The aim of the project, entitled “An Innovative Process for Work Environment Enhancement,” was to develop a standardized process to empower and motivate nursing staff to actively participate in improvement of unit-based nurse-sensitive patient outcomes and to plan, implement and evaluate quality improvement projects. This process began on three MOC units on three hospital campuses, then was replicated and evaluated annually in four “second generation” and four “third” generation” MOC units.

Nurses’ perception of work environment was used to represent cultural change in the work environment and was measured using the Pennsylvania Nurse Survey, which contains the Nursing Work Index-Revised (NWI-R) as a component. Measurement of all “first generation” MOC units occurred at the beginning of process implementation, and both MOC and “non-MOC” units were measured approximately one year later, thus comparisons both across time and across units were performed. Additionally, nurse-sensitive quality indicators were trended. Although mean NWI-R scores were high prior to process implementation, NWI-R scores improved significantly in the “first generation” MOC units across time as well as when compared to “non-MOC” units. Additionally, trends in several nurse-sensitive indicators improved over time on the MOC units.

Although delivery of satisfiers such as increased staffing and improved technology may improve perception of the work environment, processes that involve staff more fully in improving patient outcomes may have aided in sustaining these gains.

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