Better nurse work environments, better outcomes: A look at what works
Coauthored by Nora Warshawsky, Nurse Scientist, Press Ganey.
Safety and the patient experience start with where care happens: the nurse practice environment. A new analysis of 2024 national data from the National Database of Nursing Quality Indicators (NDNQI) and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) underscores a powerful truth: When the nurse practice environment is strong, both patient safety and experience benefit.
This analysis compares the top and bottom 25% of acute care units across key domains of the practice environment. The results quantify just how much supportive conditions impact outcomes—and reveal which aspects of the environment matter most.
Measuring impact at the intersection of environment and outcomes
To get a clear picture of how the work environment affects outcomes, we focused on the variables that matter most to nurses and patients alike. The analysis zeroed in on four core domains from the NDNQI RN survey—factors that directly shape the daily experience of front-line care teams and their ability to deliver safe, high-quality care:
- Overall Practice Environment Scale (PES) score
- Staffing resources and adequacy
- Nurse manager leadership and support
- Nurse-to-nurse collaboration
These domains were assessed against key outcomes across stepdown, medical-surgical, and critical care units, including adverse events like falls, HAPI, CLABSI, and CAUTI, as well as patient-reported experiences through HCAHPS scores.
Adverse events are lowest when leadership and practice environment are strong
Across the board, top-quartile units saw reductions in nurse-sensitive adverse events. But not all improvements were equal, and the magnitude varied by domain.
- HAPI rates were 0.80% lower in units with the highest nurse manager leadership scores.
- CLABSI rates were up to 0.22 lower in high-performing nurse manager leadership units.
- Units with top staffing adequacy saw 0.67 fewer falls per 1,000 patient days.
- CAUTI rates were up to 0.17 lower in units with top-quartile practice environment scores.
The takeaway? Nurse manager leadership and the overall practice environment showed the greatest impact on nursing-sensitive indicator (NSI) outcomes. These findings suggest that investing in strong, supportive nurse leadership and a healthy work environment holds substantial potential to reduce preventable harm.
Patient experience: Better conditions, better care perceptions
The pattern holds true in patient-reported outcomes. Units in the top quartile for PES and staffing adequacy saw significant gains in nearly every HCAHPS domain.
- Hospital rating: 9.0% higher in top-quartile staffing units
- “Likelihood to Recommend”: 7.9% higher in top-quartile staffing units
- Communication about medicines: 5.1% higher in top-quartile PES units
- Communication with nurses: 4.7% higher in top-quartile PES units
- Responsiveness of staff: 8.6% higher in top-quartile staffing units
- Restful environment: 9.0% higher in top-quartile staffing units
These findings reinforce a clear reality: The overall nurse practice environment and perceptions of staffing shape the care experience in profound ways. So, when nurses are well-supported, patients feel the difference.
3 actions for nurse leaders
For health system and nursing leaders focused on safety, experience, and retention, this analysis offers actionable direction.
- Prioritize nurse manager development. Strong leadership is a cornerstone of safer, higher-performing units.
- Benchmark and monitor work environment performance. Use the data to track progress and identify gaps.
- Invest in appropriate staffing. Ensuring the right resources are in place empowers nurses to deliver safe, high-quality care.
When we support nurses, we improve care and patient experience
This national snapshot of 2024 data offers compelling confirmation of what many nurse leaders have seen firsthand: When nurses are empowered by strong practice environments, safety, quality of care, and patient experience improve.
For any health system aiming to improve safety and experience, strengthening the nursing practice environment isn't a nice-to-have; it’s a must-have. Let's keep building the conditions where nurses can thrive—and patients can heal.
To discuss the findings of our analysis further or learn how Press Ganey’s nursing solution and consulting can benefit your organization, reach out to a member of our team.