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Abstract

This work is licensed under CC BY-SA License.Better nurse work environments are associated with patient and nurse outcomes reflecting nursing care quality. Mechanisms through which the work environment influences nursing care quality are not well documented. Unfinished nursing care, electronic health records, and job satisfaction may be involved. Clear mechanistic pathways that explain how these variables might interact to influence care quality are lacking. The aim of this study was to examine how satisfaction with the electronic health record, unfinished care, the work environment, and job satisfaction collectively affect nursing care quality. A secondary analysis of cross-sectional data was performed using survey data collected from inpatient hospital staff nurses in a single U.S. state. Survey responses (n=916) were analyzed using bivariate correlations and path analysis. Moderate bivariate correlations were documented among all study variables. However, smaller effects were identified in the full path analysis model. The nurse work environment had direct and indirect effects (through unfinished nursing care and job satisfaction) on nursing care quality. Satisfaction with the electronic health records affected nursing care quality indirectly through an inverse relationship with unfinished nursing care. Unfinished nursing care and job satisfaction are key mechanisms through which the nurse work environment impacts care quality. More research is needed to better understand the mechanisms through which the electronic health record influences the nurse work environment and nursing care quality are needed.