Title: Hospital Nurse Satisfaction’s Impact on Patient Outcomes. This study is part of a larger study entitled Hospital Restructuring’s Impact on Outcomes supported by the National Institute of Nursing Research (NIH Grant No: 1 RO!NRO4285-01).
Objective: The objective of the study was to identify the relationship of hospital nurse satisfaction on patient outcomes.
Design: A nested design was used enabling a macroscopic and microscopic view of Nurse Satisfaction and it’s impact.
Population, Sample, Setting, Years: The population was Registered Staff Nurses working in 29 University Teaching Hospitals across the nation in 1997 and 1998. The sample consisted of 8551 Registered Staff Nurses working in 29 University Teaching Hospitals across the nation in 1997 and 1998.
Concept, Variable, and Outcome Variables: The conceptual model for the study was based on Donabedian’s (1980) construct of structure and process interacting to result in outcomes. The variable Nurse Satisfaction was one of a number of process variables. Outcome variables measured were nosocomial pressure ulcer rate, fall rate and serious injury rate related to falls, nosocomial urinary track infection rate, and elements of patient satisfaction.
Methods: Site administrators were chosen by the participant University Teaching Hospitals and were responsible for data collection. An Individual Nurse Questionnaire (INQ), was excerpted from The Organization and Management of Intensive Care Units, Copyright 1989, Shortell & Rousseau, a 77 item 5 point Likert Instrument plus a 4 item subscale on decision-making from The Quality of Employment Survey by Quinn & Shepard, 1974. Reliability and validity were established by the developers and Reliability (Cronbach’s Alpha) for 81 INQ items with this study sample was 95%. The INQ was distributed in 1997 and 1998 to all staff RNs working on the study Medical and Surgical Units and a randomized 20% of staff RNs working on other adult acute care units.
Patient Outcome data were collected from each UTH in a standardized format ensuring interrater reliability and data accuracy.
Data for variables were summarized using descriptive statistics. Group comparisons were made using t-test and/or the Mann-Whitney Test. Association between variables and within each of the groups as well as between groups were examined by using Spearman correlation. A series of hierarchical regression models were use to predict outcomes.
Findings: In both 1997 and 1998, Nurse Satisfaction was significantly correlated with Processes of Care variables: 1) Nurse Decision-Making, 2) Inter unit working relationships, 3) Unit Nursing Leadership, 4) Nurse & Physician Recruitment and Retention, 5) Achieving Quality Patient and Family Outcomes, 6) Information Exchange on Patient Status, 7) Nurse Autonomy, 8) Unit Medical Director Fiscal and Patient Care Authority, 9) Collaboration (Nurse to Physician), 10) Collaboration (Nurse to Nurse), 11) Unit Nurse Manager Fiscal and Patient Care Authority, and 12) Communication (Nurse to Physician). The rank order of significant correlations changed between 1997 and 1998.
In 1998, Nurse Satisfaction explained more than 20% of the variance in Nosocomial Pressure Ulcer (NPU) Rate and Patient Satisfaction with Pain Management in the desired direction.
Conclusion: Hospital Nurse Satisfaction affects Patient Outcomes
Implications: Executives need to implement proven strategies to enhance Nurse Satisfaction, for example establishing a professional practice environment. Executives need to establish mechanisms to monitor and evaluate all strategies to enhance Nurse Satisfaction, Reduce Turnover and Improve Patient Outcomes.
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