Nurse-reported Quality Of Care Research Articles

Strategies and Interventions to Support Quality Outcomes in the Home Care Setting: A Longitudinal Multilevel Study.

The relationship between the practice environment, empowerment, and outcomes such as quality of care, job satisfaction, and intent to stay has been extensively studied in healthcare settings, including hospitals and long-term care facilities. Research consistently demonstrates that a positive practice environment, characterized by supportive leadership, adequate resources, and opportunities for professional growth, are associated with better quality of care, increased job satisfaction, and higher intent to stay among healthcare professionals. Limited knowledge exists regarding the specific relationship between the practice environment, empowerment, and these outcomes within home care organizations. This study assesses the impact of strategies on nurse practice environment, social capital, decision latitude, workload, care quality, job satisfaction, and retention in a Belgian home healthcare organization. A longitudinal survey was conducted in a home healthcare organization, with data collected at 3 time points: baseline (T1) (2015), T2 (2018), and T3 (2021). In T3, respondents reported significantly higher scores for departmental and general management compared with T1. The interventions led to significant improvements in social capital and decision latitude. Self-reported quality of care at the department level showed a significant increase, whereas no significant change was observed for quality of care during the last round. The implementation of strategies and interventions as part of a broader healthcare transformation process had a positive impact. Improvements were observed in nurse-reported quality of care, job satisfaction, and intent to stay in nursing. These findings emphasize the effectiveness of the implemented measures in enhancing nursing practice and creating a positive work environment. Continuous efforts to implement and evaluate such strategies are essential for enhancing the satisfaction and retention of nursing teams within healthcare organizations.

Influence of the Team Effectiveness of Nursing Units on Nursing Care Left Undone and Nurse-Reported Quality of Care.

The aim of this study was to identify the influence of nursing unit team effectiveness on nursing care left undone and nurse-reported quality of care. This was a cross-sectional study with a sample of 230 nurses working at general hospitals in South Korea. Data were collected in January 2023 using an online questionnaire. Nursing unit team effectiveness was measured, consisting of the following sub-scales: leadership of the head nurse, cohesion, job satisfaction, competency of nurses, work productivity, and coordination. Multiple regression analyses were used to assess relationships between nursing unit team effectiveness and nursing care left undone and nursing-reported quality of care. Among these sub-domains, the study found that the higher the coordination (β = -0.22, p < 0.001), the significantly lower the nursing care left undone. The higher the competency of nurses (β = 0.26, p < 0.001) and work productivity (β = 0.20, p < 0.001), the higher the nurse-reported quality of care. In addition, nursing care left undone had a negative effect on nurse-reported quality of care (β = -0.15, p < 0.001). Therefore, nursing managers should make efforts to manage team effectiveness in nursing units to improve nurse-reported quality of care.

Relationships among nurse managers' job design, work environment, and nurse and patient outcomes.

The importance of nurse managers' practice environments in affecting outcomes for direct care nurses and patients has been well-researched. Nonetheless, much remains to be learned about the determinants of the nurse manager practice environment. In this study, 541 US nurse managers' survey responses were matched to unit-level aggregate data of their subordinates' responses on the National Database of Nursing Quality Indicators. A model relating job design and experience to the nurse manager's practice environment and direct care nurse (i.e., job satisfaction, intent to stay, and joy and meaning in work) and patient outcomes (i.e., nurse-reported quality of care and missed nursing care) was evaluated through multilevel path analysis. Nurse manager span of control, support staff, and experience influence nurse managers' perceptions of their practice environment and nurse and patient outcomes. Although support staff can offset some negative effects of wide spans of control, it does not fully compensate for wide spans. Thus, nurse manager job design factors and experience relate to nurse manager practice environments and valued downstream outcomes. The present research emphasizes the importance of a positive nurse manager practice environment and provides guidance for nurse manager hiring and job design decisions.

Organisation-level and individual-level predictors of nurse-reported quality of care in primary care: A multilevel study in China.

Knowledge of the predictors of nursing quality and safety remains a gap in global primary care research. This study examines organisational-level and nurse-level predictors of nurse-reported quality of care from a management perspective. We recruited 175 primary care nurses in 38 community health centres (CHCs) varying by size and ownership in Jinan, Tianjin, Shenzhen and Shanghai. Guided by the Systems Engineering Initiative for Patient Safety model, the organisation-level predictors comprised organisational structure, organisational culture, psychological safety and organisational support, while the nurse-level predictors included organisational commitment and organisational citizenship behaviour. Nurse-reported quality of care was measured by two questions: "How do you rate the quality of care that you provide?" and "Do you often receive complaints from patients or their family members at work?" Multilevel linear regression models were used to examine the predictors of nurse-reported quality of care. Among the four organisation-level predictors, organisational structure, psychological safety and organisational support were positive predictors of nurse-reported quality of care. Nurses working in CHCs with highly hierarchical organisational structures (Coef.=0.196, p=0.000), a high level of organisational support (Coef.=0.158, p=0.017) and a high level of psychological safety (Coef.=0.159, p=0.035) were more likely to report high quality of care or less likely to receive medical complaints. In terms of nurse-level predictors, nurses willing to increase their knowledge through continuous education were more likely to report good quality of care (Coef.=0.107, p=0.049) and less likely to receive medical complaints from patients (Coef.=0.165, p=0.041). Potential management levers to improve quality of nursing care include formalised organisational structures, strong organisational support and a psychologically safe environment as well as the provision of training to facilitate continuous education. Implementing these recommendations is likely to enhance the nursingquality in primary care.

Pathway Analysis on the Effects of Nursing Informatics Competency, Nursing Care Left Undone, and Nurse Reported Quality of Care on Nursing Productivity among Clinical Nurses

Nursing informatics competency is used to manage and improve the delivery of safe, high-quality, and efficient healthcare services in accordance with best practices and professional and regulatory standards. This study examined the relationship between nursing informatics competency (NIC), nursing care left undone, and nurse reported quality of care (NQoC) and nursing productivity. A path model for their effects on nursing productivity among clinical nurses was also established. Data were collected using structured questionnaires answered by 192 nurses working in a tertiary hospital located in J city, Korea, and analyzed using SPSS/WIN 23.0 and AMOS 21.0 program. The fit indices of the alternative path model satisfied recommended levels χ² = .11 (p = .741), normed χ² (χ²/df) = .11, SRMR = .01, RMSEA = .00, GFI = 1.00, NFI = 1.00, AIC = 18.11. Among the variables, NIC (β = .44, p < .001), NQoC (β = .35, p < .001) had a direct effect on nursing productivity. Due to the mediating effect of NQoC on the relationship between NIC and nursing productivity, the effect size was .14 (95% CI .08~.24). Meanwhile, nursing care left undone through NQoC in the relationship between NIC and nursing productivity, has a significant mediation effect (estimate .01, 95% CI .00~.03). The explanatory power of variables was 44.0%. Education and training for enhancing NIC should be provided to improve nursing productivity, quality of care and to reduce missed nursing care. Furthermore, monitoring the quality of nursing care and using it as a productivity index is essential.

The influence of nurse manager competency on practice environment, missed nursing care, and patient care quality: A cross-sectional study of nurse managers in U.S. hospitals.

Identify and examine drivers of nurse manager competency and high-quality practice environments. Nurse managers are a key predictor of positive professional practice environments, which are, in turn, associated with nurse, patient, and organisational outcomes. However, little work has examined the factors that contribute to nurse manager competency. Nurse managers completed online surveys, which were matched to unit-level aggregate data of their subordinate direct care nurses' responses on the National Database of Nursing Quality Indicators. This resulted in a final sample of 541 nurse managers across 47 U.S. hospitals. Multilevel path analysis was utilized to assess a model of the antecedents and consequences of nurse manager competency. Nurse manager competency and practice environments were predictive of missed nursing care and nurse-reported quality of care. Nurse manager experience was found to have twice the effect on competency as advanced education. Nurse manager competency and its downstream effects are achieved through nurse manager experience and advanced education. Nurse manager competency yields better practice environments and nursing care. Considering the influence of experience, careful attention should be paid to the competency development process of more novice nurse managers.

How do three components of professional commitment influence nurse-reported patient-centred care and care quality?

To test how the three components of professional commitment (i.e. affective, continuance and normative professional commitment) are associated with nurse-reported patient-centred care and care quality. Patient-centred care and care quality are the two critical care outcomes. However, no study has yet examined how the three components of professional commitment are related to nurse-reported patient-centred care and care quality, showing a research gap. This study adopted a two-wave design (first wave in 2017 and second wave in 2019), which is known to reduce the possibility of reverse causality, and which was conducted in a large hospital in Northern Taiwan. Proportionate random sampling was used. Full-time nurses were surveyed, while nursing students, interns, nurse practitioners and nursing supervisors were excluded. The first wave included 524 nurses, and 438 nurses were retained in the second wave. We used confirmatory factor analysis to verify the psychometric properties of the measures. Structural equation modelling was used to implement hypothesis testing. We used the Professional Commitment Scale of Meyer et al. (Journal of Applied Psychology, 1993, 78, 538), the Patient-Centered Care Scale of Laird-Fick et al. (Patient Education and Counseling, 2011, 84, 90) and the Care Quality Perceptions Scale of Teng et al. (Journal of Nursing Management, 2010, 18, 275). The STROBE statement was chosen as the EQUATOR checklist. Affective professional commitment was positively associated with nurse-reported patient-centred care (β=.18, p=.002 and .01), which was positively associated with nurse-reported care quality (β=.85, p<.001). Affective and normative professional commitment were also positively associated with nurse-reported care quality (β=.17, p<.001). Our findings offer insights for nursing managers that nurses' affective and normative professional commitment could help upgrade care outcomes. Hospital managers should consider professional commitment as relevant to their workforce. Nursing managers could publicise reports documenting nurses' significant contributions to public health. This could strengthen affective professional commitment among nurses.

Resilience as a mediator between compassion fatigue, nurses' work outcomes, and quality of care during the COVID-19 pandemic

BackgroundNurses in the frontline of the battle against COVID-19 are highly vulnerable to compassion fatigue (CF), which may affect their mental health, work effectiveness, and patient safety outcomes. However, no studies have investigated nurses' CF in relation to job outcomes and care quality during the pandemic. AimsThis study aims to examine the mediating role of resilience in the relationship between CF and frontline nurses' job outcomes (job satisfaction and turnover intention) and care quality. DesignAn online, cross-sectional survey containing five self-report scales was used to collect data from 270 frontline nurses in selected hospitals in the Philippines. ResultsOverall, 38.5% of frontline nurses experienced medium to high CF during the second wave of the pandemic. Increased CF was associated with poorer nurse-reported quality of care (β = −0.145, p = 0.019), lower job satisfaction (β = −0.317, p = 0.001), and higher organizational turnover intention (β = 0.301, p = 0.001). Moreover, resilience fully mediated the relationship between CF and quality of care (β = −0.088, p = 0.169), and partially mediated the relationship between CF and job satisfaction (β = −0.259, p = 0.001), and CF fatigue and organizational turnover intention (β = 0.272, p = 0.001). ConclusionFrontline nurses are at risk of developing CF during the pandemic. Psychological resilience reduces the negative impact of CF on frontline nurses' job satisfaction, turnover intention, and the quality of care in their assigned unit. Proactive measures to reduce CF should be prioritized by nursing administrators. Resilience-promoting interventions could foster job satisfaction and retention in nurses and, hence, the quality of care delivered in their units.

Predictors of Nurse-Reported Quality of Care in Neonatal Intensive Care Units in Korea

PurposeThis study aimed to investigate predictors of nurse-reported quality of care (NQoC) in neonatal intensive care units (NICU) in Korea. Design and methodsThe study participants were 217 NICU nurses working in four tertiary general hospitals and three general hospitals across South Korea. Data were collected in February 2019, when a survey was performed to measure nurse-related characteristics, intent to leave, job satisfaction, and NQoC. Collected data were analyzed using t-test, chi-square test, and hierarchical logistic regression on the SPSS WIN 26.0 program. ResultsApproximately 53% of NICU nurses perceived good quality of care. NICU work experience of less than 2 years and 2 to 4 years were associated with increased odds of good NQoC in all regression models. Perceived adequacy of nurse staffing level was significantly associated with increased odds of good NQoC in model 2 (OR 4.90, 95% CI: 1.75–13.70), model 3 (OR 5.01, 95% CI: 1.73–14.50), and model 4 (OR 3.96, 95% CI: 1.29–12.12). Moreover, in model 3, intent to leave was associated with decreased odds of good NQoC (OR 0.83, 95% CI: 0.21–0.71), and job satisfaction was associated with increased odds of good NQoC (OR 5.41, 95% CI: 2.74–10.67) in model 4. ConclusionsNurses' NICU work experience, adequate nurse staffing level, no intent to leave, and job satisfaction were predictors of good NQoC among NICU nurses. Practice implicationImprovement of nurse staffing levels and job satisfaction is a promising strategy to achieve good quality of care in NICUs.

Commentary: Is leadership of nurses associated with nurse-reported quality of care? A cross-sectional survey.

Commentary: Is leadership of nurses associated with nurse-reported quality of care? A cross-sectional survey.

Is leadership of nurses associated with nurse-reported quality of care? A cross-sectional survey.

BackgroundNurses need to exhibit stronger leadership by taking more responsibility and accountability to improve healthcare quality and patient safety.AimsThe aim of this study was to determine the association between quality of care and leadership styles and practices, and whether the characteristics of nurses influence this interaction.MethodsWe conducted a multicentre cross-sectional survey of 655 nurses working on clinical wards in Dutch university medical centres in 2018.ResultsTransformational leadership was significantly associated with quality of care which explained 5.9% of the total variance (R2 = 0.059 F = (11,643) = 3.726, p = 0.011), and the nurse characteristics gender, profession and type of practice area were significant influencing factors. Nurses rated the quality of care (mean (M) = 7.7, standard deviation (SD) = 1.3) as moderate and they showed moderate levels of transformational leadership style (M = 3.7, SD = 0.5) and transformational leadership practices (M ≥ 6.2 and ≤ 7.6).ConclusionsWhen considering quality improvement on clinical wards strategic managers need to be aware of the fact that leadership is associated with quality of care and that nurse characteristics influence this association. The findings indicate a pressing need for education and training for nurses in how to develop leadership and raising the awareness among strategic managers about the importance of leadership in health care is recommended.

Systematic review: What is the impact of self-scheduling on the patient, nurse and organization?

To systematically review and evaluate the literature on the impact of self-scheduling on patient, nurse and organization-related outcomes. A systematic review. PubMed, Embase, Web of Science, Cinahl, Scopus, Google Scholar, ERIC and Cochrane Library were screened until October 2019 (week 40) for peer-reviewed, empirical articles, written in English, Dutch or French. Two reviewers screened title and abstractusing predetermined eligibility criteria and one reviewer screened the full texts of relevant hits. Quality was assessed with the Mixed Methods Appraisal Tool. Studies (N=23) were retained and classified into explanatory and descriptive studies. The articles reported on a range of outcomes: patient- and nurse-reported quality of care, job satisfaction, satisfaction with scheduling, work/life balance, planning involvement, interaction with colleagues, health and well-being, psychosocial factors, professional development, nurse manager's scheduling time, general working conditions, turnover, temporary employment agency use and absenteeism, recruitment and retention. The evidence base is limited. Several studies confirmed the positive impact of self-scheduling on the nurse and the organization. However, other studies found negative outcomes or no change. These outcomes should be interpreted in the light of contextual factors and the implementation process, which was often not without difficulties. Future research should use a multimethod longitudinal design, bear in mind the possibilities of quantitative research (e.g. for studying psychosocial factors) and employ a theoretical framework. This review informs about the inconsistent evidence on the association between self-scheduling and patient, nurse and organization-related outcomes and includes enablers and barriers to a successful implementation. These outcomes are influenced by the implementation process and the sustainability of the self-scheduling system, which are still major challenges for healthcare management. This demonstrates the urgent need for further research.

Workplace verbal abuse, nurse-reported quality of care and patient safety outcomes among early-career hospital nurses.

To examine the differences in early-career nurses' verbal abuse experiences based on their sociodemographic characteristics, and to investigate the associations of verbal abuse experiences with nurse-reported care quality and patient safety outcomes. Few studies have examined the relationships between early-career nurses' verbal abuse experiences and nurse-reported patient care quality and safety outcomes. Cross-sectional survey data from 799 early-career hospital nurses in the United States were analysed. Items assessed verbal abuse experiences from patients or their families, physicians and other employees. Associations between verbal abuse experiences and nurse-reported care quality and patient safety outcomes were examined using multiple logistic regression analyses. There were significant differences in verbal abuse experiences by age, gender and work unit. Nurses who experienced verbal abuse, regardless of the perpetrator, were less likely to report high-quality care and a favourable safety grade. Nurses who experienced verbal abuse specifically from physicians or other employees were also less likely to feel comfortable reporting safety problems. Managing verbal abuse may be important for improving patient care quality and safety. Future intervention study is needed to reduce verbal abuse. To optimize patient safety, managers should thoroughly monitor verbal abuse and organisations' need to establish clear expectations and ramifications for when verbal abuse occurs.

Electronic Health Record Adoption and Nurse Reports of Usability and Quality of Care: The Role of Work Environment.

Despite evidence suggesting higher quality and safer care in hospitals with comprehensive electronic health record (EHR) systems, factors related to advanced system usability remain largely unknown, particularly among nurses. Little empirical research has examined sociotechnical factors, such as the work environment, that may shape the relationship between advanced EHR adoption and quality of care. The objective of this study was to examine the independent and joint effects of comprehensive EHR adoption and the hospital work environment on nurse reports of EHR usability and nurse-reported quality of care and safety. This study was a secondary analysis of nurse and hospital survey data. Unadjusted and adjusted logistic regression models were used to assess the relationship between EHR adoption level, work environment, and a set of EHR usability and quality/safety outcomes. The sample included 12,377 nurses working in 353 hospitals. In fully adjusted models, comprehensive EHR adoption was associated with lower odds of nurses reporting poor usability outcomes, such as dissatisfaction with the system (odds ratio [OR]: 0.75; 95% confidence interval [CI]: 0.61-0.92). The work environment was associated with all usability outcomes with nurses in better environments being less likely to report negatively. Comprehensive EHRs (OR: 0.83; 95% CI: 0.71-0.96) and better work environments (OR: 0.47; 95% CI: 0.42-0.52) were associated with lower odds of nurses reporting fair/poor quality of care, while poor patient safety grade was associated with the work environment (OR: 0.50; 95% CI: 0.46-0.54), but not EHR adoption level. Our findings suggest that adoption of a comprehensive EHR is associated with more positive usability ratings and higher quality of care. We also found that-independent of EHR adoption level-the hospital work environment plays a significant role in how nurses evaluate EHR usability and whether EHRs have their intended effects on improving quality and safety of care.

Common predictors of nurse-reported quality of care and patient safety.

In the era of the Patient Protection and Affordable Care Act, quality of care and patient safety in health care have never been more visible to patients or providers. Registered nurses (nurses) are key players not only in providing direct patient care but also in evaluating the quality and safety of care provided to patients and families. We had the opportunity to study a unique cohort of nurses to understand more about the common predictors of nurse-reported quality of care and patient safety across acute care settings. We analyzed cross-sectional survey data that were collected in 2015 from 731 nurses, as part of a national 10-year panel study of nurses. Variables selected for inclusion in regression analyses were chosen based on the Systems Engineering Initiative for Patient Safety model, which is composed of work system or structure, process, and outcomes. Our findings indicate that factors from three components of the Systems Engineering Initiative for Patient Safety model-Work System (person, environment, and organization) are predictive of quality of care and patient safety as reported by nurses. The main results from our multiple linear and logistic regression models suggest that significant predictors common to both quality and safety were job satisfaction and organizational constraints. In addition, unit type and procedural justice were associated with patient safety, whereas better nurse-physician relations were associated with quality of care. Increasing nurses' job satisfaction and reducing organizational constraints may be areas to focus on to improve quality of care and patient safety. Our results provide direction for hospitals and nurse managers as to how to allocate finite resources to achieve improvements in quality of care and patient safety alike.

Relationships between Army nursing practice environments and patient outcomes.

Favorable nursing practice environments have been associated with lower patient mortality, failure to rescue, nurse-administered medication errors, infections, patient complaints, and patient falls. Favorable environments have also been associated with higher nurse-reported care quality and patient satisfaction in civilian hospitals. However, limited information exists on the relationship between favorable nursing practice environments and positive outcomes in military facilities. Using 4 years of secondary data collected from 45 units in 10 Army hospitals, generalized estimating equations were used to test the associations between nurses' scores on the Practice Environment Scale of the Nursing Work Index (PES-NWI) and patient outcomes of falls with and without injury, medication administration errors with and without harm, and patient experience. Four significant associations were found between the PES-NWI subscales and the patient outcomes under study. The Staffing and Resource Adequacy subscale was significantly associated with patient falls, the Collegial Nurse Physician Relations subscale was significantly associated with the rate of nurse-administered medication errors, and the Nursing Foundations for Quality Care and Collegial Nurse Physician Relations subscales were both significantly associated with patient experience with nursing care. As in civilian hospitals, favorable nursing practice environment was associated with improved patient outcomes within these military nursing units.

Concordance between nurse-reported quality of care and quality of care as publicly reported by nurse-sensitive indicators.

BackgroundNurse-sensitive indicators and nurses’ satisfaction with the quality of care are two commonly used ways to measure quality of nursing care. However, little is known about the relationship between these kinds of measures. This study aimed to examine concordance between nurse-sensitive screening indicators and nurse-perceived quality of care.MethodsTo calculate a composite performance score for each of six Dutch non-university teaching hospitals, the percentage scores of the publicly reported nurse-sensitive indicators: screening of delirium, screening of malnutrition, and pain assessments, were averaged (2011). Nurse-perceived quality ratings were obtained from staff nurses working in the same hospitals by the Dutch Essentials of Magnetism II survey (2010). Concordance between the quality measures was analyzed using Spearman’s rank correlation.ResultsThe mean screening performances ranged from 63 % to 93 % across the six hospitals. Nurse-perceived quality of care differed significantly between the hospitals, also after adjusting for nursing experience, educational level, and regularity of shifts. The hospitals with high-levels of nurse-perceived quality were also high-performing hospitals according to nurse-sensitive indicators. The relationship was true for high-performing as well as lower-performing hospitals, with strong correlations between the two quality measures (rS = 0.943, p = 0.005).ConclusionsOur findings showed that there is a significant positive association between objectively measured nurse-sensitive screening indicators and subjectively measured perception of quality. Moreover, the two indicators of quality of nursing care provide corresponding quality rankings. This implies that improving factors that are associated with nurses’ perception of what they believe to be quality of care may also lead to better screening processes. Although convergent validity seems to be established, we emphasize that different kinds of quality measures could be used to complement each other, because various stakeholders may assign different values to the quality of nursing care.

Nurse Burnout, Nurse-Reported Quality of Care, and Patient Outcomes in Thai Hospitals.

The purpose of this study was to investigate the effect of nurse burnout on nurse-reported quality of care and patient adverse events and outcomes in Thai hospitals. Cross-sectional analysis of data from 2,084 registered nurses working in 94 community hospitals across Thailand. Data were collected through survey questionnaire, including the Maslach Burnout Inventory (MBI), which measures of nurse perceived quality of care and patient outcomes. Multiple logistic regression modeling was performed to explore associations between nurse burnout on quality of care and patient outcomes. Thirty-two percent of nurses reported high emotional exhaustion, 18% high depersonalization, and 35% low personal accomplishment. In addition, 16% of nurses rated quality of care on their work unit as fair or poor, 5% reported patient falls, 11% reported medication errors, and 14% reported infections. All three subscales of the MBI were associated with increased reporting of fair or poor quality of care, patient falls, medication errors, and infections. Every unit of increasing emotional exhaustion score was associated with a 2.63 times rise in reporting fair or poor quality of care, a 30% increase in patient falls, a 47% increase in medication errors, and a 32% increase in infection. Findings clearly indicate that nurse burnout is associated with increased odds of reporting negative patient outcomes. Implementing interventions to reduce nurse burnout is critical to improving patient care in Thai hospitals. Hospital administrators, nurse managers, and health leaders urgently need to create favorable work environments supporting nursing practice in order to reduce burnout and improve quality of care.

Linking Unit Collaboration and Nursing Leadership to Nurse Outcomes and Quality of Care.

The objective of this study is to identify the effects of unit collaboration and nursing leadership on nurse outcomes and quality of care. Along with the current healthcare reform, collaboration of care providers and nursing leadership has been underscored; however, empirical evidence of the impact on outcomes and quality of care has been limited. Data from 29742 nurses in 1228 units of 200 acute care hospitals in 41 states were analyzed using multilevel linear regressions. Collaboration (nurse-nurse collaboration and nurse-physician collaboration) and nursing leadership were measured at the unit level. Outcomes included nurse job satisfaction, intent to leave, and nurse-reported quality of care. Nurses reported lower intent to leave, higher job satisfaction, and better quality of care in units with better collaboration and stronger nursing leadership. Creating a care environment of strong collaboration among care providers and nursing leadership can help hospitals maintain a competitive nursing workforce supporting high quality of care.

Does job satisfaction mediate the relationship between healthy work environment and care quality?

A healthy work environment can increase nurse-reported job satisfaction and patient care outcomes. Yet the associations between healthy work environment, nurse job satisfaction and QC have not been comprehensively examined in Chinese ICUs. To investigate the mediating effect of nurse job satisfaction on the relationship between healthy work environment and nurse-reported quality of care (QC) in Chinese intensive care units (ICUs). A total of 706 nurses were recruited from 28 ICUs of 14 tertiary hospitals. The nurses completed self-reported questionnaires to evaluate healthy work environment, job satisfaction and quality of patient care. Mediation analysis was conducted to explore the mediating effect between nurse-reported healthy work environment and QC. Nurse work environment showed positive correlations with nurse-reported QC in the ICUs. Nurse-reported job satisfaction showed full mediating effects between healthy work environment and QC in the medical-surgical ICUs, surgical ICUs and neonatal/paediatric ICUs and indicated a partial mediating effect in the medical ICUs. Significant mediating effects of nurse job satisfaction provide more support for thinking about how to use this mediator to increase nurse and patient care outcomes. Nurse administrators can design interventions to increase nurse work environment and patient care outcomes with this mediating factor addressed.