The link between negative working conditions and
employee stress is well known. Work stress and
burnout are also associated with negative work
attitudes and performance. In healthcare settings,
these conditions threaten the quality of patient care
and patient safety. A 2004 report by the Institute of
Medicine1 raised serious concerns about the impact
of hospital restructuring in the 1990s on nursing
work environments and patient safety outcomes.
The authors noted that typical nursing work
environments are ‘‘characterized by many serious
threats to patient safetyI’’ (p3) and suggested that
these conditions are caused by organizational
management practices, work design issues, organizational
culture, and the way nurses are deployed
in current inpatient settings. The report found that
strong, visible nursing leadership was an important
factor in creating a positive work environment and
a ‘‘culture of safety.’’ The Institute of Medicine
report also showed that many hospitals have
inadequate numbers of nurses to provide safe
patient care and that unsafe work practices pose
threats to patient safety. Indeed, Aiken et al2 and
Tourangeau et al3 linked nurse staffing adequacy to
patient mortality. Nurse burnout played a major
role in these studies of relationships between
nursing work environments and patient outcomes.