Changes in Patient Care Experiences and the Nurse Work Environment: A Longitudinal Study of U.S. Hospitals.

Addressing patient experience is a priority in the health care system. Hospital Consumer Assessment of Providers and Systems (HCAHPS) survey results incentivize hospitals to elevate patient experience, a factor in patient-centered care. Although hospital nursing resources have been positively associated with better HCAHPS ratings, it is unknown how changes in nursing resources are associated with changes in HCAHPS ratings over time. This two-period longitudinal study ranked the associations between changes in nurse staffing, skill mix, nurse education, and work environment on HCAHPS ratings and found that changes in the work environment had the strongest associations (β = 2.29;  < .001) with improved HCAHPS ratings. Our findings provide hospital administrators with empirical evidence that may help make informed decisions on how to best invest limited resources to improve HCAHPS ratings, including the potential utility of improving the work environment through enhancing Nursing Quality of Care and Nurse Participation in Hospital Affairs.