The Relationship Between Nurses’ Perception of Work Environment and Patient Satisfaction in Adult Critical Care


Dr. Christine Boev, St. John Fisher College, 3690 East Ave., Rochester, NY 14618. E-mail:


Background: Patient satisfaction in critical care is rarely measured yet has a major impact on hospital reimbursement. The critical care setting is characterized by high patient acuity and a fast-paced work environment. Nurses’ perception of work environment in relation to various patient outcomes including patient satisfaction has not been explored exclusively in critical care.

Objectives: (a) Examine patient's perception of nursing care associated with their hospitalization in the intensive care unit. (b) Describe nurses’ perception of work environment within a defined sample of adult critical care units, using the Practice Environment Scale of the Nursing Work Index (PES-NWI). (c) Explore the relationships between nurses’ perception of work environment and patient satisfaction in adult critical care.

Methods: This study used existing data to address the study aims. Unit-level comparisons were examined using analysis of variance. The final aim was examined using multilevel modeling for longitudinal data.

Results: Patients were very satisfied with their hospitalization (4.48 out of 5.0). Significant differences were noted among all unit level comparisons (p < .001). Nurses also reported moderate satisfaction with work environment as measured by the PES-NWI, with perception of the role of their nurse manager receiving the highest scores. Perception of nurse manager leadership and ability was significantly related to patient satisfaction (p= .018). Favorable perception of the nurse manager was associated with a .424 point increase in patient satisfaction.

Conclusions: This study offers preliminary support for the relationship between nurses’ perception of work environment and patient satisfaction in critical care. It also highlights the pivotal role of the nurse manager in both nurse and patient satisfaction.

Clinical Relevance: This study examines two important aspects that are both relevant and important to clinical nursing. The first aspect is the healthy work environment. Multiple studies have linked the nursing work environment to patient outcomes and this is an area that deserves further attention. The second aspect, patient satisfaction, is now associated with hospital reimbursement. The relationship between the nursing work environment and patient satisfaction highlights an important link to improving patient care.