Perceptions of organizational climate by intensive care unit (ICU) nurses: Preliminary results from the ICU Working Conditions Study

OBJECTIVES: Due to the complexity of patientsʹ illnesses and reportedly difficult working conditions, ICUs are potentially dangerous places for both patients and nurses. Organizational climate (OC) is frequently identified as an important working condition factor related to nurse retention and safety outcomes. The specific aims of this study include examining the relationships between nurse working conditions and patient and employee safety outcomes and identifying predictors (i.e., staffing ratios, nursesʹ income, workload, and setting characteristics) that influence the OC perceived by nurses. METHODS: Because healthcare-associated infections are a major patient safety outcome, hospitals were invited to participate through the Association of Professionals in Infection Control and Epidemiology, Inc., (APIC) electronic list and the National Nosocomial Infections Surveillance System (NNIS). Administrative data on nurse working conditions and employee safety were collected. In addition, patient-level data came from Medicare files and infection surveillance reports. ICU nurses were surveyed to understand their perceptions of OC. RESULTS: Infection control professionals from 68 hospitals in 26 states enrolled 110 ICUs. Surveys were obtained from 2323 ICU nurses (mean response rate = 41%/ICU). The average nurse respondent was 39.5 years old (SD = 9.4), had 15.6 years (SD = 9.2) experience in healthcare, and had worked in their current position for 8.0 years (SD = 7.5). Overall, 17% (n = 391) of the nurses indicated they intended to leave their positions in the coming year. Because not every hospital provided all requested data, this multivariable analysis of predictors that influenced OC perceived by ICU nurses consisted of data from 27 ICUs from 17 hospitals. After controlling for staffing ratios, nursesʹ income and workload had significant independent positive effects on OC, as did NNIS affiliation. Hospital teaching status had a significant negative effect on OC (all p values <0.05). CONCLUSIONS: These findings may help hospitals to design and implement strategies aimed at improving the OC in their setting, which may ultimately result in improved patient and employee outcomes. While market solutions (e.g., wage increases) may help, they are not the only solutions. Ensuring appropriate nurse workloads may improve the OC. Multivariate analyses relating OC to safety outcomes are being conducted and should further inform these issues.