Adverse events and serious errors are common
in critical care. Although factors in the work environment are
important predictors of adverse outcomes for patients, communication
between nurses and physicians may be the most
significant factor associated with excess hospital mortality in
critical care settings.
Objectives To examine the relationships between nurses’ perceptions
of their practice environment, nurse-physician communication,
and selected patients’ outcomes.
Methods A nonexperimental, descriptive design was used,
and all nurses (N=866) working in 25 intensive care units in
southeastern Michigan were surveyed. The Conditions for Work
Effectiveness Questionnaire-II and the Practice Environment
Scale of the Nursing Work Index were used to measure characteristics
of the work environment; the ICU Nurse-Physician
Questionnaire was used to measure nurse-physician communication.
Nurses self-rated the frequency of ventilator-associated
pneumonia, catheter-related sepsis, and medication errors in
patients under their care.
Results A total of 462 nurses (53%) responded. According to
multi level modeling, both practice environment scales accounted
for 47% of the variance in nurse-physician communication
scores (P=.001). Nurse-physician communication was predictive
of nurse-assessed medication errors only (R2=0.11). Neither
environment scale was predictive of any of the patient outcomes.
Conclusions Healthy work environments are important for
nurse-physician communication. In intensive care units, characteristics
of the work environment did not vary enough to be
significantly predictive of outcomes, suggesting that even in
various types of critical care units, characteristics of the work
environment may be more similar than different.