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 schedules (Cochrane-Ruotsalainen 2015), nursing supervisor support (Weigl 2016), and shared governance, in which nurses are active participants in organizational decision making (Kutney-Lee 2016*). Magnet hospitals can be another way to support nurse-friendly environments (Hastings 2014).
Expected Beneficial Outcomes (Rated)
Increased nurse retention
Improved quality of care
Other Potential Beneficial Outcomes
Increased job satisfaction
Evidence of Effectiveness
Nurse-friendly work environments are a suggested strategy to increase nurse retention (CWF-Keenan 2003, Weinberg 2013) and improve quality of care (Costa 2016*, Smith 2017, Winsett 2016*, Weinberg 2013, IOM-Nursing 2010). 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 nurses (Kutney-Lee 2013*, Kutney-Lee 2016*). 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 patients (Smith 2017, Winsett 2016*). Improved nurse work environments are also associated with reduced rates of hospital acquired infections, such as ventilator associated pneumonia in intensive care units (Costa 2016*). Strong nursing leadership may increase job satisfaction (Cummings 2010*), increase retention (CWF-Keenan 2003, Blake 2013*), and reduce burnout (Weigl 2016, Lewis 2016a*). Modified work schedules, including weekend breaks and two week schedules, may reduce stress (Cochrane-Ruotsalainen 2015).
Hospitals with Magnet status are associated with practice environments that support nurses’ job satisfaction (Hastings 2014, Budin 2013*, Brewer 2013*), increase retention (Park 2016b*, Budin 2013*, Brewer 2013*), improve engagement in organizational decision making (Kutney-Lee 2016*), and reduce verbal abuse toward nurses (Budin 2013*, Brewer 2013*). Magnet hospitals are also associated with improved quality of care (Stimpfel 2015*).
Experts suggest that nurses should all learn techniques to foster healthy work environments, and nursing school curriculums should include such techniques (Blake 2017*).
Impact on Disparities
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 US (ANCC-Magnet).
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 safety (Huddleston 2016*).
Citations - Evidence
* Journal subscription may be required for access.
CWF-Keenan 2003 - Keenan P, Kennedy JF. The nursing workforce shortage: Causes, consequences, proposed, solutions. New York: The Commonwealth Fund (CWF): 2003: Issue Brief #619.
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.
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.
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.
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.
IOM-Nursing 2010 - Institute of Medicine (IOM). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press; 2010.
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.
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.
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.
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.
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.
Lewis 2016a* - Lewis HS, Cunningham CJL. Linking nurse leadership and work characteristics to nurse burnout and engagement. Nursing Research. 2016;65(1):13-23.
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.
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.
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.
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.
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.
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.
Blake 2017* - Blake N, Collins M. Importance of healthy work environment education in nursing schools. AACN Advanced Critical Care. 2017;28(3):289-290.
Citations - Implementation Examples
* Journal subscription may be required for access.
ANCC-Magnet - American Nurses Credentialing Center (ANCC). Magnet Recognition Program.
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.
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