The state of the science of nurse work environments in the United States: A systematic review

Abstract

A healthy nurse work environment is a workplace that is safe, empowering, and satisfying. Many research studies were conducted on nurse work environments in the last decade; however, it lacks an overview of these research studies. The purpose of this review is to identify, evaluate, and summarize the major foci of studies about nurse work environments in the United States published between January 2005 and December 2017 and provide strategies to improve nurse work environments. Databases searched included MEDLINE via PubMed, CINAHL, PsycINFO, Nursing and Allied Health, and the Cochrane Library. The literature search followed the PRISMA guideline. Fifty-four articles were reviewed. Five major themes emerged: 1) Impacts of healthy work environments on nurses' outcomes such as psychological health, emotional strains, job satisfaction, and retention; 2) Associations between healthy work environments and nurse interpersonal relationships at workplaces, job performance, and productivity; 3) Effects of healthy work environments on patient care quality; 4) Influences of healthy work environments on hospital accidental safety; and 5) Relationships between nurse leadership and healthy work environments. This review shows that nurses, as frontline patient care providers, are the foundation for patient safety and care quality. Promoting nurse empowerment, engagement, and interpersonal relationships at work is rudimental to achieve a healthy work environment and quality patient care. Healthier work environments lead to more satisfied nurses who will result in better job performance and higher quality of patient care, which will subsequently improve healthcare organizations' financial viability. Fostering a healthy work environment is a continuous effort.

Nurses’ views on hospital organizational characteristics

“…The overall mean of the hospital organizational characteristics indicates a low level of nurses’ views on hospital organizational characteristics. This indicates poor work environments as marked by low nurse professional autonomy, consistent with other studies; low nurse satisfaction and high nurse turnover, similar to Kutney‐Lee et al; low quality of work, consistent with Olds et al and Wei et al; and, in turn, low patient satisfaction, similar to Olds et al and Wei et al…”

“…The strongest positive hospital organizational characteristic was the presence of adequate support services, which give nurses more time for patient care, which is supported by other studies . This is mandated in hospitals as a result of quality and accreditation initiatives …”

“…Wei et al conducted a systematic review of 54 articles published between 2005 and 2017 focusing on work environments in the United States, which included hospital organizational characteristics. The study yielded the following major themes: (1) impacts of healthy work environments on nurse outcomes such as psychological health, job satisfaction, and retention; (2) associations between healthy work environments and nurse interpersonal relationships at workplaces, job performance, and productivity; (3) effects of healthy work environments on patient care quality; (4) influences of healthy work environments on hospital accidental safety; and (5) relationships between nurse leadership and healthy work environments.…”

The long‐term effects of psychological demands on chronic fatigue

“…These findings are consistent with previous research examining the working environment of nurses (Abdul Rahman et al, ; Lavoie‐Tremblay et al, ; Parhizi et al, ; Theorell et al, ). Almost three decades of research has shown that nurses’ work environment remains difficult and challenging (Wei, Sewell, Woody, & Rose, ).…”

“You only have time for so much in 12 hours” unmet social needs of hospitalised patients: A qualitative study of acute care nurses

“…Higher nurse staffing levels, for example, are associated with lower mortality and readmissions, and fewer pressure ulcers and falls (McHugh & Ma, ; Shin, Park, & Bae, ). Similarly, nurses in good work environments have greater autonomy, excellent collaborative relationships with other members of the healthcare team and exceptional communication with colleagues, all of which empower a nurse's ability to meet patient care needs (Wei, Sewell, Woody, & Rose, ). While the relationship between adequate organisational support and patient outcomes is well established, less is known about how these factors influence nurses’ ability to tailor care for socially at‐risk patients.…”