Study defines the nursing workplace that is safest for patients

Good leadership among hospital nursing staff and a higher proportion of registered nurses are key factors in improved safety in hospitals and better outcomes for patients according to a recently completed UTS study.

Glueing it together: Nurses, Their Work Environment and Patient Safety is the report of a three-year analysis of the hospital workplace in NSW, undertaken by a team led by Christine Duffield, Professor of Nursing and Health Services Management in the Faculty of Nursing Midwifery and Health.

Professor Christine-Duffield

The Australian-first study, delivered to the State Government late last month, was commissioned by the NSW Department of Health from the UTS Centre for Health Services Management to inform future policy development on nursing workforce issues.

Professor Duffield said the study had focused on the nursing ward as the "business and operational unit of the hospital." The researchers sought frank opinions from nurses on a wide range of issues, from whether they felt empowered in their job to experiences of emotional or physical violence.

"There are some wards that function very well, where nurses feel they own their work and are proud of it, feel supported by leadership and colleagues, and where patient outcomes are not negatively affected. There are other wards which are less stable, and this pattern occurs across all hospital peer groups," Professor Duffield said.

The factors that lent stability to a unit's operations included a high proportion of  registered nurses, a high degree of autonomy for the nursing staff, effective leadership and a lower rate of "churn" – the movement of patients on and off wards that increases the work burden for nurses.

"Up until eight years ago, you could not link what nurses did to patient outcomes," Professor Duffield said. "Did they reduce morbidity, did they decrease mortality, did they have any impact on patient outcomes at all?

"In about 1998-1999 there was a significant piece of work done in the US that showed that nursing certainly does have an impact on patients. They found the higher the proportion of registered nurses the better the patient outcomes and that better qualified nurses, those with degrees, produced better patient outcomes.

"They also found that the quality of the work environment had a significant impact on patient safety, and mortality is one of those, and that these same characteristics are very related to whether nurses are satisfied with their work and satisfied with nursing – and they're two different concepts.

"The difference between our study and nearly all the rest of the work is that our results are not at the hospital level, they're down at the unit level. And that makes it, in some ways, more meaningful because what you do at a hospital level isn't necessarily going to filter down to all the units."

Professor Duffield said the result for NSW hospitals was the opportunity to make staffing decisions based on sound evidence.

"It's not going to come up with a climate score that says your working climate is good, bad or indifferent; it's going to say the environment here allows autonomy and decision making, and that has an impact on this patient outcome or this staff outcome," she said.

"So what it will do hopefully is lead to appropriate workloads for nurses that should enhance retention, enhance job satisfaction for them, and it should make it a safer place for patients."

The Centre for Health Services Management is a joint initiative between the Faculty of Nursing, Midwifery and Health and the Faculty of Business. The Centre was established to provide education, research and consultancy and to inform health policy at state and national levels.

The report is available for download here.

Photographer: Garth Knight