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

Falls in hospitalized patients are common adverse events with substantial consequences for patient safety and hospital costs. Understanding modifiable organizational factors associated with falls is essential for prevention.

To examine whether nurse job satisfaction, practice environment, and turnover are associated with patient falls.

This cross-sectional study examined US acute care hospital unit-level data from the National Database of Nursing Quality Indicators between January 1, 2022, and December 31, 2023. Unit types included medical, surgical, and medical-surgical combined. Data were received on December 20, 2024, and analyzed from January 6 to April 30, 2025.

Nurse job satisfaction and practice environment measured at the unit level.

The primary outcome was the reported rate of patient falls per 1000 patient-days. Structural equation modeling was used to evaluate both direct associations of job satisfaction and practice environment and indirect association of nurse turnover with falls.

The cohort comprised 8584 units (2736 medical, 1384 surgical, and 4464 medical-surgical combined), with 3459 units (40.3%) in hospitals with 199 beds or fewer, 2215 (25.8%) in hospitals with 200 to 299 beds, and 3375 units (39.3%) situated in Magnet-designated hospitals. The total number of patient falls from 2022 to 2023 was 42 929, ranging from 12.3% in surgical units to 52.5% in medical-surgical units. High registered nurse and advance practice registered nurse turnover was significantly associated with increased patient falls (β = 0.01; 95% CI, 0.01-0.02). The job satisfaction item nurses' intent to stay was significantly associated with lower turnover (β = -3.50; 95% CI, -6.25 to -0.75). No other satisfaction or practice environment items were significantly associated with turnover. Indirect associations of job satisfaction or practice environment with regard to falls through nurse turnover were not consistently significant.

This cross-sectional study found that higher nurse turnover was associated with increased patient falls. While limited evidence links specific job satisfaction measures to turnover, these findings reinforce the importance of nurse retention in supporting patient safety. Future research should explore targeted strategies to improve retention and reduce falls.