ED Work Environment Discord Affects Patient Outcomes

Medscape

02-06-2025

In a recent study, emergency nurses and physicians in approximately half of the study hospitals disagreed on the quality of the work environment. An environment rated "unfavorable" by both groups was significantly associated with worse clinician and patient outcomes.
METHODOLOGY:
A cross-sectional analysis included emergency department (ED) clinicians (1190 nurses and 414 physicians) from 47 Magnet hospitals who completed the 2021 US Clinician Wellbeing Study.
Researchers classified hospitals into profiles according to the level of agreement between nurses and physicians regarding the hospital work environment.
Researchers assessed clinician job outcomes (burnout, job dissatisfaction, and intent to leave), patient safety, and quality-of-care metrics.
TAKEAWAY:
Hospital profiles revealed three distinct patterns: "Agree, Unfavorable Environment" (10 hospitals); "Agree, Favorable Environment" (15 hospitals); and "Disagree, Less Favorable Environment Among Nurses" (22 hospitals).
Compared with hospitals where clinicians agreed on a favorable environment, hospitals where clinicians agreed on an unfavorable environment had significantly higher rates of burnout (β, 25.8), job dissatisfaction (β, 32.5), intent to leave (β, 31.7), and unfavorable patient safety grades (β, 29.1), after adjustment for hospital characteristics ( P < .001 for all).
< .001 for all). Hospitals where nurses rated the environment less favorably than physicians demonstrated increased burnout (β, 15.4; P < .001) and poorer patient safety grades (β, 11.9; P < .01), after adjustment for hospital characteristics.
< .001) and poorer patient safety grades (β, 11.9; < .01), after adjustment for hospital characteristics. Compared with physicians in hospitals with an "Agree, Favorable" profile, those in hospitals rated as having an "Unfavorable" work environment showed significantly higher rates for all outcomes except burnout and patient-care quality. Similarly, nurses in hospitals with a "Disagree, Less Favorable Among Nurses" profile experienced higher rates across all job-related and patient-care outcomes.
IN PRACTICE:
"This cross-sectional study found that ED nurses and phy­sicians in close to half of study hospitals disagreed on the quality of their work environment. Clinician job and patient outcomes were worse when both clinicians rated their work environment unfavorably and when nurses only reported their work environments as unfavor­able," the authors wrote.
"The implication of these findings is that, if two essential partners in emergency care within the same institution do not agree on the deficiencies in ED work environments, significant interdisciplinary research is needed to bridge these gaps and disparate experiences," they added.
SOURCE:
The study was led by Jane Muir, Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia. It was published online on May 16, 2025, in BMC Health Services Research .
LIMITATIONS:
The study included only Magnet hospitals, which are known for favorable work environments and good physician-nurse collaboration, suggesting the findings may have underestimated the variation in clinician work environment agreement across all hospitals. The cross-sectional design prevented causal inference, and the sample had more nurses than physicians.
DISCLOSURES:
The research was funded by the Clinician Well-being Study Consortium and the National Institutes of Health. Additionally, it was supported by the Agency for Healthcare Research and Quality, the National Institute of Nursing Research, the National Clinician Scholars Program, and the Emergency Medicine Foundation/Emergency Nurses Association Foundation. The authors reported having no relevant conflicts of interest.