Muir K Jane, Agarwal Anish K, Golinelli Daniela, Lasater Karen B, Ballinghoff James, Mattioni Colleen, McHugh Matthew D, Aiken Linda H
Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Fagin Hall, Philadelphia, PA, 19104, USA.
The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
BMC Health Serv Res. 2025 May 16;25(1):709. doi: 10.1186/s12913-025-12720-x.
Emergency medicine is a highly interdisciplinary field, and emergency nurses and physicians have high rates of burnout compared to other specialties. National and international agencies prioritize investments in systems-based solutions to improve clinicians' work environments. The objective of this study was to determine whether emergency department (ED) clinicians agree on the quality of work environments, and whether their agreement is associated with job outcomes, patient safety, and quality of care.
This cross-sectional study used data from 1,604 ED nurses (n = 1,190) and physicians (n = 414) who completed the 2021 US Clinician Wellbeing Study in 47 Magnet hospitals. A K-means algorithm classified hospitals into 'profiles' based on nurse and physician agreement on work environment assessments. Hospital-level linear regression models determined the relationship between hospital profiles and clinician job and patient outcomes.
The overall clinician sample (n = 1,604) was on average 39.4 years of age (SD = 11.2), 72.3% female, with 8.3 years of experience (SD = 7.9), 77.7% White, and 93.6% non-Hispanic. Two hospital profiles indicated clinician agreement: "Agree, Unfavorable Environment" (n = 10 hospitals), and "Agree, Favorable Environment" (n = 15); the third profile indicated disagreement: "Disagree, Less Favorable Environment among Nurses" (n = 22). There were no hospital profiles with physicians rating their work environment less favorably than nurses. Compared to the "Agree, Favorable Environment" hospitals, the "Agree, Unfavorable Environment" and "Disagree, Less Favorable among Nurses" hospitals were associated with higher burnout (e.g., β = 25.8%, 95% CI 11.6, 40.1, p <.001 and β = 15.4, 95% CI 3.7, 27.2, p <.001, respectively), job dissatisfaction, and intent to leave; and unfavorable patient care quality and unfavorable patient safety grades (e.g., β = 29.1%, 95% CI 18.4, 39.8, p <.001 and β = 11.9%, 95% CI 3.0, 20.8, p <.01, respectively).
In this cross-sectional study, emergency nurses and physicians in almost half of study hospitals disagreed on the quality of the work environment, suggesting that two essential collaborators in high-stakes care do not agree on deficiencies in ED work environments. Sustainable systems-based solutions to improve ED work environments involve bridging these disparate workplace experiences.
急诊医学是一个高度跨学科的领域，与其他专科相比，急诊护士和医生的职业倦怠率较高。国家和国际机构将投资重点放在基于系统的解决方案上，以改善临床医生的工作环境。本研究的目的是确定急诊科（ED）临床医生对工作环境质量是否达成共识，以及他们的共识是否与工作成果、患者安全和护理质量相关。
这项横断面研究使用了来自47家磁铁医院完成2021年美国临床医生幸福感研究的1604名急诊科护士（n = 1190）和医生（n = 414）的数据。一种K均值算法根据护士和医生对工作环境评估的共识将医院分为“类型”。医院层面的线性回归模型确定了医院类型与临床医生工作及患者结局之间的关系。
临床医生总体样本（n = 1604）平均年龄为39.4岁（标准差 = 11.2），72.3%为女性，有8.3年工作经验（标准差 = 7.9），77.7%为白人，93.6%为非西班牙裔。两种医院类型表明临床医生达成了共识：“达成共识，不利环境”（n = 10家医院）和“达成共识，有利环境”（n = 15家）；第三种类型表明存在分歧：“存在分歧，护士中较不利环境”（n = 22家）。没有医院类型中医生对其工作环境的评价比护士更不利。与“达成共识，有利环境”的医院相比，“达成共识，不利环境”和“存在分歧，护士中较不利环境”的医院与更高的职业倦怠（例如，β = 25.8%，95%置信区间11.6，40.1，p <.001和β = 15.4，95%置信区间3.7，27.2，p <.001）、工作不满和离职意向相关；以及不利的患者护理质量和不利的患者安全等级（例如，β = 29.1%，95%置信区间18.4，39.8，p <.001和β = 11.9%，95%置信区间3.0，20.8，p <.01）。
在这项横断面研究中，近一半研究医院的急诊护士和医生对工作环境质量存在分歧，这表明在高风险护理中两个重要的协作方对急诊科工作环境的缺陷没有达成共识。基于系统的可持续解决方案以改善急诊科工作环境涉及弥合这些不同的工作场所体验。
