The Professional Nurse Practice Environment and Staff Nurse Care Coordination

Purpose:
This study examined factors believed to affect a key inpatient nursing process. The relationship between the professional practice environment, patient mix, and any hospital level effect were explored for an impact on staff nurse care coordination activities, up to and including discharge.

Background/Significance:
Previous research linked hospitals with professional nurse practice environments to better patient outcomes such as lower mortality and higher satisfaction. Little is known, however, about how these work environments impact central nursing processes, for example, care coordination. Understanding the context for achieving better outcomes through processes like staff nurse care coordination is critical, particularly as the number of chronically ill patients in the hospital continues to rise.

Methods:
This study was descriptive correlation, using a cross-sectional survey design. The sample consisted of 750 Registered Nurses on 32 medical surgical units in four metro area hospitals. The survey consisted of a demographic questionnaire and three measurement instruments. The first instrument was the PES-NWI (Lake), endorsed by NDNQI, measuring professional practice in the work environment). The second, the NCCI (Lamb, et.al), measured activities of staff nurse care coordination. The third, the RCI (Gittell), was as an alternate coordination measure. Analyses included aggregation of data to the unit level, correlations, regression and multilevel modeling to partition variance components.

Results:
The nurses comprising this sample were experienced and highly educated; more than 50% had more than 10 years as a nurse and held a BSN degree or higher. The majority of the nurses worked full time, 12 hour, shifts. 60% of the RNs were night shift and 35% were day shift. The largest percentages of reported race were white (34%) and African-American (31%). Study findings supported analysis at the patient care unit level. A significant relationship between a professional practice environment and higher relational coordination, less backfilling activities(including prompting of other team members) and less nursing time, in general, on the activities of care coordination (p≤.05).

Conclusions and Implications for Practice:
Results of this study support a relationship between the professional practice environment and nursing process. As nurses expand NDNQI, it will be important to develop and include measures of core nursing processes, including nurse care coordination, to ultimately improve related patient outcomes.