Table 3.
Effects of the Work Environment Composite Scale and Subscales on Quality Measures, Adjusting for Other Nursing Home Characteristics
| Quality Measures | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Percent of long-stay residents with pressure ulcers (n=222)† | Percent of long-stay residents on antipsychotics (n=230) | Number of hospitalizations per resident year (n=244) | |||||||
| Work Environment Measures | β | 95% CI | p | β | 95% CI | p | β | 95% CI | p |
| PES-NWI Composite Scale | |||||||||
| Bivariate | −0.88* | (−1.61, −0.14) | .02 | −1.42* | (−2.67, −0.18) | .03 | −0.05 | (−0.15, 0.05) | .32 |
| Adjusted | −0.90* | (−1.64, −0.17) | .02 | −1.10 | (−2.32, 0.12) | .08 | −0.08* | (−0.15, −0.001) | .05 |
| PES-NWI Subscales | |||||||||
| Nurse participation in organizational affairs | |||||||||
| Bivariate | −0.59 | (−1.34, 0.16) | .12 | −1.39* | (−2.65, −0.13) | .03 | −0.01 | (−0.11, −0.10) | .92 |
| Adjusted | −0.57 | (−1.32, 0.19) | .14 | −0.92 | (−2.15, 0.32) | .14 | −0.03 | (−0.11, 0.04) | .39 |
| Nursing foundations for quality of care | |||||||||
| Bivariate | −0.86* | (−1.60, −0.13) | .02 | −1.34* | (−2.58, −0.11) | .03 | −0.06 | (−0.16, 0.03) | .20 |
| Adjusted | −0.86* | (−1.61, −0.12) | .02 | −1.01 | (−2.23, 0.21) | .11 | −0.06 | (−0.14, 0.02) | .12 |
| Nurse manager ability, leadership, and support | |||||||||
| Bivariate | −0.78* | (−1.51, −0.05) | .04 | −1.22 | (−2.45, 0.01) | .05 | −0.03 | (−0.13, 0.63) | .48 |
| Adjusted | −0.81* | (−1.54, −0.08) | .03 | −0.96 | (−2.16, 0.24) | .12 | −0.06 | (−0.13, 0.02) | .12 |
| Staffing/resource adequacy | |||||||||
| Bivariate | −0.65 | (−1.42, 0.11) | .10 | −1.37* | (−2.65, −0.08) | .04 | −0.12* | (−0.23, −0.02) | .02 |
| Adjusted | −0.72 | (−1.50, 0.07) | .07 | −1.14 | (−2.44, 0.16) | .09 | −0.10* | (−0.18, −0.02) | .01 |
| Collegial nurse-physician relationships | |||||||||
| Bivariate | −1.47* | (−2.27, −0.66) | <.001 | −0.32 | (−1.70, −1.07) | .65 | −0.14* | (−0.24, −0.03) | .01 |
| Adjusted | −1.46* | (−2.26, −0.66) | <.001 | −0.28 | (−1.63, 1.07) | .69 | −0.12* | (−0.19, −0.04) | .005 |
Differences were significant at p < .05, as indicated by z–scores in bivariate and adjusted linear regression models. β coefficients represent the difference in outcomes between nursing homes with average vs. poor, and good vs. average work environments. Adjusted models control for nursing home ownership type, chain affiliation, Medicare census, Medicaid census, and RN skill mix. Additional covariates vary by outcome, as follows: (1) for pressure ulcers, certified nursing assistant (CNA) staffing was also controlled; (2) for antipsychotics, CNA staffing and presence of Alzheimer’s unit were controlled; and (3) for hospitalizations per resident year, average Resource Utilization Group (RUG) score, and an indicator for whether the facility accepts ventilator–dependent patients were controlled. All models, including bivariate models, weight the aggregated nursing home work environment score by the number of respondents per facility using analytic weights, and control for the number of respondents per facility. The three categories of the composite Practice Environment Scale of the Nursing Work Index (PES–NWI), and the subscales that comprise it, are treated as a linear term; thus, a one unit change represents the difference between average and poor environments, and a two unit change represents the difference between good and poor environments. CI = confidence interval; p = the probability that the coefficients are zero.
Sample sizes vary across outcomes because of missing outcomes data