“Can nurse work environment influence readmission risk?” – a systematic review

Abstract

Background: Readmissions have been targeted as events that can improve quality of care while reducing health care expenditures. While increasing evidence has linked nurse work environment to various patient outcomes, no systematic review has assessed evidence examining nurse work environment in relation to readmission. Methods: This review was guided by the Institute of Medicine's Standards for Systematic Reviews. Comprehensive searches were conducted in PubMed, CINAHL, and PsycINFO, and were complemented by hand searching. Two reviewers independently completed full-text review and quality assessment using a validated tool. Results: Ten studies met the inclusion criteria and were included for final review. Various methods were used to measure readmission and nurse work environment, and analyses were conducted at both the patient and hospital levels. Overall, associations between nurse work environment and readmission emerged, and better nurse work environments (particularly higher levels of nurse staffing) were associated with fewer readmissions. Discussion: The interpretation of results from each study was limited by the differences in variable measures across studies and methodological flaws. The relationship between nurse work environment and readmission needs to be further confirmed by stronger evidence from studies using standardized measures and more rigorous research design.

Nurse work environment and quality of care by unit types: A cross-sectional study

“…We found that better unit work environments were associated with superior quality of care, both the overall quality of care and care improvement. This finding is consistent with results in previous research Ma et al, 2014Ma et al, , 2015aMcHugh and Ma, 2013). In a hospital-level multi-country study, the researchers found that hospitals with poor hospital work environments had more nurses reporting poor quality of care, and this association was common across countries .…”

Hospital Magnet Status, Unit Work Environment, and Pressure Ulcers

“…On the other hand, findings from other researchers who examined other nursing factors at the unit level indicate the need to investigate the relationship between unit‐level work environments and HAPUs (Choi, Bergquist‐Beringer, & Staggs, ; Park, Boyle, Bergquist‐Beringer, Staggs, & Dunton, ). Therefore, our findings are consistent with previous studies that reported the impact of hospital‐level work environments on patient outcomes (Aiken, Clarke, Sloane, Lake, & Cheney, ; Ma, Shang, & Stone, ), and it also expands the understanding of unit work conditions in relation to patient outcomes.…”

Organization of Hospital Nursing and 30-Day Readmissions in Medicare Patients Undergoing Surgery

“…12 A recent study of Medicare patients with HF, AMI, and PN found that patients have significantly lower risk for 30-day readmissions when cared for in hospitals with better nurse work environments, nurse staffing, and/or more nurses with a bachelor's degree. 13 Hospitals with better nurse staffing were 25% less likely to be penalized under the HRRP.…”

“…15 Other hospital nursing factors shown to be predictive of patient outcomes, such as work environment, were rarely considered. 12,15 …”