Nurse-friendly work environments

Evidence Rating  
Evidence rating: Expert Opinion

Strategies with this rating are recommended by credible, impartial experts but have limited research documenting effects; further research, often with stronger designs, is needed to confirm effects.

Health Factors  
Decision Makers
Date last updated

Nurse-friendly work environments support increased nurse control over their practice, foster nurse leadership and nurse-physician collaboration, and include strong organizational support. Such efforts can take place in outpatient and inpatient settings, and may include modified work schedules1, nursing supervisor support2, and shared governance, in which nurses are active participants in organizational decision making3. Magnet hospitals can be another way to support nurse-friendly environments4.

What could this strategy improve?

Expected Benefits

Our evidence rating is based on the likelihood of achieving these outcomes:

  • Increased nurse retention

  • Improved quality of care

Potential Benefits

Our evidence rating is not based on these outcomes, but these benefits may also be possible:

  • Increased job satisfaction

What does the research say about effectiveness?

Nurse-friendly work environments are a suggested strategy to increase nurse retention5, 6 and improve quality of care6, 7, 8, 9, 10. Available evidence suggests that improvements in nurse work environments can reduce rates of burnout, intent to leave current positions, and levels of job dissatisfaction among nurses3, 11. However, additional evidence is needed to confirm effects and determine which efforts are most effective.

Positive work environments which foster teamwork are associated with less missed patient care, for example, mouth care, ambulation, and turning of bedridden patients8, 9. Improved nurse work environments are also associated with reduced rates of hospital acquired infections, such as ventilator associated pneumonia in intensive care units7. Strong nursing leadership may increase job satisfaction12, increase retention5, 13, and reduce burnout2, 14. Modified work schedules, including weekend breaks and two week schedules, may reduce stress1.

Hospitals with Magnet status are associated with practice environments that support nurses’ job satisfaction4, 15, 16, increase retention15, 16, 17, improve engagement in organizational decision making3, and reduce verbal abuse toward nurses15, 16. Magnet hospitals are also associated with improved quality of care18.

Experts suggest that nurses should all learn techniques to foster healthy work environments, and nursing school curriculums should include such techniques19.

How could this strategy impact health disparities? This strategy is rated no impact on disparities likely.
Implementation Examples

The American Nurses Credentialing Center’s (ANCC’s) Magnet Recognition Program recognizes hospitals for superior nursing processes and quality of care. As of Fall 2017, there are 461 Magnet recognized facilities in the U.S.20.

The Association of Critical Care Nurses (ACCN) outlines eight standards that can be used to establish a healthy nurse work environment: authentic leadership, skilled communication, true collaboration, appropriate staffing, meaningful recognition, effective decision making, genuine teamwork, and physical and psychological safety21.

Implementation Resources

AACN-HWE - American Association of Critical-Care Nurses (AACN). AACN’s healthy work environments initiative.

ANA-Healthy work - American Nurses Association (ANA). Healthy work environment.


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1 Cochrane-Ruotsalainen 2015 - Ruotsalainen JH, Verbeek JH, Mariné A, Serra C. Preventing occupational stress in healthcare workers. Cochrane Database of Systematic Reviews. 2015;(4):CD002892.

2 Weigl 2016 - Weigl M, Stab N, Herms I, Angerer P, Hacker W, Glaser J. The associations of supervisor support and work overload with burnout and depression: A cross-sectional study in two nursing settings. Journal of Advanced Nursing. 2016;72(8):1774-1788.

3 Kutney-Lee 2016 - Kutney-Lee A, Germack H, Hatfield L, et al. Nurse engagement in shared governance and patient and nurse outcomes. JONA: The Journal of Nursing Administration. 2016;46(11):605-612.

4 Hastings 2014 - Hastings SE, Armitage GD, Mallinson S, Jackson K, Suter E. Exploring the relationship between governance mechanisms in healthcare and health workforce outcomes: a systematic review. BMC Health Services Research. 2014;14:479.

5 CWF-Keenan 2003 - Keenan P. The nursing workforce shortage: Causes, consequences, proposed, solutions. New York: The Commonwealth Fund (CWF): 2003: Issue Brief #619.

6 Weinberg 2013 - Weinberg DB, Avgar AC, Sugrue NM, Cooney-Miner D. The importance of a high-performance work environment in hospitals. Health Services Research. 2013;48(1):319-332.

7 Costa 2016 - Costa DK, Yang JJ, Manojlovich M. The critical care nurse work environment, physician staffing, and risk for ventilator-associated pneumonia. American Journal of Infection Control. 2016;44(10):1181-1183.

8 Smith 2017 - Smith JG, Morin KH, Wallace LE, Lake ET. Association of the nurse work environment, collective efficacy, and missed care. Western Journal of Nursing Research. 2017.

9 Winsett 2016 - Winsett RP, Rottet K, Schmitt A, Wathen E, Wilson D. Medical surgical nurses describe missed nursing care tasks—Evaluating our work environment. Applied Nursing Research. 2016;32:128-133.

10 IOM-Nursing 2011 - Institute of Medicine (IOM). The future of nursing: Leading change, advancing health. Washington, D.C.: National Academies Press; 2011.

11 Kutney-Lee 2013 - Kutney-Lee A, Wu ES, Sloane DM, Aiken LH. Changes in hospital nurse work environments and nurse job outcomes: An analysis of panel data. International Journal of Nursing Studies. 2013;50(2):195–201.

12 Cummings 2010 - Cummings GG, MacGregor T, Davey M, et al. Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review. International Journal of Nursing Studies. 2010;47(3):363–385.

13 Blake 2013 - Blake N, Leach LS, Robbins W, Pike N, Needleman J. Healthy work environments and staff nurse retention: The relationship between communication, collaboration, and leadership in the pediatric intensive care unit. Nursing Administration Quarterly. 2013;37(4):356–370.

14 Lewis 2016a - Lewis HS, Cunningham CJL. Linking nurse leadership and work characteristics to nurse burnout and engagement. Nursing Research. 2016;65(1):13-23.

15 Budin 2013 - Budin WC, Brewer CS, Chao YY, Kovner C. Verbal abuse from nurse colleagues and work environment of early career registered nurses. Journal of Nursing Scholarship. 2013;45(3):308–316.

16 Brewer 2013 - Brewer CS, Kovner CT, Obeidat RF, Budin WC. Positive work environments of early-career registered nurses and the correlation with physician verbal abuse. Nursing Outlook. 2013;61(6):408–416.

17 Park 2016b - Park SH, Gass S, Boyle DK. Comparison of reasons for nurse turnover in Magnet® and non-Magnet hospitals. Journal of Nursing Administration. 2016;46(5):284–290.

18 Stimpfel 2015 - Stimpfel AW, Rosen JE, McHugh MD. Understanding the role of the professional practice environment on quality of care in Magnet® and non-Magnet hospitals. Journal of Nursing Administration. 2015;45(10 Suppl):S52–S58.

19 Blake 2017 - Blake N, Collins M. Importance of healthy work environment education in nursing schools. AACN Advanced Critical Care. 2017;28(3):289-290.

20 ANCC-Magnet - American Nurses Credentialing Center (ANCC). Magnet Recognition Program.

21 Huddleston 2016 - Huddleston P, Gray J. Describing nurse leaders’ and direct care nurses’ perceptions of a healthy work environment in acute care settings, part 2. JONA: The Journal of Nursing Administration. 2016;46(9):462-467.