Association of Clinical Nursing Work Environment with Quality and Safety in Maternity Care in the United States

Purpose: Maternal outcomes in the United States are the poorest of any high-income country. Efforts to improve the quality and safety of maternity care are frequently reported by individual hospitals, limiting generalizability. The purpose of this study is to describe maternity care quality and safety in hospitals in four states. Study Design and Methods: This cross-sectional study is a secondary analysis of the Panel Study of Effects of Changes in Nursing on Patient Outcomes data. Registered nurses reported on maternity unit quality, safety, and work environment. Descriptive statistics and clustered linear regressions were used. Results: The sample included 1,165 nurses reporting on 166 units in California, New Jersey, Pennsylvania, and Florida in 2015. One-third of nurses, on average, gave their units an overall safety grade of excellent, but this decreased to less than one-sixth of nurses in units with poor work environments. Overall, 65% of nurses reported that their mistakes were held against them. A good work environment, compared with poor, was significantly associated with fewer nurses grading safety as poor (beta -35.6, 95% CI -42.9 - -28.3). Clinical Implications: Our research found that the nurses in the majority of hospitals with maternity units in four states representing a quarter of the nation's annual births felt their units do not provide excellent quality care and have a less than optimal safety climate.