• Patricia W Stone, Cathy Mooney-Kane, Elaine L Larson, Teresa Horan, Laurent G Glance, Jack Zwanziger, and Andrew W Dick.
• Columbia University School of Nursing, New York, New York 10032, USA. ps2024@columbia.edu
• Med Care. 2007 Jun 1; 45 (6): 571-8.

BackgroundSystem approaches, such as improving working conditions, have been advocated to improve patient safety. However, the independent effect of many working condition variables on patient outcomes is unknown.ObjectiveTo examine effects of a comprehensive set of working conditions on elderly patient safety outcomes in intensive care units.DesignObservational study, with patient outcome data collected using the National Nosocomial Infection Surveillance system protocols and Medicare files. Several measures of health status and fixed setting characteristics were used to capture distinct dimensions of patient severity of illness and risk for disease. Working condition variables included organizational climate measured by nurse survey; objective measures of staffing, overtime, and wages (derived from payroll data); and hospital profitability and magnet accreditation.Setting And PatientsThe sample comprised 15,846 patients in 51 adult intensive care units in 31 hospitals depending on the outcome analyzed; 1095 nurses were surveyed.Main Outcome MeasuresCentral line associated bloodstream infections (CLBSI), ventilator-associated pneumonia, catheter-associated urinary tract infections, 30-day mortality, and decubiti.ResultsUnits with higher staffing had lower incidence of CLBSI, ventilator-associated pneumonia, 30-day mortality, and decubiti (P ConclusionsNurse working conditions were associated with all outcomes measured. Improving working conditions will most likely promote patient safety. Future researchers and policymakers should consider a broad set of working condition variables.

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