The influence of healthcare work environment on patient safety outcomes in Ethiopian hospital settings

Background: Nurses’ work environment is a multidimensional concept and is defined as organizational characteristics of a work setting that facilitate or hinder professional nursing practice or nurses’ ability to practice skilfully and deliver high-quality care. Nurses’ work environment is one of many organizational factors that are associated with patient safety outcomes. It is also recognized as one of the important dimensions to maintain health and sustainable nursing workforce. A good work environment constitutes a factor for a better quality of care. Objectives: The main aim of this study is aimed at determining the level of nurses work environment and its relationship with patient safety outcomes in the acute care settings of Amhara Regional State, Ethiopia. Methods: Prospective observational study was conducted from July 2018 to March 2019. For phase one survey all 126 nurses who were working in the medical-surgical units of the study hospitals were invited to participate and 74 of them completed and returned the survey questionnaire. For phase two data collection, 80 nurses completed and returned the questionnaire. Regarding the patients’ record review, a sample of 528 patient records was planned to be reviewed. Data regarding nurses’ work environment were collected using the practice environment scale-nursing work index (PES-NWI). Data were entered into IBM SPSS 24.0 and descriptive statistics was done to describe the frequency and percentage of predictor and outcome variables. Chi-square test and Fischer exact test was calculated to see the relationship between the level of nurses’ work environment and patient safety outcomes. Results: The composite mean score of the subscales of the nurses’ work environment index during the first phase of the study for the public hospital was 2.3. The work environment of nurses in the public hospital during phase one of the study shows that none of the five subscales “nurse manager, ability, leadership and support” score was greater than 2.5. The score of the subscale for the nurses’ participation in hospital affairs is below 2.5 during both phases of study for all study units. At the unit level, the work environment of all the medical, surgical and orthopedics units of the public hospital was poor or unfavorable. Regarding the work environment of nurses in the private hospital, the score of two of the five subscales “nurse manager ability, leadership and support of nurses” and “nurse participation in hospital affairs” was greater than 2.5 which makes the category as mixed work environment. Conclusion: The Nurses work environment level in the public hospital is categorized as unfavourable while that of the private hospital was mixed during first phase of the study. Level of nurses’ participation in the hospital affairs is low in both hospitals.