EVALUATION OF SELECTED COMPONENTS OF THE NURSING WORKLIFE MODEL PATHWAYS AND ASSOCIATION WITH CATHETER ASSOCIATED URINARY TRACT INFECTIONS

Abstract

ABSTRACT Identification of elements of the practice environment that influence both nurse satisfaction and patient outcomes is an important area for nursing research. While several valid and reliable tools to measure the components of the practice environment have been developed by nurse researchers with two measures, , the Practice Environment Scale and Job Enjoyment Scale, are included in the National Database of Nursing Quality Indicators® (NDNQI®) RN Satisfaction Survey. Leiter and Lachinger (2006) posited the Nursing Worklife Model (NWLM) to explain how the elements identified are interrelated in the complex system of the nurse practice environment with subsequent work that extended the model to include association of nurse perception of patient adverse events. Further exploration of the impact of the specific elements of the practice environment on patient adverse events is needed. To date, researchers have primarily evaluated the impact of clinical outcomes using administrative data at the hospital or individual nurse level using nurse perceived adverse patient outcomes. In addition to RN Survey data, the NDNQI® provides a database of nurse-sensitive clinical outcomes (e.g., urinary tract infections rates) at the unit level. The purpose of this study was to evaluate the association of elements of the NWLM on a measured nurse-sensitive outcome, catheter associated urinary tract infection (CAUTI) at the unit level. Hospital acquired conditions (HACs) related to nosocomial infection are adverse patient events that have a significant impact on financial, morbidity and mortality outcomes. Catheter associated urinary tract infections (CAUTI) has been identified as one of the nurse sensitive indicators that is the most commonly occurring HACs (CDC, 2010). Specifically this study used a secondary analysis to fit the NWLM to unit level data from the 2011 NDNQI® RN Survey using structural equation modelling and resulted in a modified NWLM of job enjoyment. Additional significant paths were added to job enjoyment, staffing and resource adequacy, and foundations for quality care (CFI=.999; RMSEA=.059 [95% CI=.034-.089]; SRMR= .002). A second study followed that confirmed the modified NWLM of job enjoyment using 2012 NDNQI® RN Survey data. The model was extended to include data from the Quality Outcome database from which CAUTI rate was calculated to evaluate the NWLM path to CAUTI using structural equation modelling (CFI=.995; RMSEA= .04 [95% CI=.028-.056]; SRMR=.020). This study will add to the literature about the impact of the nurse practice environment on clinical outcomes at the unit level using a measured clinical outcome.