Increasing interest has been focused on understanding the role working conditions play in terms of the serious issues facing hospitals today, including quality of patient care, nurse shortages, and financial challenges. One particular working condition that has been the subject of recent research, is the impact of organizational climate on nurses' well-being, including occupational health outcomes. To examine evidence-based research on the association between organizational climate and occupational health outcomes among acute-care registered nurses, a systematic review of published studies was conducted. Studies assessing the association between organizational climate variables and three common health outcomes in nurses (blood/body fluid exposures, musculoskeletal disorders, and burnout) were reviewed. Fourteen studies met the inclusion criteria. Although most were cross-sectional in design and variability was noted across studies with respect to operational definitions and assessment measures, all noted significant associations between specific negative aspects of hospital organizational climate and adverse health impacts in registered nurses. While evidence for an association between organizational climate constructs and nurses' health was found, data were limited and some of the relationships were weak. Additional studies are warranted to clarify the nature of these complex relationships.

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The Institute of Medicine supports proposed changes in the overall delivery of healthcare and the nurses' work environment to achieve improved patient outcomes and protect the public from unnecessary harm. Allowing nurses to have a voice in decision making and influence over their practice, in an environment that fosters autonomy and interdisciplinary collaboration, enhances nurse satisfaction while improving the quality of patient care. The authors describe how a pediatric medical unit engaged in small tests of change to improve communication and patient satisfaction on an inpatient unit.