Sam Robinson
In the patient care setting, the boots on the ground play the biggest role in shaping outcomes. Nurses sit at the foundation of the healthcare delivery chain and considerably influence the quality of their patient’s care. As a result, health system performance is largely a reflection of their experience.
The downstream effects of capable nursing care should not be overlooked. Studies have shown nursing quality to be definitive of the care environment. Kaiser Permanente—the largest nonprofit health system in the United States—can attribute much of its success to the competency of its nurses. More broadly, bedside care has been shown to have a significant impact on health-related outcomes and patient satisfaction—two key considerations when evaluating the merits of any healthcare entity.
If the quality of nursing care has such a strong relationship with health system performance, it raises an important question: How can organizations effectively invest in and support their nursing staff?
Maintaining sufficient staffing levels should be a top priority. Patient care can be complex and demanding—nurses need adequate time and resources to treat each patient. When a unit is understaffed, smaller teams are expected to manage more patients, leading to an excessive workload that compromises care. By ensuring adequate staffing levels, health systems can bolster outcomes and make nursing a more fulfilling endeavor.
Given the fluid nature of healthcare demand, striking a balance between proper staffing levels and cost control can be challenging. Because of this difficulty, decisions to address dynamic staffing needs should be based on established, well-grounded research.
This 2021 study found that maintaining a higher staffing level at baseline demanded slightly higher upfront costs but decreased inpatient care days and patient deaths. A combination of low baseline staffing and on-demand nurses was found to be ineffective for meeting staff needs. It also failed at reducing costs—increased spending on flexible staff during high demand periods offset any savings gained from decreased upfront staffing.
Higher staffing levels also lead to improved patient experiences. This is likely due to a decrease in workload that provides nurses with adequate time to tend to their patients. Further, some suggest that higher upfront costs demanded by increased staffing may be offset by future savings from reduced adverse events, such as falls and medication errors, healthcare associated infections (HAIs), and death.
Hospitals can build a high-quality roster of nursing staff by building relationships with nursing programs, establishing structured interview processes to attract and retain candidates, and incentivizing referrals from in-house staff. But hiring is only half the battle: Once recruited, organizations must seek to retain their nurses by providing them with a supportive work environment.
Like most other professions, leadership in nursing markedly defines the work atmosphere. Nurses working on units with more impactful leaders have healthier lifestyles, while supervisors who demonstrate workplace incivility have a detrimental effect on nursing performance.
Robust nursing leadership should be based on a successful leadership style. In healthcare, one of the most effective is servant leadership. A servant leader prioritizes others ahead of themselves and exercises skills like active listening and empathy to connect with and support employees. Servant leaders can help reinforce essential concepts like collaboration, autonomy, and putting patient care first, all of which are fundamental to success in nursing.
Aspects of a transformational leadership style also promote positive workplace engagement. Transformation leaders empower their staff to believe in their own capability and inspire active engagement in their work. Their ability to encourage can promote better outcomes—nurses are most effective in their work when they internalize positive values and develop self-efficacy.
Leadership is one of the key factors that defines workplace culture—something that shapes both nursing and patient outcomes. A 2024 analysis found that 40% of nurses who planned on leaving their positions cited their work environment as the cause. Similar notions are seen in the literature—this systematic review demonstrated that positive organizational culture, climate, and politics were all associated with nurse happiness in the workplace. All three of these variables also correlated with levels of work-related stress, meaning that the organizational environment can both benefit and detract from nurse satisfaction.
A positive work environment lowers nurse turnover. Preventing turnover is essential for developing and sustaining health system performance in the long term—high turnover rates exacerbate nursing shortages and are associated with lower care quality. This systematic review found that nurse turnover negatively impacted nurses and patients alike, strained staffing levels, and cost US-based providers up to $88,000 for each leaving nurse.
Some of the best ways to improve the culture of a healthcare environment are to encourage open communication between team members, promote collaboration, and support a work-life balance among employees. It’s essential to recognize, however, that these changes cannot be made successfully without sufficient staffing levels.
A final (and crucial) investment for healthcare organizations to consider is education. Smarter nurses are better nurses, and better nurses produce better outcomes. This 10-year 2016 study found that mortality rates and lengths of stays were reduced in hospitals where the average number of nurses with a Bachelor of Science in Nursing increased from 41% to 56%. Furthermore, the success of Kaiser Hospital nurses (mentioned earlier) can be attributed in large part to their greater level of education.
Administrative teams can leverage financial resources to promote education among their staff. For example, academic hospitals like Northwestern and Rush in Chicago offer tuition reimbursement for nurses who work for their health systems. This allows organizations to have influence over the education their nurses receive, ensuring they understand and can uphold a certain standard of care.
In-house training extends beyond the academic environment—in 2020, HCA Healthcare acquired a majority stake in Galen College of Nursing to enhance educational opportunities for its nurses. According to Sam Hazen, CEO of HCA Healthcare, this expansion of HCA’s resources will allow HCA to “[give] nurses – at the bedside and in leadership – great programs and career advancement opportunities that will enable them to deliver better care”.
Smaller providers can support the education of their nurses all the same. Creating and offering continuing education (CE) classes that actively involve nurses in learning can help them stay up-to-date on their licensure as well as refine their skills. CE is a great way to show support for nursing staff while simultaneously reinforcing their dependability as providers.
Health systems must acknowledge the benefits of investing in their employees, specifically nurses. Although healthcare leaders may not see immediate financial returns, being able to recruit, retain, and grow alongside their nursing staff yields healthier patient populations and strengthens organizations against the external perturbations of today’s volatile healthcare environment.
Hospitals that obtain Magnet certification exemplify the benefits of investing in your nursing staff. Magnet certification is provided by the American Nurses Credentialing Center through the Magnet Recognition Program to recognize organizations that provide high-quality nursing care and develop innovative nursing practices. The current Magnet framework consists of five components that define organizations with superior nursing practices:
The Magnet accreditation process is rigorous, and usually takes anywhere from 2-5 years (or longer) to complete, and can involve significant up-front costs. However, the costs and time demands are worth it—obtaining Magnet certification leads to improvements in the healthcare environment seen across several key markers. Magnet hospitals are associated with decreased mortality and improved patient outcomes. They also have superior nurse work environments, seen by lower rates of burnout, decreased intent to leave, greater satisfaction, and better perceptions of care quality.
Completing the certification process may yield financial returns—this 2014 study demonstrated that attaining Magnet status led to a greater increase in inpatient income compared to additional costs, netting a gain of more than $100 per patient discharge, translating to an additional $1.2 million per year.
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1 thought on “Promoting Quality in Nursing is Worth the Investment”
Sam, this was a great article. Succinct and informative. This presents a strong case for organizations to shift their focus to the recruitment, retention, education and growth of their nursing staff. As someone entering the workforce, I thought your description of transformational leadership was broadly applicable as well. I want to look out for those kinds of things in a manager or a team.
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