Abstract：
We sought to evaluate if better work environments or staffing were associated with improvements in care quality, patient safety, and nurse outcomes across hospitals caring for different proportions of patients who are economically disadvantaged. Few actionable approaches for hospitals with quality and resource deficits exist. One solution may be to invest in the nurse work environment and staffing. This cross-sectional study utilized secondary data from 23,629 registered nurses in 503 hospitals from a four-state survey collected in 2005-2008. Each 10% increase in the proportion of patients who are economically disadvantaged was associated with 27% and 22% decreased odds of rating unit-level care quality as excellent and giving an \"A\" safety grade, respectively. Each 10% increase was also associated with 9%, 25%, and 11% increased odds of job dissatisfaction, intent to leave, and burnout, respectively. The work environment had the largest association with each outcome. Accounting for the nurse work environment lessened or eliminated the negative outcomes experienced at hospitals serving high proportions of patients who are economically disadvantaged. Leaders at hospitals serving high proportions of patients who are economically disadvantaged, as well as state and federal policymakers, should work to improve quality, safety, and nurse outcomes by strengthening nurse work environments. Improving work environments highlights the role of nursing in the health care system, and policies focused on work environments are needed to improve the experiences of patients and nurses, especially at hospitals that care for many patients who are economically disadvantaged.
摘要：
我们试图评估更好的工作环境或人员配备是否与护理质量的改善有关，患者安全,和护理结果跨医院照顾不同比例的患者谁是经济上的不利。对于质量和资源短缺的医院，几乎没有可行的方法。一种解决方案可能是投资于护士工作环境和人员配备。这项横断面研究利用了2005-2008年收集的四州调查中503家医院的23,629名注册护士的二级数据。经济上处于不利地位的患者比例每增加10％，将单元级护理质量评为优秀并给出“A”安全等级的几率分别降低了27％和22％。分别。每增加10%也与9%相关，25%,工作不满意的几率增加了11%，打算离开，和倦怠,分别。工作环境与每个结果的关联最大。考虑到护士的工作环境，减少或消除了为高比例经济上处于不利地位的患者提供服务的医院所经历的负面结果。医院的领导者为经济上处于不利地位的高比例患者提供服务，以及州和联邦决策者，应该努力提高质量，安全,通过加强护士工作环境来提高护士的工作成果。改善工作环境突出了护理在卫生保健系统中的作用,需要针对工作环境的政策来改善患者和护士的体验，特别是在照顾许多经济上处于不利地位的患者的医院。
