospitalisation and lack of organisational supports may deter nurses from fully addressing social concerns. Relevance to clinical practice Acute care nurses should be involved in the development of future efforts to address the needs of socially at‐risk patients and be provided with additional supports in their practice environments. This could include continuing education to build nursing competencies in community‐based care and social vulnerability.

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