Observational study using secondary data collected in 2018 through the Press Ganey National Database of Nursing Quality Indicators® (NDNQI®) RN survey and staffing measures; Patient Experience of Care surveys; and ED throughput data available through the Center for Medicare and Medicaid Services’ (CMS) Hospital Compare tool. Patient experience surveys for ED experience and inpatient experience were used. The impact of nurse work environment and staffing on RN outcomes (job enjoyment, intention to stay, joy and meaning in work), patient outcomes (RN reported quality of care, missed care activities), patient experience, and patient throughput were examined through regression path models. Hospital characteristics were used as control variables.

Population Studied:

Seventy-two (72) U.S.-based hospitals with emergency departments participating in the NDNQI survey and staffing data and Press Ganey patient experience surveys were included.

Principal Findings:

Similar to findings in inpatient care settings, EDs with better nursing work environments have better nurse and patient outcomes. Specifically, better staffing, RN teamwork, nurse managers and RN-MD relationships are linked to greater job enjoyment, intent to stay and joy and meaning in work. Better staffing and RN teamwork are also related to lower missed care rates and higher overall rating of the quality of care provided. RN ratings of the appropriateness of their patient assignment is related to lower overall length of stay for patients discharged from the ED as well as those admitted to the hospital, and a lower rate of patients who left the ED without being seen. Higher levels of RN staffing are associated with longer overall length of stay for non-psychiatric patients, but shorter overall length of stay for psychiatric patients. Nursing factors such as staffing, RN certification, nurse teamwork, and better nurse managers are associated with high ratings of patient experience of care.