Delivery of quality safe care a factor of the work environment?

Quality safe care tends to cost more initially, but many believe that it ultimately reduces costs because it allows for more money to be spent on care than on lawsuits, relapses, infections, and other unwanted consequences. To what extent is the delivery of quality safe care a factor of the work environment? Explain. Does ethics education play a role in the creation of a work environment dedicated to quality safe care? Why or why not?

Relation between nursing work environment and patient experiences of the quality of care

The American Nurses Credentialing Center (ANCC) started the Magnet Recognition Program in the early 1990s. This programme was built upon the study carried out in 1983 by McClure et al. [23]. It is focused on improving patient care, patient safety and patient experiences by creating a good and healthy work environment for nurses. Research has shown that patient experiences in healthy work environments are significantly better [24–26].

The relationship between the nursing work environment and patient experiences was also investigated in a cross-sectional study carried out in 430 hospitals by Kutney-Lee et al. [18]. The researchers used data on patient experiences from the national CAHPS

HCA 827 TOPIC 7 Discussion Question Two

survey. The nursing work environment was measured with the PES-NWI tool, which includes items on nursing leadership and nurse–physician relationships. Data on 20,984 staff nurses were used in the study. The nursing work environment had significant relations with all ten CAHPS measures, indicating that the quality of the work environment has an influence on patient experiences of the quality of care.

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This finding corresponds with the cross-sectional study by McHugh et al. [19] in which 428 hospitals and 95,499 registered nurses participated. The researchers used data from the PES-NWI and the CAHPS. They concluded that nurses’ dissatisfaction with their work environment was associated with a significantly lower quality of patient experiences.

In the RN4Cast project [20], 61,168 hospital nurses and more than 131,000 patients in Europe and the United States were questioned in a cross-sectional survey. The aim of this immense study was to determine whether the nursing work environment affected patient care. The PES-NWI was used to measure the nurses’ perceptions of their work environment. Patients’ overall satisfaction was measured with the national CAHPS survey. The perceptions of nurses and those of patients were found to be consistent, indicating that both patients and nurses had more positive experiences in hospitals with better work environments.

Although there is a relationship between the nursing work environment and patient experiences of the quality of care, it is not clear how this relationship is formed and characterised from the perspective of Dutch nurses, and which aspects in daily practice influence patient experiences. Could these aspects somehow be linked to the ‘essentials of magnetism’? Little is known about the underlying mechanisms and how these result in better patient experiences. In 2006, the Dutch government started to move towards a healthcare model of responsible consumer choice and care services competition [27]. Because of this entrepreneurial approach, healthcare organisations transformed their policy towards a cost-efficiency and productive care system (e.g. a shorter length of stay per patient) [28]. Furthermore, today’s patients tend to suffer from multiple disorders or illnesses, which results in a higher complexity of care and an increased nursing workload. The increasing complexity of patient care requires well-trained nurses who are capable of creating a safe and patient-centred environment [29]. In 2011, the Netherlands Institute for Health Services Research conducted a literature study to investigate the roles and positions of nurses in Belgium, Germany, the United Kingdom, the United States and Canada, and found differences in levels of education and nursing job profile or job description in all five countries [30].

Given the circumstances and changes with which Dutch nurses are confronted, it is important and relevant to examine and comprehend their views on how their work and work environment contribute to positive patient experiences.