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Updated: Jan 23, 2026

Using Learning Outcome Measures to assess Doctoral Nursing Education
Published on: June 21, 2010
Nurse Work Environment and Stress Biomarkers: Possible Implications for Patient Outcomes
Judith Arnetz1, Sukhesh Sudan, Courtney Goetz
1Department of Family Medicine (Dr Arnetz, Mr Sudan, Ms Goetz, Dr Counts, Dr Arnetz); Department of Translational Science and Molecular Medicine (Dr Counts), Michigan State University College of Human Medicine, Grand Rapids, Michigan.
Objective:
To examine associations between nurse work environment, serum biomarkers, and patient outcomes in a large hospital.
Methods:
A work environment questionnaire was administered in 2017 to the total sample of nurses in a Midwestern hospital. A subsample of nurses (n = 83) provided blood samples. Correlation analyses examined associations between work environment ratings, biomarkers (dehydroepiandrosterone-sulphate [DHEA-S] and interleukin-6 [IL-6]), and unit-level patient outcomes.
Results:
Work stress was negatively correlated with DHEA-S (r = -0.23) and positively correlated with IL-6 (r = 0.31; P < 0.05). Psychological safety (r = 0.22) and competence development (r = 0.25) were both positively correlated with DHEA-S (P < 0.05). DHEA-S was negatively correlated with central line-associated bloodstream infections (rho = -0.61; P < 0.05).
Conclusions:
Work environment-associated physiological mechanisms might adversely impact patient safety, in addition to nurse health.
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