Evaluation of Selected Components of the Nurse Worklife Model Association with Catheter-Associated Urinary Tract Infection

Purpose:
To test the pathways of a modified NWLM with catheter associated urinary tract infection (CAUTI) at the nurse work unit level.

Background/Significance:
Exploring associations among elements of the nurse practice environment based on the Nurse Worklife Model (NWLM) with clinical outcomes is an important area for research. Care occurs at the work unit level. Testing relationships at the unit level is needed to extend previous research based on the NWLM.

Methods:
A secondary data analysis of a national sample (N= 1,083) of medical, surgical, and medical-surgical unit level data from the National Database for Nursing Quality Indicators® (NDNQI®), was conducted using structural equation modeling to validate a modified NWLM that included nurse job enjoyment and to evaluate the association with a clinical outcome measure—CAUTI rate.

Results:
An a priori model derived from previous work testing the modified NWLM at the unit level was fit to 2012 NDNQI® data with excellent model fit (CFI = 0.995, RMSEA= .041, CI= 0.028-0.056), SRMR= 0.020). The results revealed a significant negative pathway from job enjoyment to CAUTI rates (-.08). Hospital characteristics were controlled with significant positive effects on CAUTI for Academic Medical Centers (.13) and hospitals greater than 500 beds (.07), indicating both had higher CAUTI rates. Previously tested pathways within the practice environment also were supported

Conclusions and Implications for Practice:
The results demonstrated the association of the unit practice environment as depicted in the NWLM with a measured clinical outcome at the unit level. In addition to attention on process and outcomes, strategies to support a culture of professional practice are indicated.