Employee Net Promoter Score Links Nursing Satisfaction to Quality of Care Before and During the COVID-19 Pandemic

To measure the association between job satisfaction and perceived quality of care among nurses on labor and delivery (LD) units.

Nurses constitute the largest segment of the US healthcare workforce. Low job satisfaction is a critical factor in nurse turnover and quality of care.

A web-based survey was distributed across LD units in the United States. We used logistic regression to assess the association between job satisfaction, as measured by the employee net promoter score (eNPS), and perceived indicators of quality of care.

Among 1021 LD nurses who responded, those characterized as passive or detractors had greater odds of rating that the quality of care on their LD unit was fair or good rather than excellent (adjusted odds ratio [aOR] 3.45, 95% CI: 2.44-4.88 and aOR 6.58, 95% CI: 4.08-10.75, respectively, with both p < 0.0001), agreeing that nurses were spending less time with laboring patients suspected or confirmed to have COVID-19 (aOR 1.42, 95% CI: 1.04-1.95, p = 0.0288; aOR 2.08, 95% CI: 1.33-3.28, p = 0.0014) and reporting that professional labor support was frequently or always missed during the pandemic (aOR 2.19, 95% CI: 1.49-3.20, p < 0.0001; aOR 1.82, 95% CI: 1.09-3.03, p = 0.0217) compared to respondents characterized as promoters.

Higher nursing job satisfaction as measured by the eNPS is associated with higher perceived quality of care on the LD units.

eNPS is a one-question survey that is easy to deliver, simple to interpret, and is associated with perceived quality of care. Nursing management can use it to track progress over time and understand reasons for job dissatisfaction on their units.