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Associations between the Pathway to Excellence® framework and nurse, patient, and organizational outcomes: A
Kathryn A Connell1, Nicole George, Hyunmin Yu
1Kathryn A. Connell is Assistant Professor, Department of Biobehavioral Health Sciences, Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing, a Senior Fellow at Leonard Davis Institute of Health Economics, a Clinical Nurse 2 at Penn Medicine, Pennsylvania Hospital, and a Nurse Scientist at Corporal Michael J. Crescenz VA Medical Center in Philadelphia, PA. Nicole George is Vice President, Associate Chief Nursing Officer at Press Ganey in South Bend, IN. Hyunmin Yu is a Postdoctoral Research Fellow at the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing and an Associate Fellow at Leonard Davis Institute of Health Economics in Philadelphia, PA. Matthew D. McHugh is a Professor of Nursing at the University of Pennsylvania School of Nursing, Director of the Center for Health Outcomes and Policy Research, and a Senior Fellow at Leonard Davis Institute of Health Economics in Philadelphia, PA.
Background:
Supportive nursing practice environments are consistently associated with improved nurse, patient, and organizational outcomes. The American Nurses Credentialing Center's Pathway to Excellence® (Pathway) program is designed to establish and sustain healthy work environments, yet the empirical evidence evaluating its outcomes remains fragmented.
Purpose:
To systematically synthesize quantitative evidence examining the association between Pathway designation or Pathway standards and nurse, patient, and organizational outcomes.
Methods:
A quantitative systematic review was conducted in January 2026 using PubMed, CINAHL, and Embase to identify peer-reviewed studies examining nurse, patient, or organizational outcomes associated with Pathway designation or standards. Risk of bias was independently assessed by two authors using the Joanna Briggs Institute critical appraisal checklists.
Results:
Eight US-based observational studies met the inclusion criteria. Across diverse health care settings, Pathway designation or stronger alignment with Pathway standards was consistently associated with more favorable nurse work environments, lower burnout and intent to leave, stronger engagement in evidence-based practice, higher patient satisfaction, and more positive organizational safety climates.
Conclusion:
The evidence indicates that Pathway designation and standards are positively associated with nurse, patient, and organizational outcomes. Although causal inference is limited, the consistency of findings supports Pathway as a meaningful organizational strategy for strengthening professional nursing practice environments and advancing health care quality.
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