Little is known about how the work environment of hospital nurses affects the likelihood that a patient will be admitted to the ICU. A retrospective observational study was undertaken to examine the relationships among nurse work environment, ICU admission, and mortality in a large sample of Medicare beneficiaries undergoing general, orthopedic, or vascular surgery.

Based on scores on a standardized scale measuring quality, staffing, resources, and interprofessional communication, hospitals were classified as having good, mixed, or poor work environments.

Of 269,764 patients undergoing general, orthopedic, or vascular surgery in 453 hospitals, 12% were admitted to the ICU during their index hospitalization. In-hospital mortality was 1.8%, and 30-day mortality was 3.1%. Patients in hospitals that had good versus mixed nurse work environments and mixed versus poor nurse work environments had 16% lower odds of admission to an ICU, 12% lower odds of in-hospital mortality, 11% lower odds of 30-day mortality, and 15% lower odds of being admitted to an ICU or 30-day mortality.

The authors write that future studies are needed to account for recent changes in hospital characteristics and in the diagnoses and acuity of ICU populations. They add that their findings may not be generalizable to younger patients or to those outside the U.S. health care system. They conclude that ICU admissions could be reduced by interventions that improve the nurse work environment.