Poor Patient Care Outcomes and Nurse Job Outcomes Associated With Unfavorable Intensive Care Unit and Emergency Department Nurse Work Environments: Implications for Critical Care Medicine.

Abstract

Objectives: Efforts to improve critical care outcomes are traditionally focused on intensive care unit (ICU) work environments, despite the reality that nurses in emergency departments (EDs) also deliver critical care. EDs and ICUs in the same hospitals tend to be differently resourced and may have different work environments as assessed by nurses. The objective of this study was to assess similarities in ED and ICU nurse work environment evaluations and associations with patient care and nurse job outcomes.

Methods: Cross-sectional evaluation of ED and ICU nurses in 169 hospitals from a study of nurses licensed to work in New York and Illinois hospitals in the United States, the 2021 RN4CAST-New York/Illinois (NY/IL) survey, was administered electronically. K-means clustering classified hospitals into profiles on the basis of similarities in ED and ICU nurse work environment reports. Hospital-level regression models determined the association between the profiles and the following hospital-level outcomes, namely, patient care quality and safety, nurse burnout, job dissatisfaction, and intent to leave.

Results: Three hospital profiles characterized similarities and differences in nurses' favorable and unfavorable work environments: "ED and ICU nurse-favorable" (n = 67 hospitals), and "ED and ICU nurse-unfavorable" (n = 42); and "ED nurse-unfavorable" (n = 60) indicating less favorable environments for ED than ICU nurses. Hospitals that were unfavorable for both ED and ICU nurses, or unfavorable for ED nurses only were associated with higher percentages of poorer outcomes, as compared to hospitals in which nurses in both settings reported favorable environments.

Conclusions: To optimize critical care, better nurse work environments are needed in both ICUs and EDs.