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Publication Date



UM campus only

Embargo Period


Degree Type


Degree Name

Doctor of Philosophy (PHD)


Nursing (Nursing)

Date of Defense


First Committee Member

Rosina Cianelli

Second Committee Member

Karina Gattamorta

Third Committee Member

Natalia Villegas-Rodriguez

Fourth Committee Member

Terri A. Scandura


The acute care hospital environment is one of the most demanding professional work environments. Although there are many professions that practice within the acute care setting, nurses comprise the largest segment of the hospital workforce and the associated costs. In an effort to provide quality care to complex patient populations and reduce cost, many hospitals in the United States have targeted the Nursing Professional Practice Environment (NPPE). There is an established relationship between the NPPE and organizational outcomes, however, no studies to date have determined the relationship between specific elements of the NPPE and patient churn on clinical outcomes and organizational outcomes. The aims of this study were to: (1) explore if the NPPE and nursing workload were predictors for the incidences of CLABSI, CAUTI, patient falls, nurse ITL and nurse turnover; and (2) to determine if ITL moderated the relationship between the NPPE, nursing workload, and the incidence of CLABSI, CAUTI, patient falls, and nurse turnover. A retrospective, cross-sectional design was utilized to address study aims. Data was taken from a large dataset comprised of variables and values collected in 2015 and 2016 from inpatient and episodic care units in an academic teaching hospital in the southeastern United States. The theoretical framework used in this study was an adaptation of the Job Demands-Resources Model. A secondary data analysis was conducted on data from 22 units in 2015 and 21 units in 2016 using descriptive analysis, bivariate analyses and multiple regression. The results demonstrated that some aspects of the NPPE and nursing workload were related to clinical and organizational outcomes. The predictive value of NPPE and nursing workload were found to only be significant for patient falls, intent to leave and nurse turnover. Lastly, ITL did not moderate the relationship between the NPPE, nursing workload and the incidence of CLABSI, CAUTI, falls, and nurse turnover among this study sample. Study results suggest that although PES/NWI is an adequate measure of the NPPE, additional research linking the NPPE and workload to outcomes is necessary. The volatility of the current health care market further demonstrates the need to develop measurable improvement initiatives that focus on creating and maintaining the ideal NPPE. Specifically, inter-professional research that examines quality and patient safety outcomes across disciplines are urgently needed to guide the creation and maintenance of NPPEs that facilitate the provision of quality care and cost reduction. Further studies that explore the work environments and workload measures in other clinical or ancillary disciplines will be conducted to provide a more comprehensive understanding of an organizations’ overall work environment and safety profile.


Nurse Professional Practice Environment (NPPE), Patient Churn; Nursing Workload; Practice Environment Scale of the Nursing Work Index