title: Effects of hospital care environment on patient mortality and nurse outcomes.
abstract: OBJECTIVE
  The objective of this study was to analyze the net effects of nurse practice environments on nurse and patient outcomes after accounting for nurse staffing and education.
  
  
  BACKGROUND
  Staffing and education have well-documented associations with patient outcomes, but evidence on the effect of care environments on outcomes has been more limited.
  
  
  METHODS
  Data from 10,184 nurses and 232,342 surgical patients in 168 Pennsylvania hospitals were analyzed. Care environments were measured using the practice environment scales of the Nursing Work Index. Outcomes included nurse job satisfaction, burnout, intent to leave, and reports of quality of care, as well as mortality and failure to rescue in patients.
  
  
  RESULTS
  Nurses reported more positive job experiences and fewer concerns with care quality, and patients had significantly lower risks of death and failure to rescue in hospitals with better care environments.
  
  
  CONCLUSIONS
  Care environment elements must be optimized alongside nurse staffing and education to achieve high quality of care.
authors.affiliation: Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania 19104-6096, USA. laiken@nursing.upenn.edu
authors.forename: Linda H
authors.initials: LH
authors.lastname: Aiken
authors.forename: Sean P
authors.initials: SP
authors.lastname: Clarke
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Sloane
authors.forename: Eileen T
authors.initials: ET
authors.lastname: Lake
authors.forename: Timothy
authors.initials: T
authors.lastname: Cheney