For better or worse, nurse managers influence outcomes

In ways both direct and indirect, unit nurse managers play a key role in patient and nurse outcomes.

Having the most patient contact of any health care professionals, bedside nurses have an undeniable effect on key performance indicators, such as measures of quality of care, patient safety, and patient experience. A recent Press Ganey report, however, investigated the role of nurse manager leadership on patient outcomes as well as nurse outcomes (such as job satisfaction, retention, and burnout) and found a significant effect — particularly the leadership of nurse managers on the unit level.

“While the establishment of a supportive nurse work environment requires strong nursing leadership at all levels of the organization, nurse managers at the unit level exert substantial influence on the work environment of nurses at the bedside, and, ultimately, on performance across measures of safety, quality and patient experience, as well as indicators of nurse engagement, such as nurse job satisfaction and retention,” the report states.

In ways both direct and indirect, unit nurse managers play a key role in patient and nurse outcomes.

Work environment

To compile the report, researchers analyzed nearly 200,000 National Database of Nursing Quality Indicators (NDNQI) nurse surveys from 2016 as well as patient experience data. In addition to the effectiveness of nurse managers, results revealed the quality of the work environment plays a pivotal role in nurse and patient outcomes.

“Nurse managers are in a uniquely powerful position to advance care across their organizations by creating a supportive practice environment that promotes the delivery of safe, high-quality, patient-centered care and cultivates strong workforce engagement to help nurses achieve it,” said Christina Dempsey, MSN, CNOR, CENP, FAAN, chief nursing officer at Press Ganey.

Across unit types, positive nurse manager leadership was linked with numerous work environment mediators.

Most influential on nurse outcomes, researchers found, were autonomy and professional development. When it came to patient outcomes, autonomy, appropriate staffing, and teamwork were the most powerful work environment mediators.

Priority practices

The report also includes perspective from high-performing nurse managers on management priorities they considered most important for nurturing a positive work environment. Foundations of quality care was the top priority for 40% of nurse managers, while adequate staffing and professional practice environment each were considered most important by 20% of respondents. Interprofessional relationships, meanwhile, was the highest priority for 10% of the managers. Safe patient handling, safe scheduling and quality improvement were most important to the remaining nurse managers.

“By focusing on these essential elements, nurse managers create the structures and processes through which optimal patient and nurse outcomes are achieved,” the report states. “They also create an environment in which autonomy and professional development, both of which are key to nurse satisfaction, can thrive.”

As to how they support those top priorities, nurse managers revealed numerous best practices. Here is a sample of what the paper reported:

• Foundations of quality care: Use RN-led shared governance.
• Professional practice environment: Involve nurses in decisions affecting the workplace.
• Staffing: Eliminate rotating shifts.
• Interprofessional relationships: Support nurses as full members of multidisciplinary teams.
• Quality improvement: Nurture a workplace culture that is nonpunitive and just.
• Nurse outcomes: Connect with staff in a caring manner.
• Patient outcomes: Promote bedside reporting, whiteboards, hourly rounding, and communication.

For the full list of best practices, download the free report in its entirety on the Press Ganey website.

“Though not an exhaustive list,” the paper notes, “these practices help nurse managers create a positive practice environment for the nurses on their teams to deliver safe, effective care that meets patients’ needs and to find joy and satisfaction in their work.”

Focusing on quality

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