Associations between the nurse practice environment and nurse-sensitive patient outcomes: Empirical research quantitative
Author(s)
Author(s)
Chau, J. P. C.
Lo, S. H. S.
Choi, K. C.
Butt, L.
Tong, D. W. K.
Kwok, A. M. L.
Lee, I. F. K.
Lee, D. T. F.
McHugh, M. D.
Thompson, D. R.
Date Issued
2026
Publisher
John Wiley & Sons
Journal
Nursing Open
Volume
13
Issue
2
Abstract
Aim: This study aimed to investigate associations between the nurse practice environment and nurse-sensitive patient outcomes in Hong Kong.
Design: This was a 4-wave repeated cross-sectional study. Methods: The sample comprised 71 adult general medical, surgical and orthopaedic wards recruited from four public hospitals. Data on nurses' practice environment and nurse-sensitive patient outcomes were collected quarterly from each hospital over a one-year period from January 2016 to December 2018. The number of participating nurses per survey wave ranged from 604 to 865. Measures comprised the Practice Environment Scale of the Nursing Work Index and four nurse-sensitive patient outcomes identified from the National Quality Forum-endorsed nursing-sensitive care measure set. The associations between each outcome and the practice environment were examined using multiple regression analysis. Results: Nurse practice environments were rated favourably. The ‘Nursing foundations for quality of care’ subscale received the highest score (59.6) while the ‘Staffing and resource adequacy’ subscale received the lowest score (36.7). Though no significant associations were found between the overall practice environment and nurse-sensitive patient outcomes, the subscale of ‘Staffing and resource adequacy’ was significantly associated with the incidence of inpatient falls and catheter-associated urinary tract infections. Conclusions: Our findings suggest that staffing is a core nurse workplace concern which impacts the outcomes of inpatient falls and catheter-associated urinary tract infections. However, the overall nurse practice environment was not significantly associated with any patient outcomes, and further studies are needed to corroborate these results. Additional mediating factors such as nurse resilience, which may potentially affect patient outcomes, should also be explored. No Patient or Public Contribution: Patients or the general public were not involved in the design, analysis, or interpretation of the data in this study.
Design: This was a 4-wave repeated cross-sectional study. Methods: The sample comprised 71 adult general medical, surgical and orthopaedic wards recruited from four public hospitals. Data on nurses' practice environment and nurse-sensitive patient outcomes were collected quarterly from each hospital over a one-year period from January 2016 to December 2018. The number of participating nurses per survey wave ranged from 604 to 865. Measures comprised the Practice Environment Scale of the Nursing Work Index and four nurse-sensitive patient outcomes identified from the National Quality Forum-endorsed nursing-sensitive care measure set. The associations between each outcome and the practice environment were examined using multiple regression analysis. Results: Nurse practice environments were rated favourably. The ‘Nursing foundations for quality of care’ subscale received the highest score (59.6) while the ‘Staffing and resource adequacy’ subscale received the lowest score (36.7). Though no significant associations were found between the overall practice environment and nurse-sensitive patient outcomes, the subscale of ‘Staffing and resource adequacy’ was significantly associated with the incidence of inpatient falls and catheter-associated urinary tract infections. Conclusions: Our findings suggest that staffing is a core nurse workplace concern which impacts the outcomes of inpatient falls and catheter-associated urinary tract infections. However, the overall nurse practice environment was not significantly associated with any patient outcomes, and further studies are needed to corroborate these results. Additional mediating factors such as nurse resilience, which may potentially affect patient outcomes, should also be explored. No Patient or Public Contribution: Patients or the general public were not involved in the design, analysis, or interpretation of the data in this study.
SFU Affiliated Publication
Yes
Availability at SFU Library
No database links found.