title: Hospital Magnet Status, Unit Work Environment, and Pressure Ulcers.
abstract: OBJECTIVE
  To identify how organizational nursing factors at different structural levels (i.e., unit-level work environment and hospital Magnet status) are associated with hospital-acquired pressure ulcers (HAPUs) in U.S. acute care hospitals.
  
  
  METHODS
  A cross-sectional observational study used data from the National Database of Nursing Quality Indicators®. Responses from 33,845 registered nurses (RNs) were used to measure unit work environments. The unit of analysis was the nursing unit, and there were 1,381 units in 373 hospitals in the United States.
  
  
  METHODS
  Unit work environment was measured by the Practice Environment Scale of Nurse Working Index (PES-NWI). Multilevel logistic regressions were used to estimate the effects of unit work environment and hospital Magnet status on HAPUs. All models were controlled for hospital and unit characteristics when considering clustering of units within hospitals.
  
  
  RESULTS
  Magnet hospital units had 21% lower odds of having an HAPU than non-Magnet hospital units (95% confidence interval [CI], 0.64-0.98). With one unit increase of the PES-NWI score, units had 29% lower odds of having an HAPU (95% CI, 0.55-0.91). When including both hospital Magnet status and unit work environment in the model, hospital Magnet status no longer had a significant effect on HAPUs (odds ratio [OR] = 0.82; 95% CI, 0.66-1.02), whereas the significant effect of unit work environment persisted (OR = 0.73; 95% CI, 0.56-0.93).
  
  
  CONCLUSIONS
  Both hospital and unit environments were significantly associated with HAPUs, and the unit-level work environment can be more influential in reducing HAPUs.
  
  
  CONCLUSIONS
  Investment in the nurse work environments at both the hospital level and unit level has the potential to reduce HAPUs; and additional to hospital-level initiatives (e.g., Magnet recognition program), efforts targeting on-unit work environments deserve more attention.
authors.affiliation: Assistant Professor, New York University College of Nursing, New York, NY, USA.
authors.forename: Chenjuan
authors.initials: C
authors.lastname: Ma
authors.affiliation: Assistant Professor, University of Kansas School of Nursing, Kansas City, KS, USA.
authors.forename: Shin Hye
authors.initials: SH
authors.lastname: Park
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D006302:Health Services Research; D006739:Hospital Administration; D006757:Hospital Units; D006761:Hospitals; D006801:Humans; D007857:Leadership; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D015401:Nursing Administration Research; D009741:Nursing Staff, Hospital / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling; D011312:Pressure; D003668:Pressure Ulcer / Q000517:prevention & control*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D014481:United States; D000078329:Workforce; D017132:Workplace
keywords: Magnet hospital; nursing; pressure ulcer; work environment