Nurse Practice Environment, Job Satisfaction, and Turnover and Patient Falls.

Area of Science:

• Nursing Quality
• Patient Safety
• Healthcare Management

Background:

• Hospitalized patient falls are frequent adverse events impacting patient safety and increasing healthcare costs.
• Identifying modifiable organizational factors is critical for effective fall prevention strategies.

Purpose of the Study:

• To investigate the association between nurse job satisfaction, practice environment, and patient falls.
• To determine if nurse turnover mediates the relationship between job satisfaction/practice environment and patient falls.

Main Methods:

• A cross-sectional study utilizing unit-level data from the National Database of Nursing Quality Indicators (2022-2023).
• Structural equation modeling was employed to analyze direct and indirect associations.
• Data included 8584 units across medical, surgical, and combined units in US acute care hospitals.

Main Results:

• Higher registered nurse (RN) and advanced practice registered nurse (APRN) turnover was significantly associated with increased patient falls (β=0.01; 95% CI, 0.01-0.02).
• Nurses' intent to stay was linked to lower turnover (β=-3.50; 95% CI, -6.25 to -0.75).
• No consistent indirect associations were found between job satisfaction or practice environment and falls via nurse turnover.

Conclusions:

• Increased nurse turnover is a significant predictor of higher patient fall rates.
• While direct links between specific job satisfaction measures and falls are not consistently significant, nurse retention is vital for patient safety.
• Further research should focus on developing targeted interventions to enhance nurse retention and mitigate patient falls.