Better work environments: The key to nurse retention and patient outcomes

Coauthored by Nora Warshawsky, Ph.D., R.N., NEA-BC, CNE, FAAN, Nurse Scientist. 

While nursing is a rewarding profession, the job is, as it’s always been, a challenging one. Long hours. High pressure. A demanding workload. Even workplace violence and bullying have taken a significant toll in recent years.

These trying conditions, on top of mass retirement, have contributed to a national nursing shortage that threatens both the quality of patient care and the well-being of our nurses on the front lines. So how do we, as leaders and an industry, make things better for our workforce in a way that’s both meaningful and sustainable? How do we prevent burnout? How do we keep nurses happy and engaged on the job?

Press Ganey analyzed data from nearly 115,000 registered nurses (RNs) and advanced practice registered nurses (APRNs) to understand why nurses stay in, or leave, their roles—as well as the nursing profession as a whole. Our report, "The nurse work environment in 2024," also explores how their professional setting impacts these decisions, and how healthcare organizations can make strategic improvements to enhance nurse retention and overall job satisfaction.

How a healthy environment impacts nurses’ work

While nurses are largely satisfied in their roles, nearly 25% of RNs in acute care still plan to leave their positions within the next three years. But there’s also good news: Less than 4% intend to leave the nursing profession entirely.

Personal circumstances, like family obligations or simply an easier commute, certainly influence nurses’ decisions to leave their roles. But most (40%) of those who intend to leave within a year cite the work environment as the primary factor—particularly when it comes to three things: dissatisfaction with management, scheduling and staffing, and compensation.

In this context, nurse managers become instrumental in shaping a positive work culture and high-quality environment. When nurses feel supported and valued, they are more likely to stay, leading to improved patient outcomes and organizational success.

How great nurse work environments impact patient outcomes

A healthy environment—characterized by support from leaders, respect among colleagues, and recognition—is not only essential for improving nurse job satisfaction and retention. It’s also associated with better patient satisfaction, experience, and outcomes.

While we have clear evidence that employee engagement directly influences patient experience and outcomes, the ways in which the work environment itself impacts patient care remain less understood.

Top-performing units see significantly fewer patient safety events—including rates of catheter-associated urinary tract infections (CAUTI) (0.15 fewer per 1,000 catheter days), central line-associated blood stream infections (CLABSI) (0.17 fewer per 1,000 line days); hospital-acquired pressure injuries (HAPI) (1.37% lower) and falls with injury (0.13 fewer per 1,000 patient days).*

These improvements translate directly into higher patient satisfaction scores: Hospitals with the most positive work environments achieve 7.4% higher patient ratings and a 6.7% increase in “Likelihood to Recommend” scores.

4 proven strategies for building a better nurse work environment

Nurses are a cornerstone of our healthcare workforce, vital for delivering high-quality patient care and driving optimal outcomes. Fostering a positive, supportive culture is key to sustaining workforce morale and resilience. But it’s not just retention at stake: Healthy work environments are also essential for recruitment and for nurturing the next generation of nurse leaders.

1. Solicit and tune in to nurse feedback: New technologies enable unprecedented real-time listening to help the industry understand what matters most to RNs, APRNs, and patients, as well as what fuels the relationships between these groups. Press Ganey’s Nursing Centers of Excellence, strategic consultants, and advisory teams can further support your journey. Our partnerships with organizations like the DAISY Foundation, ANCC, AONL, AAACN, and ANA keep us connected to other industry experts, and ensure we stay aligned with emerging best practices.

2. Connect the dots: The nurse work environment is closely tied to overall organizational performance. High-quality workplaces not only boost nurse satisfaction and collaboration, but also lead to fewer patient safety incidents and improved experiences. Use cross-platform reporting to integrate insights from patient and nurse feedback for actionable improvements.

3. Empower nurse managers: Effective leadership drives success throughout the organization. And nurse managers need support and resources to effectively cultivate a thriving RN workforce. Strong, engaged nurse managers can improve job satisfaction, nurse retention, and patient outcomes while reducing costs associated with turnover and safety events.

4. Accelerate insight to action: Integrated analytics and industry benchmarks can simplify complex data. Advanced AI technology streamlines your ability to interpret feedback—significantly reducing manual workload for your teams.

To learn more about creating a positive and supportive work environment for nurses, download the latest report. If you’d rather discuss your top-of-mind challenges one on one, reach out to a nurse expert, and we’ll be in touch. 

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