A cross-sectional study to identify organisational processes associated with nurse-reported quality and patient safety

OBJECTIVES: The purpose of this study was to identify organisational processes and structures that are associated with nurse-reported patient safety and quality of nursing. DESIGN: This is an observational cross-sectional study using survey methods. SETTING: Respondents from 31 Norwegian hospitals with more than 85 beds were included in the survey. PARTICIPANTS: All registered nurses working in direct patient care in a position of 20% or more were invited to answer the survey. In this study, 3618 nurses from surgical and medical wards responded (response rate 58.9). Nurses' practice environment was defined as organisational processes and measured by the Nursing Work Index Revised and items from Hospital Survey on Patient Safety Culture. OUTCOME MEASURES: Nurses' assessments of patient safety, quality of nursing, confidence in how their patients manage after discharge and frequency of adverse events were used as outcome measures. RESULTS: Quality system, nurse–physician relation, patient safety management and staff adequacy were process measures associated with nurse-reported work-related and patient-related outcomes, but we found no associations with nurse participation, education and career and ward leadership. Most organisational structures were non-significant in the multilevel model except for nurses’ affiliations to medical department and hospital type. CONCLUSIONS: Organisational structures may have minor impact on how nurses perceive work-related and patient-related outcomes, but the findings in this study indicate that there is a considerable potential to address organisational design in improvement of patient safety and quality of care.