T4 Nursing Matters! Better Nurse Staffing and Work Environments Associated with Lower Burn Patient Mortality

The complexity of modern burn care requires an integrated team of specialty providers working together to achieve the best possible outcome for each burn survivor. Nurses are central to many aspects of a burn survivor's care, including physiologic monitoring, fluid resuscitation, pain management, infection prevention, complex wound care, and rehabilitation. Research suggests that in general, hospital nursing resources, defined as nurse staffing and the quality of the work environment, relate to patient mortality. Still, the relationship between those resources and burn mortality has not been previously examined. This study used a multivariable risk-adjusted regression model and a linked, cross-sectional claims database of more than 14,000 adults (≥18 years) thermal burn patients admitted to 653 hospitals to evaluate these relationships. Hospital nursing resources were independently reported by more than 29,000 bedside nurses working in the study hospitals. In the high burn patient-volume hospitals (≥100/y) that care for the most severe burn injuries, each additional patient added to a nurse's workload is associated with 30% higher odds of mortality (P < .05, 95% CI: 1.02-1.94), and improving the work environment is associated with 28% lower odds of death (P < .05, 95% CI: 0.07-0.99). Nursing resources are vital in the care of burn patients and are a critical, yet previously omitted, variable in the evaluation of burn outcomes. Attention to nurse staffing and improvement to the nurse work environment is warranted to promote optimal recovery for burn survivors. Given the influence of nursing on mortality, future research evaluating burn patient outcomes should account for nursing resources.

The coronavirus disease 2019 (COVID-19) outbreak led to a massive influx of patients into hospitals, thus prompting the implementation of various response mechanisms to manage the surge in number of patients. During the mitigation period, hospital response mechanisms ceased and ensued a return to normal settings. However, changing hospital settings can affect nurses' work environments. Therefore, the primary objectives of this study were to investigate the impact of changes during disease outbreaks and the mitigation period on nurses' work environments, and to analyse the relationship between nurses' background variables and work environments. A longitudinal research design is employed herein. Two surveys were conducted in a hospital: the first during the COVID-19 outbreak period, when the hospital implemented response mechanisms, and the second during the COVID-19 mitigation period, when the hospital returned to normalcy. The questionnaire covered the nurses' background variables and work environment. When the COVID-19 outbreak transitioned to the mitigation period, satisfaction with managerial (p < 0.05) and unit support (p < 0.05) in the workplace decreased. Regarding the relationship between nurses' backgrounds and work environment satisfaction, we found that nurses working in COVID-19 dedicated units reported higher satisfaction with manager support (p < 0.001), peer support (p < 0.001), unit support (p < 0.05) and intent to stay (p < 0.05) than those in non-COVID-19 dedicated units. Additionally, factors such as age, nursing experience, sex, education, clinical teaching/mentoring roles, perceived COVID-19 infection risk, work shifts, housing problems during the outbreak and experience of discrimination influenced work environment satisfaction. Hospitals need to adjust the transformational steps of their COVID-19 or emerging infectious disease response mechanisms, or provide sufficient support to these nurses to mitigate the impact on their work environment.

This study aimed to identify the effects of nurses' professional autonomy and work environment on patient safety in general hospitals. By understanding this relationship, we sought to identify practical measures to improve patient safety in the healthcare context. Professional autonomy and nursing work environments have positive effects on job performance, job satisfaction, and patient outcomes. Data were collected from 200 nurses working in general hospitals, using a cross-sectional survey design. The survey was conducted in 2021 using self-report questionnaires that included the Nursing Work Environment Scale and items on professional autonomy and patient safety activities. The total professional autonomy score was 162.06 (range: 60-240). The mean scores of nursing work environment and nurses' patient safety activities were 2.55 out of 4 and 4.22 out of 5, respectively. Multiple regression analysis revealed that professional autonomy (β = 0.234 and p=0.001) and nursing work environment (β = 0.138 and p < 0.05) were identified as variables that had significant effects on patient safety activities. Among the independent variables, professional autonomy had the greatest influence on patient safety. The findings confirm the need to improve and find ways to enhance nurses' professional autonomy and nursing work environment. Implications for Nursing Management. The findings confirm the need to improve and find ways to enhance nurses' professional autonomy and the nursing work environment. Based on these findings, medical institutions and nursing managers should continue to make efforts to improve the nursing work environment to enhance patient safety, especially system improvements, expand nurse autonomy within medical institutions, strengthen hospital management support to evaluate its effectiveness, and further improve government-level policies and systems.

To investigate the relationship between nursing ethical leadership style, work environment (workload, interpersonal conflicts) and patients' objective nursing-sensitive outcomes (accidental falls, pressure ulcers, nosocomial infections, restraints and deaths). Nationwide multicentre cross-sectional multilevel survey. Validated self-report scales were used to assess nurses' perceptions of ethical leadership, workload and interpersonal conflict. Nursing staffing and objective patient' nursing-sensitive outcomes were measured at the ward level. Descriptive and inferential analyses were conducted. Structural equation modelling examined the relationships among these variables based on Donabedian's conceptual framework. Data from 2349 nurses across 158 wards in 25 Italian acute care hospitals were analysed. The multilevel model showed an excellent fit. Ethical leadership was negatively associated with both workload and interpersonal conflict. Workload was significantly linked to higher rates of pressure ulcers, falls and deaths in patients. Ethical leadership was indirectly associated with improved patient outcomes through reduced workload. Head nurses' ethical leadership has a pivotal role in shaping the work environment and enhancing nursing-sensitive outcomes by reducing workload and fostering positive interpersonal dynamics. These findings emphasise the need for healthcare organisations to invest in ethical leadership development as a critical strategy for improving care quality and promoting better patient outcomes. These findings emphasise the need for healthcare organisations to invest in ethical leadership development as a critical strategy for improving care quality and promoting safer, more effective patient outcomes. The study adhered to The Strengthening the Reporting of Observational Studies in Epidemiology checklist. This study did not include patient or public involvement. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Cultivating moral values and principles in leadership enables leaders to effectively communicate these values to their staff. Addressing unethical behaviours, fostering open dialogue about organisational ethics, and supporting leaders in the ethical decision-making process contribute to a healthier nurses' work environment. Healthcare organisations investing in the development and promotion of ethical leaders improve care quality. The study was registered in the research registry (www.researchregistry.com) under the record number (researchregistry7418), following a published protocol.

Aim. The aim is to describe and analyse the available studies describing the assigned nursing care and work environment of nurses. Design: Scoping review. Methods. The search was conducted in four scientific databases Ovid Nursing, ProQuest, PubMed, and Scopus. Eleven studies published between years 2000 and 2020 were included in the review. Results. Eleven cross-sectional and correlational studies were analysed to document the prevalence of rationed nursing care in the acute hospital care setting. Studies evaluating rationed nursing care confirm a strong relationship with the workplace nursing environment. Thus, the work environment is among the significant determinants of rationed nursing care. The most commonly used tools include the PIRNCA tool for assessing hidden rationing of care and the PES-NWI tool for monitoring the work environment of nurses. When the work environment is rated as unfavourable, there is a higher rate of rationed nursing care. Conclusions. Rationed nursing care is a phenomenon that is monitored globally, and its assessment is essential in health care delivery. The main reasons for the development of hidden rationing of care include inadequate staffing and facilities. Factors that contribute significantly to the rationed nursing care are based on the work environment - mainly interpersonal relationships and communication, multidisciplinary collaboration.

Introduction: The increasing emphasis on creating healthy work environments is driven by their impact on both nurse and patient outcomes. Previous evidence has established a link between supportive nursing leadership and work environments, but demographic characteristics have not been adequately explored. This study aims to investigate whether demographic variations among nurses influence their perceptions of supervisory support and work environment. Methods: Secondary data analysis of a cross-sectional quantitative survey was utilized to recruit registered nurses employed in a government-owned and corporate-controlled (GOCC) tertiary hospital in the Philippines from September 2022 and October 2022. The primary data were collected through a demographic questionnaire, the validated Supervisory Support Scale tool, and the American Association of Critical-Care Nurses’ Healthy Work Environment Assessment Tool. Inferential analyses were employed to examine differences between study variables. Data processing was performed using Microsoft Excel 2022 and the R program, with a significance level set at 0.05. Results: The original dataset with a sample of 519 registered nurses was predominantly composed of non-married female nurses with bachelor’s degrees and varying clinical experiences. The secondary data analysis revealed no significant differences in work environment and supervisory support perceptions in relation to nurses’ demographic characteristics. Conclusions: This study provides critical insights into the Philippine nursing workforce literature by demonstrating that nurses’ demographic variations alone do not significantly influence their supervisory support and work environment perceptions. These results suggest that shifting the focus to broader factors beyond demographic variations among nurses may play a more critical role in shaping nurses’ work environment and supervisory support perceptions. Future research should explore the potential intersection of systemic factors such as leadership competencies, psychological safety, and workplace policies in shaping the nursing workforce dynamics.

I am writing in response to the article in the June issue “Clinical Units With the Healthiest Work Environments” (2008:65–77). Although the study undertaken by the 2 nurse researchers provides valuable and needed evidence into the work environments of nurses, I am concerned about the groupings of units. The coupling of postanesthesia units (PACUs) and the operating room (OR) is particularly troubling to me as a perianesthesia nurse.In the article, Schmalenberg and Kramer state that only staff nurses can effectively confirm if their environment is healthy. As such the pairing of OR and PACU skews the reality of these staff nurses. Although the nursing staff of the PACU and OR coordinate and collaborate very closely, their work environments are very different. The OR nurses work in close proximity with physicians, while for the most part advocating and caring for sedated or anesthetized patients. OR nurses typically monitor one patient in one OR room. PACU nurses monitor patients recovering from anesthesia, and this often entails more than one patient at varying points in the recovery process. In addition, many PACU nurses are caring for overflow patients, including intensive care unit (ICU), telemetry, and medical surgical patients while bed availability is scarce.Although the findings of the study may reflect that PACU and OR nurses work in unhealthy work environments, I would be interested in the findings that specify the work environment of PACU and OR nurses separately. This study included 251 OR and PACU nurses, yet the units where these nurses practice is not available to the reader, so it is unclear if there were more nurses from one unit than the other.Job satisfaction is reported to be the lowest among the PACU and OR nurses, but the validity of these findings must be questioned considering the failure specify the number of PACU and OR nurses surveyed, and the lack of differentiation with the PACU and OR findings. It is essential that nurse managers have a well-founded differentiation on the work environments of these 2 different nursing specialties. A secondary analysis would be beneficial. The evidence garnered enables the nurse managers of these units to promote healthy environments and to improve job satisfaction and retention.Future research studies examining unit differences should not combine PACU and OR nurses into one category, but separate them to reflect the uniqueness of their practice. By using this strategy the depth of understanding the nurse work environment is expanded.The reader is absolutely correct, and if we had to do it all over again, perhaps we would have separated PACU and OR. Why did we couple them? Two reasons: the number of PACU nurses responding to the tool used to measure the health of the work environment was so small that statistically they could not stand alone. Secondly, the 2 units were most often under the same director or manager; this influences structures, policies, and practices and therefore the unit work environment.Unless there is a marked increase in the number of survey participants among PACU nurses, it is quite likely that PACU nurses will need to be grouped with some other service in studies of this type. Although some of the PACU units in our study were faced with occasionally holding overflow ICU patients until beds were available, most were patients recovering from anesthesia. None were faced with the variety of patients the reader mentions. It might be that units that are primarily postanesthesia recovery units may be more like surgical ICUs than like the OR. PACUs that care for the variety of patients described by the reader may actually be more like a mixed medical-surgical ICU in terms of work environment.We agree that a separate analysis on work environments for the PACU would be very helpful to nurse managers and staff nurses in improving their work environment. We certainly will keep this in mind for our future research. Even without knowing where the PACU currently falls relative to other units, clinical nurses and nurse managers can use the follow-up articles on each of the essentials of a healthy work environment to look at the structures and practices that produce a healthy work environment and use these as a guide for assessment and potential action.

Evidence-based findings of the effects of nursing station design on nurses' work environment and work behavior are essential to improve conditions and increase retention among these fundamental members of the healthcare delivery team. The purpose of this exploratory study was to investigate how nursing station design (i.e., centralized and decentralized nursing station layouts) affected nurses' use of space, patient visibility, noise levels, and perceptions of the work environment. Advances in information technology have enabled nurses to move away from traditional centralized paper-charting stations to smaller decentralized work stations and charting substations located closer to, or inside of, patient rooms. Improved understanding of the trade-offs presented by centralized and decentralized nursing station design has the potential to provide useful information for future nursing station layouts. This information will be critical for understanding the nurse environment "fit." The study used an exploratory design with both qualitative and quantitative methods. Qualitative data regarding the effects of nursing station design on nurses' health and work environment were gathered by means of focus group interviews. Quantitative data-gathering techniques included place- and person-centered space use observations, patient visibility assessments, sound level measurements, and an online questionnaire regarding perceptions of the work environment. Nurses on all units were observed most frequently performing telephone, computer, and administrative duties. Time spent using telephones, computers, and performing other administrative duties was significantly higher in the centralized nursing stations. Consultations with medical staff and social interactions were significantly less frequent in decentralized nursing stations. There were no indications that either centralized or decentralized nursing station designs resulted in superior visibility. Sound levels measured in all nursing stations exceeded recommended levels during all shifts. No significant differences were identified in nurses' perceptions of work control-demand-support in centralized and decentralized nursing station designs. The "hybrid" nursing design model in which decentralized nursing stations are coupled with centralized meeting rooms for consultation between staff members may strike a balance between the increase in computer duties and the ongoing need for communication and consultation that addresses the conflicting demands of technology and direct patient care.

To identify nurses' professionalism, work environment, and communication with healthcare professionals as factors influencing clinical nurses' perception of patient safety culture. Patient safety is a representative indicator of the quality of nursing care. A multidisciplinary approach, including individual and organizational components, is needed to improve patient safety culture. A cross-sectional study was conducted in January 2021 involving a total of 271 nurses in six tertiary hospitals. Data were collected from participants on nurse professionalism, work environment, communication, and patient safety culture. A multiple regression model was used to analyze variables influencing patient safety culture. Factors affecting patient safety culture were nursing foundations for quality of care (β = 0.230, p < 0.001), nurse manager ability, leadership, support of nurses (β = 0.294, p < 0.001), and collegial nurse-physician relations (β = -0.138, p=0.026) in the nursing work environment. Accuracy (β = 0.117, p=0.007), shift communication (β = 0.128, p=0.026), satisfaction (β = 0.283, p=0.001), and timeliness (β = 0.239, p < 0.001) of communication between healthcare professionals and nurses have a significant impact on patient safety culture. All these predictors accounted for 59% (R 2) of patient safety culture awareness (p < 0.001). Enhancing patient safety culture requires a systematic and organizational approach that considers individual characteristics. Nurse managers play a crucial role in promoting patient safety by employing various communication channels and leading team education and training initiatives to foster collaboration among healthcare professionals. Implications for Nursing Management. The provision of patient safety education directly influences patient safety culture, and continuous education enables nurses to grow within the institution. To ensure effective communication in healthcare settings, nurse managers should prioritize shift communication, evaluate the accuracy of information exchange, and establish diverse communication channels, including social media platforms or business messengers, for internal hospital communication.

Objective To analyze the relationship between nursing work environment and nurses' work values of tertiary public hospitals in Tianjin ,and provide a scientific basis for the development of nurses' work values. Methods The sample was 1 875 clinical nurses from 7 tertiary public hospitals in Tianjin, and investigated with Practice Environment Scale(PES)and Work Values Scale. Results The score of nurses' work values and each dimension(material work values, affective work values,cognitive work values)were different in different level of work environment, ＂better ＂work environments >mixedwork environments >＂poor ＂work environments(F=121.528, 38.555, 86.834, 136.816,P <0.01). The nursing work environment was positively correlated with work values(r=0.127-0.423, P<0.01). Foundation for quality of care and leadership of the head nurse could predict the nurse work values, and could explain 16.9% of the nurse work values(F=191.315,P <0.01). Conclusions By improving nursing work environment, especially in foundation for quality of care and leadership of the head nurse,can promote the development of nurses' work values. Key words: Nurse; Nursing work environment; Work value

Background: Globally, the environments in which nurses work influence the quality of nursing practice and health care. In recent decades, the nursing work environment has become a central foundation to provide quality, safe, ethical nursing care. Nurses' Work environment can be described as the system that supports nurses’ control over the delivery of nursing care, the environment in which care is delivered and the characteristics of an organization that facilitate or constrain professional nursing practice. A supportive and enabling work environment promotes professional development and the safety and quality of health care. Addressing these factors is important in optimizing work place environments. Objective: The main objective of this study was to assess perceived work environment and associated factors among nurses working in Jimma University Medical Center, Jimma town, south west Ethiopia. Methods: Institution based cross-sectional study design was done from March 15 to 27, 2018. Data was collected by using a modified nurse work index questionnaire. 250 participants were included in the study by simple random sampling technique. Data was entered into Epidata version 3.1 and exported to SPSS version 20 for analysis. Descriptive statistics and linear regression were done to describe and identify factors associated with perceived level of work environment. P-value of <0.05 at 95% CI was used to declare statistical significance. Results: More than half (54%) of the respondents had low perception to their work environment. Control over the practice setting, autonomy and nurse physician relationship had significant association with perception towards nurse work environment. Conclusion: Overall level of nurses’ perception towards work environment was low. Autonomy, control over the practice setting and nurse-physician relationship were identified as factors significantly affect the level of nurses perception towards their working environment.

BackgroundAddressing the growing challenge of nurse retention requires coordinated actions at national and global levels to improve recruitment, retention policies, and investments in the nursing work environment. The nursing work environment, defined as the "organizational characteristics of a work setting that facilitate or constrain professional nursing practice", is critical in influencing whether nurses decide to leave their jobs. This study investigates the impact of differentiated nursing practices – which involved tailoring roles and responsibilities based on nurses’ training, skills, and experience in Dutch hospitals – and investigated their impact on the nursing work environment and turnover intention (i.e., nurses’ intentions to leave their organization). We also explored whether the work environment mediates this relationship.MethodsA multicenter longitudinal cohort study was conducted across 19 Dutch hospitals between 2019 and 2023. Nursing professionals participated via digital surveys administered before (T0) and after (T1) differentiated nursing practices were introduced. The nursing work environment was assessed using the Practice Environment Scale of the Nursing Work Index. A multilevel analysis with a random intercept and fixed slope was used to evaluate the impact of differentiated nursing practices on the work environment and on nurses' turnover intentions.ResultsWe received 5411 responses to our questionnaire – 4259 at T0 and 1152 at T1. Results showed that, while the overall work environment improved, particularly in the dimensions of staffing and resource adequacy, collegial nurse–physician relationships, and participation in hospital affairs, there were no significant improvements in nursing foundation for quality of care or nurse managers' ability, leadership, and support of nurses. Additionally, differentiated nursing practices did not significantly impact turnover intention, nor did the work environment mediate this relationship.ConclusionsThis study is the first to explore the unique effects of practice differentiation on turnover intention mediated by the work environment. The findings suggest that, while differentiated practices can enhance certain aspects of the work environment, a more systemic and integrated approach is required for sustained improvements. Future research should include longer term studies to fully understand the complex relationship and accompanying mechanisms between differentiated nursing practices, the nursing work environment, and turnover intention.Trial registrationClinical trial number not applicable.

Objective: Assurance of patient safety to realize the quality of health services is the responsibility of all health workers, especially nurses. Improving patient safety can reduce the risk of nosocomial infections and prevent the negative effects of nursing actions. The application of patient safety is still low due to several aspects, namely communication errors (57.7%), safety and service quality (57.4%), open communication (54.4%), management support (53.8%), and the work environment. (28.4%). An unfavorable work environment for the professional practice of nursing harms the quality of nursing care and patient safety. Methods: Analyzed the relationship between the nurse's work environment and patient safety at Mitra Sejati General Hospital, Medan. Methods: This research is a correlational analytic descriptive study with a cross-sectional approach. The study population was all nurses in the inpatient room at Mitra Sejati General Hospital, Medan, totaling 200 nurses. The sampling technique used was total sampling, by setting inclusion criteria. The study wascarried out from March to July 2022. Data analysis was carried out univariate and bivariate using the chi-square test. Results: most of the respondents stated that patient safety was well implemented (56%) and the work environment was good (64.5%). There is a significant relationship between the nurse's work environment and patient safety, p-value = 0.005. Conclusion: A good working environment for nurses ensures the optimal implementation of patient safety. Therefore, the hospital management contributes to supporting a conducive working environment for nurses by involving nurses in decision-making related to the development of nursing services, improving the ability of nurses, fulfilling nurse resources according to the required expertise

Across hospitals, there is wide variation in ICU utilization after surgery. However, it is unknown whether and to what extent the nurse work environment is associated with a patient's odds of admission to an intensive care unit. To estimate the relationship between hospitals' nurse work environment and a patient's likelihood of ICU admission and mortality following surgery. A cross-sectional study of 269 764 adult surgical patients in 453 hospitals was conducted. Logistic regression models were used to estimate the effects of the work environment on the odds of patients' admission to the intensive care unit and mortality. Patients in hospitals with good work environments had 16% lower odds of intensive care unit admission and 15% lower odds of mortality or intensive care unit admission than patients in hospitals with mixed or poor environments. Patients in hospitals with better nurse work environments were less likely to be admitted to an intensive care unit and less likely to die. Hospitals with better nurse work environments may be better equipped to provide postoperative patient care on lower acuity units.

ObjectiveThe main objective of this study was to determine the relationship between the characteristics of nurses' work environments in hospitals in the Spanish National Health System (SNHS) with nurse reported...