Care Quality, Patient Safety, and Nurse Outcomes at Hospitals Serving Economically Disadvantaged Patients: A Case for Investment in Nursing

Abstract

We sought to evaluate if better work environments or staffing were associated with improvements in care quality, patient safety, and nurse outcomes across hospitals caring for different proportions of patients who are economically disadvantaged. Few actionable approaches for hospitals with quality and resource deficits exist. One solution may be to invest in the nurse work environment and staffing. This cross-sectional study utilized secondary data from 23,629 registered nurses in 503 hospitals from a four-state survey collected in 2005–2008. Each 10% increase in the proportion of patients who are economically disadvantaged was associated with 27% and 22% decreased odds of rating unit-level care quality as excellent and giving an “A” safety grade, respectively. Each 10% increase was also associated with 9%, 25%, and 11% increased odds of job dissatisfaction, intent to leave, and burnout, respectively. The work environment had the largest association with each outcome. Accounting for the nurse work environment lessened or eliminated the negative outcomes experienced at hospitals serving high proportions of patients who are economically disadvantaged. Leaders at hospitals serving high proportions of patients who are economically disadvantaged, as well as state and federal policymakers, should work to improve quality, safety, and nurse outcomes by strengthening nurse work environments. Improving work environments highlights the role of nursing in the health care system, and policies focused on work environments are needed to improve the experiences of patients and nurses, especially at hospitals that care for many patients who are economically disadvantaged.

Identifying predictors of employee silence about patient safety based on environmental factors among nurses in Ardabil:A Cross-Sectional Study

“…One of the indicators of high-quality health care relies on patient safety or the absence of preventable harm to the patient during the health care process (32). In the study conducted about work environment factors affecting the quality of patient care, the increase in the number of patients was associated with a decrease in the quality of care (33). But high-quality, safer, standard and evidence-based nursing care are provided in environments that are more appropriate in terms of conditions than other environments (34).…”

The perception of shared governance and engagement in decision‐making among nurses

“…Globally, the number of nurses and midwives is estimated to be 27.9 million representing more than 59% of the total number of healthcare workers 1 . Therefore, nurses are the most significant occupational sector in a healthcare organization and play a vital role in producing high‐quality patient care 2,3 . Although nurses hold the key to providing the best patient care, the frequent turnover can negatively impact these services and incur additional financial burdens on the institutions 4 .…”

“…1 Therefore, nurses are the most significant occupational sector in a healthcare organization and play a vital role in producing high-quality patient care. 2,3 Although nurses hold the key to providing the best patient care, the frequent turnover can negatively impact these services and incur additional financial burdens on the institutions. 4 The effects of employees turnover extend to productivity losses and organizational inefficiencies resulting from nursing staff volatility, which imposes additional adverse consequences.…”