Environment Affects Nurses Over and Again Literature Essay

Download this Essay in word format (.doc)

Note: Sample below may appear distorted but all corresponding word document files contain proper formatting

Excerpt from Essay:

Environment Affects Nurses

Over and again, literature reviews show the consistent relationship and association between nurse working environment and patient outcome as well as superior nurse performance (Aiken et al., 1999; Aiken et al., 1994; Lake, 2004). Better environments result in better nurse care as this case model shows. The case model was based on the study popularized in our institution that was directed by Aiken et al. (2008) who sought to examine whether better hospital nurse care environments were associated with lower patient mortality and better nurse outcomes irrespective of nurse education and the quality and quantity of nurse staffing.

In 1999, the researchers had sampled 168 hospitals, which was 80% of the 210 adult acute care hospital in Pennsylvania in 1999. 60 nurses from each hospital completed the survey, with half of the hospitals having more than 50 nurses who responded. Other nurses who worked outside the hospitals also received surveys and altogether 40,000 nurses both in and out of medical institutions completed the questionnaires. The measures used were the 1999 American Hospital Association Annual Survey and the 1999 Pennsylvania Department of Health Hospital Survey which provided data on medical environment that were to be used as control variables.

The measure of the patient care environment itself was based on the PES-NWI. According to results were hospitals categorized as having "better," "mixed," or "poor" care environments.

The nurse job outcomes and their quality of care was then assessed by six survey measures that rated variables such as their job satisfaction, burnout, and intention to leave their job within the next year. Three additional questions asked nurses about their perception on their quality of care. Nurse burnout was assessed using the 9-item emotional exhaustion scale of the Masslach Burnout inventory. This is a widely standardized tool. Researchers used the Cronbach assessment to gauge outcome and set their scores o f 27 or above to indicate high burnout.

In addiction to the Maslach measure, the researchers also focused on whether patient mortality could be traced to environment and the patients' deaths within the last 30 days were analyzed. This, however, goes beyond the topic of our essay. Wanting to gauge the results of nurses environment on nursing practice, we focused on results of Aiken et al.'s (2008) study, whether, in other words, the medical environment significantly impacted or had no significant impact on nurse practical behavior.

In Aiken et al.'s study, 43 (26%) of the hospital were shown to have poor environment. This meant that the nurses were working in stressful, disorderly, disorganized, noisy, and constantly changing environments (amongst toehr negative variables). 83 (49%) of the hospitals studied were in a mixed category, and 42 ranked in top quality (this meant that they were organized, calm, quiet, and demonstrated a friendly orderly atmosphere amongst other positive qualities). Interestingly enough, Aiken et al. (2008) discovered that the highest percentage of nurse burnout and turnover occurred in hospitals with poor care environments where there was also reported dissatisfaction with their jobs. The percentage of nurses who reported that their quality of performance was poor or fair (and assessment amongst patients ratified this) was twice as high in hospitals with lower and poor environment than with hospital with superb environment. It was also observed that nurses who worked in poor environments had less confidence in their abilities to succeed and perform optimum work and also indicated less confidence in the ability of management to deal with the hospital problems. This was likely due to the disorganization of the general environment. These same nurses working in the poor environment distrusted management's ability to resolve patient problems and also were skeptical of patient ability to function independently once discharged. Apparently, poor organizational patterns promoted a discouraging effect throughout the ward leaving nurses to wonder whether the disorganization extended from environment to the managers' ability to cope and to adequately perform their responsibilities. As a peripheral observation, nurses working in these hospitals refrained from recommending treatment of these hospitals to friends or family members who needed treatment, whilst nurses working in better hospital environments usually rated the care of their hospitals more highly to others. More so, it was discovered that above all conditions sampled (e.g., long hours, nurse staffing, pay etc.) it was primarily the environment that caused nurse burnout and resolve to leave. This sounds questionable to me, but after observing it in terms of my colleagues, I see how environment (and I would add temperature conditions too as well as aestheticism) hugely impacts out performance. Finally, the rate of nurses who reported concern on patient care was about 42% to 69% higher in poor environment hospitals than in those that had a better care environment.

As an aside, but to reinforce the importance of quality environment on nursing, the rate of patients dying in hospitals with poor care environments within 30 days of admission as 14% higher than the same rate dying within 30 days of admission in better care environments. This may have been due to the negative variables of the environments such as constant change, sterility, inadequate heart, stress, disorganization, and so forth (as, for instance, Shen and Qin (2010) have discovered that unfamiliar and disorganized hospital or nursing environment can encourage fatal falls) or it may have been generated by poor nursing performance that was instigated by these negative conditions. The nurses may have treated the patients in poor fashion due to induced stress and conflict that were environmentally induced. To an extreme, patient death may even have been accidentally caused due to some outcome of the negative environment such as patient slipping on floor, pills being misplaced or mislabeled, or some other casualty of medical disorganization. Again, the determinants of patient mortality may have been a configuration of both factors: nurse impacted by environment and patient affected by it. Nonetheless, nurse performance is strongly affected by the environment and the nurse's attitude in turn has huge repercussions on patient outcome.

The authors concluded that:

if all hospitals had better care environments, a 4:1 patient-to-nurse ratio, and 60% BSN-prepared staff nurses, the overall mortality rate would have been 15.6 per 1,000 admissions, and the failure-to-rescue rate would be 68.2 per 1,000. Under the worst case scenario (a poor care environment, 8:1 patient-to-nurse ratio, and 20% BSN-prepared staff nurses), the mortality rate would have been 25.1 per 1,000 admissions, and the failure-to-rescue rate would be 105.9 per 1,000. All else being equal, hospitals that ranked poorly on all 3 factors had mortality rates and failure-to-rescue rates that were 61% and 55% higher, respectively, than hospitals that ranked high on all 3. (p.28)

In short, it seems as though a calculated approximation of 40,000 deaths could be prevented per year in hospitals if hospital environments were to be improved.

In our hospital based upon this research and similar research, we implement the guidance outlines printed by the American Burses Credentialing Center Magnet ordinances that reach for certain improvements in practice environments (Aiken et al., 2005). Apparently many hospitals that inculcate and incorporate the guidelines of the magnet system (they are often called "magnet hospitals") show better nurse and patient outcomes. Aiken et al.'s (2008) study as case study indicates the same results too.

In our hospital, we strive, according to the Magnet principles, to implement a positive environment. We find that the underlying principles of the Magnet system are excellent enabling us to feel better about ourselves and building up our confidence and, by finding our stuff, raising the quality of our work with patients. The improvement in the work environment has, by the way -- and I am convinced of this -- also succeeded in attracting a better caliber of nurses who choose to work for us rather than work elsewhere. Whether it is the pay that attracts them…[continue]

Cite This Essay:

"Environment Affects Nurses Over And Again Literature" (2011, December 06) Retrieved December 4, 2016, from http://www.paperdue.com/essay/environment-affects-nurses-over-and-again-53244

"Environment Affects Nurses Over And Again Literature" 06 December 2011. Web.4 December. 2016. <http://www.paperdue.com/essay/environment-affects-nurses-over-and-again-53244>

"Environment Affects Nurses Over And Again Literature", 06 December 2011, Accessed.4 December. 2016, http://www.paperdue.com/essay/environment-affects-nurses-over-and-again-53244

Other Documents Pertaining To This Topic

  • Imagery Literature Review Guided Imagery

    Participants filled out a Short-Form McGill Questionnaire, an Arthritis Self-Efficacy Scale, and Fibromyalgia Impact Questionnaire in order to measure their levels of pain over the past few weeks. What the researchers found through statistical analysis was self-management strategies that reduced pain over time were most effective in the group that was exposed to guided imagery techniques. The level of guided imagery therapy was not itself significant, but more of

  • Cares for Nurses by Cecil Deans 2004

    Cares for Nurses" by Cecil Deans (2004) When people become healthcare practitioners today, perhaps one of the furthest things from their minds is the increasingly violent nature of their potential workplaces. In his article, "Who Cares for Nurses" (2004), though, Cecil Deans makes the point that North American healthcare settings are very violent places to work and many institutions are not providing their practitioners with sufficient protections, and some are

  • Lactation Consultants Affecting Breastfeeding Success

    In turn, as noted earlier in this study, this ultimately positively affects society. Nevertheless, as Thurman and Allen (2008) assert, researchers need to conduct more research regarding IBCLC use in primary care settings, From the study Thurman and Allen (2008) completed, the researcher gained a greater understanding of the help that individuals with IBCLC certification are able to provide for new mothers. One point the researcher noted as particularly pertinent

  • Organisational Psychology This Chapter Reviews the Literature

    Organisational Psychology This chapter reviews the literature and research outcomes within which the current research is located. It identifies the theory currently in use and sets the theoretical context for the study. Emotions and feelings shape and lubricate social transactions and in this way emotions contribute to, and reflect, the structure and culture of organizations. Order and control, the very essence of the 'organization' of work, concern what people 'do' with their

  • ER Nurse to Patient Ratio and Morale

    Inpatient Ratio and Morale ER: INPATIENT RATIO AND MORALE Emergency Room: Nurse to Patient Ratio and Morale Nurse to patient ratios in health institutions is one of the most influential factors in health providence, in any country's health sector. Two states of the aforementioned aspect would comprise of either high or low ratios. The former demonstrates poor patient outcomes that would imply high mortality rates and dissatisfied clientele. On the contrary, the latter

  • Nursing Shortage Issues Surrounding the Nursing Shortage

    Nursing Shortage Issues Surrounding the Nursing Shortage In the early 2000s, national strategies to improve the nursing workforce profile were largely focused on increasing the number of nurses at the bedside through the use of sign-on bonuses and travel nurses. While these strategies tended to provide local short-term solutions, they did little to address long-term issues affecting the nursing shortage. With nursing education programs challenged to increase student enrollment, many colleges were

  • Grandparent Caregivers Societal Antecedents as

    It is not always easy to keep childcare arrangements running smoothly and problems may arise from time to time. . In addition to these stresses, familial stresses might occur. For instance, Grandparents and parents may have different views about raising children. Parents' expectations of grandparents may exceed their resources. Grandchildren may not always obey or comply with grandparents' rules. Grandparents may not like the role of strict disciplinarian when discipline

Read Full Essay
Copyright 2016 . All Rights Reserved