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Various factors affect RNs' view of care quality

Monday November 21, 2011
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While nurse-to-patient ratios are widely recognized as an important factor in determining the quality of patient care, those ratios are not always easy to change without significant cost and investment of resources. The projected nursing shortage will make increasing nurse staffing even more difficult.

A study published in the October/December issue of Health Care Management Review found other aspects of the work environment that RNs perceive can also have a significant impact on the quality of care they deliver.

In order of influence, those factors are: physical work environment, workgroup cohesion, nurse-physician relations, procedural justice and job satisfaction. Nurses' ratings of patient care quality were also higher in hospitals with Magnet recognition programs, and lower in work settings with greater organizational constraints such as lack of equipment and supplies.

The study findings came from a 98-question survey of 1,226 RNs, part of the RN Work Project. That project is a nationwide, 10-year longitudinal survey begun in 2006 by Christine Kovner, RN, PhD, FAAN, professor at the College of Nursing at New York University, and Carol Brewer, RN, PhD, FAAN, professor at the School of Nursing at the University at Buffalo, and funded by a grant from the Robert Wood Johnson Foundation.

"There has been a great deal of research into the impact of nurse staffing on patient care, but we know that increasing nurse-to-patient ratios isn't always possible," said Maja Djukic, RN, PhD, assistant professor at the College of Nursing at New York University and an investigator in the latest study. "What we found in our study is that hospital administrators can improve a variety of work factors that are also likely to improve the quality of patient care, without having to change nurse-to-patient ratios.

"Improvements need to be strategic, because our work shows that the value of enhancing work environment varies across different factors.

For example, the researchers found that Magnet recognition has nearly the same impact on nurses' ratings of patient care quality as workgroup cohesion, but investing in workgroup cohesion is significantly less costly and complicated than applying for and earning Magnet recognition.

Additionally, improvements in physical work environment are likely to yield a greater benefit for quality of patient care, as perceived by RNs, than improvements in nurse-physician relations. Implementing a team-building program is likely to be less costly than remodeling a hospital unit, but if a hospital is planning to remodel, incorporating RNs' preferences into the physical environment design could result in changes that improve the quality of patient care.

"Healthcare managers need to think about how they can best redesign RNs' work environments to promote high quality patient care," Kovner said. "They need to examine their resources and determine which changes are possible and which will have the most impact on improving patient care."

To read a study summary and access the study via subscription or purchase, visit http://bit.ly/up5XIE.

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