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Improve work environments for nurses

Health Factors: Access to Care
Decision Makers: Employers & Businesses State Government Healthcare Professionals & Advocates
Evidence Rating: Some Evidence
Population Reach: 100% of WI's population
Impact on Disparities: No impact on disparities likely

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Description

Work environment improvements such as improved staffing ratios and strong nursing leadership and support are potential mechanisms health care employers can use to establish nurse friendly environments. Nurse friendly environments generally allow nurses control over their practice, organizational support, and nurse-physician collaboration.

Expected Beneficial Outcomes

Increased nurse retention
Increased job satisfaction

Evidence of Effectiveness

There is some evidence that efforts to improve work environments increase retention of established nurses (Kramer 2012, Ritter 2011, Cohen 2009, Meraviglia 2008, Storduer 2007). However, additional evidence is needed to confirm effects and determine which strategies are most effective.

Healthy work environments, such as those in Magnet and Beacon designated hospitals, can reduce turnover (Kramer 2012, Ritter 2011, Cohen 2009, Meraviglia 2008, Storduer 2007). Both primary nursing (Cochrane-Butler 2011) and team-based nursing (Fairbrother 2010) approaches have been shown to reduce turnover in some circumstances. Minimum staff ratios, with increased nurse staffing levels, may also increase nurses’ job satisfaction and improve patient safety (AHRQ HCIE-Furillo). Strong nursing leadership and high nurse to patient ratios are also suggested strategies to increase retention (CWF-Keenan 2003).

The most effective strategies to improve work environments may vary by setting. Self-scheduling appears to reduce turnover in hospitals (Cochrane-Butler 2011), while strong nursing leadership appears to be the most effective strategy to reduce turnover in nursing homes (Hunt 2012). Retaining part-time and casual nurses may also require different strategies than those aimed at full-time nurses (Daniels 2012).

Implementation

United States

California has a minimum staffing ratio law (AHRQ HCIE-Furillo).

Implementation Resources

AACN-HWE - American Association of Critical-Care Nurses (AACN). AACN’s healthy work environments initiative. Accessed on November 3, 2014

Citations - Evidence

AHRQ HCIE-Furillo - Furillo J, McEwen D. State-mandated nurse staffing levels alleviate workloads, leading to lower patient mortality and higher nurse satisfaction. Rockville: AHRQ Health Care Innovations Exchange. Accessed on December 16, 2014
Cochrane-Butler 2011* - Butler M, Collins R, Drennan J, et al. Hospital nurse staffing models and patient and staff-related outcomes. Cochrane Database of Systematic Reviews. 2011;(7):CD007019. Accessed on November 10, 2014
Cohen 2009* - Cohen J, Stuenkel D, Nguyen Q. Providing a healthy work environment for nurses. Journal of Nursing Care Quality. 2009;24(4):308–15. Accessed on November 10, 2014
CWF-Keenan 2003 - Keenan P, Kennedy JF. The nursing workforce shortage: Causes, consequences, proposed, solutions. New York: The Commonwealth Fund (CWF): 2003: Issue Brief #619. Accessed on August 6, 2014
Daniels 2012 - Daniels F, Laporte A, Lemieux-Charles L, et al. The importance of employment status in determining exit rates from nursing. Nursing Economics. 2012;30(4):201–6. Accessed on November 10, 2014
Fairbrother 2010* - Fairbrother G, Jones A, Rivas K. Changing model of nursing care from individual patient allocation to team nursing in the acute inpatient environment. Contemporary Nurse. 2010;35(2):202–20. Accessed on October 2, 2014
Hunt 2012* - Hunt SR, Probst JC, Haddock KS, et al. Registered nurse retention strategies in nursing homes: A two-factor perspective. Health Care Management Review. 2012;37(3):246–56. Accessed on October 9, 2014
Kramer 2012* - Kramer M, Halfer D, Maguire P, Schmalenberg C. Impact of healthy work environments and multistage nurse residency programs on retention of newly licensed RNs. Journal of Nursing Administration. 2012;42(3):148–59. Accessed on October 9, 2014
Meraviglia 2008* - Meraviglia M, Grobe SJ, Tabone S, et al. Nurse-friendly hospital project: Enhancing nurse retention and quality of care. Journal of Nursing Care Quality, 2008;23(4):305–13; quiz 14-5. Accessed on October 20, 2014
Ritter 2011* - Ritter D. The relationship between healthy work environments and retention of nurses in a hospital setting. Journal of Nursing Management. 2011;19(1):27–32. Accessed on October 27, 2014
Storduer 2007* - Stordeur S, D’Hoore W, the NEXT-Study Group. Organizational configuration of hospitals succeeding in attracting and retaining nurses. Journal of Advanced Nursing. 2007;57(1):45–58. Accessed on October 27, 2014

Citations - Implementation

AHRQ HCIE-Furillo - Furillo J, McEwen D. State-mandated nurse staffing levels alleviate workloads, leading to lower patient mortality and higher nurse satisfaction. Rockville: AHRQ Health Care Innovations Exchange. Accessed on December 16, 2014

Page Last Updated

May 24, 2013

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